Prostatitis is swelling or
infection of the
prostate gland. It often hurts. The
prostate gland sits just below a man's bladder and makes part of the fluid for
semen. In young men, the prostate is about the size of
a walnut. It usually grows larger as you grow older.
several types of prostatitis. They vary based on how long a man has had the
problem and what kind of symptoms he has.
Sometimes prostatitis is
caused by bacteria, but often the cause is not known.
Symptoms of long-term
(chronic) prostatitis are often mild and start slowly over weeks or months.
They may include:
Symptoms of acute prostatitis are the same, but they
start suddenly and are severe. They may also include a fever and chills.
Some men may have no symptoms.
A doctor can often
tell if you have prostatitis by asking about your symptoms and past health. He
or she will also do a physical exam, including a
digital rectal exam. In this test, the doctor puts a
gloved, lubricated finger in your rectum to feel your prostate. You may also
need blood and urine tests to find out which type of prostatitis you have or to
look for another cause of your problems.
Prostatitis caused by bacteria
is treated with antibiotics and self-care.
Home treatment includes
drinking plenty of fluids and getting lots of rest. Taking
over-the-counter pain relievers can also help.
Your doctor may prescribe medicine to control pain and reduce swelling.
He or she may also prescribe medicine to soften your stool and relax your
Surgery is rarely used to treat prostatitis.
Learning about prostatitis:
Most men with
prostatitis have chronic prostatitis/pelvic pain
syndrome, inflammatory or noninflammatory. The cause of this type of
prostatitis is not known.
About 1 out of 10 men have prostatitis caused by bacteria.
Bacteria infecting the prostate cause
acute prostatitis and
chronic bacterial prostatitis. Bacteria most likely
enter the prostate by:
The specific cause of
chronic prostatitis/pelvic pain syndrome, inflammatory, is usually not known. But doctors
believe the possible causes include:
The causes of
chronic prostatitis/pelvic pain syndrome, noninflammatory, may be the same as those for chronic prostatitis/pelvic
pain syndrome, inflammatory. Some doctors think that a combination of things—including nervous
system problems and strained pelvic floor muscles—causes the
pain. Emotional problems and anxiety can make the pain worse.
The symptoms are similar for all forms of
prostatitis, with the exception of
Symptoms of the chronic forms of prostatitis,
including chronic prostatitis/pelvic pain syndrome,
noninflammatory, may include:
With acute prostatitis, symptoms are severe, come on
suddenly, and include fever and chills. Signs of
chronic bacterial prostatitis may be milder and come
on suddenly or gradually over weeks or months, and the symptoms may come and
go. Symptoms alone cannot be used to determine the type of prostatitis you
Other conditions, such as a
bladder infection or
benign prostatic hyperplasia (BPH), can cause symptoms
similar to those of prostatitis.
especially if it continues for a long time, can cause
acute prostatitis have severe pain and fever. Most men recover fully when treated with antibiotics.
Delaying treatment increases the risk of complications, such as
sepsis or an
abscess in the prostate.
Chronic bacterial prostatitis can be difficult to treat, because some
medicines have a hard time reaching the prostate.
chronic bacterial prostatitis commonly have repeated urinary tract infections.
The infection may spread to the
The presence of infected
prostate stones (prostatic calculi) can make treatment of chronic
bacterial prostatitis more difficult.
Chronic prostatitis/pelvic pain syndrome,
noninflammatory, often get better over time without
serious complications. But the symptoms sometimes return
Things that can increase
your risk for
If you have had
chronic bacterial prostatitis, you have an increased
chance of developing it again.
Contact your doctor immediately if you have sudden fever, chills, and
urinary symptoms, such as pain or burning with urination or blood or pus in the
urine. These symptoms may point to acute prostatitis.
Call your doctor if you
Most men will have some discomfort in their
prostate (prostatitis) at some time during their lives. If you
do not have a fever and chills or extreme pain, you may try home treatment for
a few weeks. Take nonprescription pain medicines, such as aspirin, ibuprofen,
or acetaminophen, to relieve pain. But if your urinary symptoms and pain
continue, be sure to see a doctor.
Health professionals who can evaluate and treat your
To prepare for your appointment, see the topic Making the Most of Your Appointment.
If your doctor suspects
that you have
prostatitis, he or she will begin with a complete
medical history and physical exam. The type of
prostatitis that you have cannot be determined solely from your history and
symptoms. Your doctor will do tests to find out the cause of your
Acute prostatitis is the least common
type but the easiest to diagnose. If acute prostatitis is suspected, a
urine culture will be done to test for the presence
and type of bacteria.
