Prostatitis is swelling and inflammation of the prostate gland, a walnut-sized gland located directly below the bladder in men. The prostate gland produces fluid (semen) that nourishes and transports sperm.
Prostatitis often causes painful or difficult urination. Other symptoms of prostatitis include pain in the groin, pelvic area or genitals and sometimes flu-like symptoms.
Prostatitis affects men of all ages but tends to be more common in men 50 years of age or younger. Prostatitis can be caused by a number of different things. If it’s caused by a bacterial infection, it can usually be treated with antibiotics. However, sometimes prostatitis isn’t caused by a bacterial infection or an exact cause is never identified.
Depending on the cause, prostatitis may come on gradually or suddenly. It may get better quickly, either on its own or with treatment. Some types of prostatitis last for months or keep recurring (chronic prostatitis).
- Recently have had a medical instrument, such as a urinary catheter (a soft, lubricated tube used to drain urine from the bladder) inserted during a medical procedure
- Engage in rectal intercourse
- Have an abnormal urinary tract
- Have had a recent bladder infection
- Have an enlarged prostate
In bacterial prostatitis, sexual transmission of bacteria is common, but hematogenous, lymphatic, and contiguous spread of infection from surrounding organs must also be considered. Although various routes have been postulated, none has been firmly substantiated.
A history of sexually transmitted diseases is associated with an increased risk for prostatitis symptoms.
The presence of acute inflammatory cells in the glandular epithelium and lumens of the prostate, with chronic inflammatory cells in the periglandular tissue, characterizes prostatitis (see the image below). However, the presence and quantity of inflammatory cells in the urine or prostatic secretions does not correlate with the severity of the clinical symptoms.
Prostatitis symptoms vary depending on the cause. They may include:
- Pain or burning sensation when urinating (dysuria)
- Difficulty urinating, such as dribbling or hesitant urination
- Frequent urination, particularly at night (nocturia)
- Urgent need to urinate
- Pain in the abdomen, groin or lower back
- Pain in the area between the scrotum and rectum (perineum)
- Pain or discomfort of the penis or testicles
- Painful orgasms (ejaculations)
- Flu-like symptoms (with bacterial prostatitis)
The differential diagnosis of prostatitis is based on the history, physical examination findings, and, frequently, analysis of expressed prostatic secretions. Absence of systemic symptoms and persistence of pain for at least 3 months indicate chronic prostatitis rather than acute disease.In addition to prostatitis, other conditions to consider include the following:
- Benign prostatic hyperplasia
- Chronic pain syndromes (ie, inflammatory bowel disease)
- Erectile dysfunction
- Prostate cancer
- Testicular cancer
Prostatitis treatments vary depending on the underlying cause. They can include:
- Antibiotics. This is the most commonly prescribed treatment for prostatitis. Your doctor will base the choice of medication on the type of bacteria that may be causing your infection. If you have severe symptoms, you may need intravenous (IV) antibiotics. You’ll likely need to take oral antibiotics for four to six weeks but may need longer treatment for chronic or recurring prostatitis.
- Alpha blockers. These medications help relax the bladder neck and the muscle fibers where your prostate joins your bladder. This treatment may lessen symptoms, such as painful urination.
- Anti-inflammatory agents. Nonsteroidal anti-inflammatory drugs (NSAIDs) may make you more comfortable.
- Prostate massage. This is done by your physician using a lubricated, gloved finger — a procedure similar to a digital rectal exam. It may provide some symptom relief, but doctors disagree about how effective it is.
- Other treatments. Other potential treatments for prostatitis are being studied. These treatments include heat therapy with a microwave device and drugs based on certain plant extracts.