If your history and physical exam show that
you do not have acute prostatitis, a
pre- and post-massage test (PPMT) or
expressed prostatic secretions test may be done to
find out which type of prostatitis you have. An expressed prostatic secretions
test is not done if acute prostatitis is suspected, because when the prostate
is inflamed or infected, massaging it to obtain a sample for tests is very
painful and possibly dangerous. Some doctors believe that
massaging an infected prostate increases the risk of developing a bacterial
infection of the blood (septicemia).
may be needed if:
Tests that may be done include:
prostatitis usually begins with taking an antibiotic
for several weeks. If you begin to feel better, you may have to take the
medicine for 2 to 3 months. If you do not get better while taking
antibiotics, more tests may be done.
acute prostatitis is aimed at curing the infection and
preventing complications. Acute bacterial prostatitis is treated with
antibiotics, pain and fever medicine, stool softeners, fluids, and
chronic bacterial prostatitis is aimed at curing the
infection and preventing complications. Antibiotics are given for 6 to 12
weeks. Long-term antibiotic treatment may be needed if the infection
chronic prostatitis/pelvic pain syndrome, inflammatory, may be difficult.
Chronic prostatitis/pelvic pain syndrome, noninflammatory, is difficult to treat because it is not clear what
causes this form of prostatitis. The primary goal of treatment is to relieve
symptoms. Many treatments are tried, including:
You may be able to prevent
Prostatitis is usually treated with antibiotics and other medicines prescribed by your doctor. But there are some things you can do at home that may help you be more
prostatitis usually begins with antibiotics and
possibly other medicines to relieve symptoms. If you begin to get better, you
may have to continue taking antibiotics for 2 to 3 months. During this time, be sure to take the antibiotics as prescribed. If you do not begin to get
better while taking medicines, your doctor may want you to have more
Antibiotics are central to treating
chronic bacterial prostatitis. Your doctor may
prescribe certain antibiotics based on your medical history, symptoms, and
other factors such as your age. Other medicines may also be used to help
control symptoms, including:
Chronic bacterial prostatitis may require long-term
antibiotics, especially if the symptoms return. Some men need treatment with
low doses of antibiotics over a long period to control infection and prevent
urinary tract infections (UTIs).
Chronic prostatitis/pelvic pain syndrome,
noninflammatory, are usually treated first with
antibiotics based on the possibility that an infection was missed during
testing. But experts advise against long-term treatment with antibiotics
unless an unusual bacterial infection is suspected.
that may be used to treat chronic prostatitis/pelvic pain syndrome,
inflammatory or noninflammatory, include:
Prostate stones (prostatic calculi) can make chronic bacterial
prostatitis more difficult to cure. If you have prostate stones, they may need
to be surgically removed.
prostatitis may be needed to treat
chronic bacterial prostatitis that does not respond to
long-term antibiotic treatment and that causes repeated
urinary tract infections. Surgery may be done to
remove part of the prostate or to remove infected prostate stones (prostatic calculi).
But this does not always cure the infection, and it may make the symptoms
worse. Surgery is typically done only if all other treatments have
Surgical removal of part of the prostate to remove prostate
stones or to treat an
infection that does not respond to antibiotic treatment is called
This surgery may not
cure prostatitis, because the surgery may not remove the portion of the
prostate causing the problem.
Prostatic massage for
prostatitis ("milking" of the prostate by a doctor) is an old treatment that many doctors are beginning to use again
because medicines do not always successfully cure prostatitis.
To massage your
prostate gland, the doctor inserts a
lubricated, gloved finger into your rectum and presses several times on your
prostate. This may need to be done 2 or 3 times a week. Why this works is not
certain, but it is believed that the massage helps open blocked ducts in the
prostate, improving circulation and antibiotic penetration into the
Prostatic massage is not done for acute prostatitis,
because it could cause the bacteria to spread from the prostate and cause a
wider infection (sepsis).
Other treatments that may be helpful for chronic
prostatitis/pelvic pain syndrome,
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The website provides information about adult and
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the Urology A–Z page to find materials about urologic problems.
The National Institute of Diabetes and Digestive and
Kidney Diseases (NIDDK) is part of the U.S. National Institutes of Health. It
conducts and supports research on many of the most serious diseases affecting
public health, particularly the diseases of internal medicine. NIDDK sponsors
the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC).
It has information about diseases of the kidneys and urologic system for people
with these diseases and their families, health professionals, and the
Publications and links to medical journal articles about
prostatitis are available at this site. The Prostatitis Foundation also
sponsors a moderated e-mail discussion group.
CitationsAnothaisintawee T, et al. (2011). Management of chronic prostatitis/chronic pelvic pain syndrome. JAMA, 305(1): 78–86.Other Works ConsultedNickel JC (2001). Consensus development of a histopathological classification system for chronic prostatic inflammation. BJU International, 87(9): 797–805.Nickel JC, et al. (2003). Leukocytes and bacteria in men with chronic prostatitis/chronic pelvic pain syndrome compared to asymptomatic controls. Journal of Urology, 170(3): 818–822.Shoskes DA, et al. (2003). Long-term results of multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome. Journal of Urology, 169(4): 1406–1410.
December 2, 2011
E. Gregory Thompson, MD - Internal Medicine & J. Curtis Nickel, MD, FRCSC - Urology
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