The prostate is a walnut-sized gland that sits below the bladder in men. This gland makes fluid that mixes with sperm to form semen.

Prostatitis is inflammation or swelling of the prostate gland. When symptoms start gradually and linger for more than a couple of weeks, the condition is called chronic prostatitis. Doctors previously believed that all chronic prostatitis was caused by infection of the prostate by bacteria. However, it is now clear that symptoms of chronic prostatitis can be caused by several different conditions and that infection plays a role in only some of these. Three major types of chronic prostatitis are:

• Chronic bacterial prostatitis � In this condition, a bacterial infection causes swelling and inflammation of the prostate. Doctors make this diagnosis only if bacteria and white blood cells, which fight infection, are found in the urine. Chronic bacterial infection accounts for only a small percentage of cases of chronic prostatitis.



• Chronic non-bacterial prostatitis, also called inflammatory chronic pelvic pain syndrome � Doctors make this diagnosis when patients have typical symptoms of chronic prostatitis, but no bacteria are found in a urine sample. The cause of most cases of non-bacterial prostatitis is not well understood. The urine often contains white blood cells, which suggests that there is inflammation or infection. Some patients may have a persistent low-grade infection that cannot be detected in a routine urine sample. However, most people with non-bacterial prostatitis have no evidence of infection, even when sophisticated tests are done.



• Prostadynia, also called noninflammatory chronic pelvic pain syndrome � This term is used when symptoms of prostatitis are present, but there is no evidence of prostate infection or inflammation. Doctors understand very little about why some people � often young, otherwise healthy men � develop this problem. Theories to explain prostadynia include an abnormal buildup of pressure in the urinary tract, irritation resulting from an autoimmune or chemical process, or pain generated in the nerves and muscles within the pelvis.

Chronic prostatitis is very common and affects adult men of all ages and from all backgrounds. About 5% of men experience symptoms of chronic prostatitis at some point in their lives. Chronic prostatitis is the reason for up to 25% of office visits to urologists, doctors who specialize in disease of the urinary tract.

Some men develop a chronic infection in the prostate that does not cause any symptoms. This condition, known as asymptomatic inflammatory prostatitis, may be diagnosed when men are evaluated for other urological conditions such as prostate cancer or infertility. Doctors often treat the infection with the same antibiotics used for chronic bacterial prostatitis.

Bacterial infection of the prostate gland also can cause acute prostatitis, which starts suddenly and usually causes fever and more serious symptoms. Acute prostatitis is less common than chronic prostatitis.

Because the prostate surrounds the urethra (the tube that carries urine out of the body from the bladder), conditions that cause the prostate to swell can press on the urethra and cause pain or problems with urination. Typical symptoms of chronic prostatitis include:

• Burning during or after urination
• Difficulty starting the urine stream
• Dribbling after urination has been completed
• A need to urinate frequently or urgently
• A sensation that the bladder cannot be emptied completely
• Pain felt above the penis, in or below the scrotum, or in the back or rectum
• Pain experienced during or after orgasm

In some men, symptoms may be hardly noticed or only slightly annoying. Other men are quite bothered by chronic prostatitis and find that the symptoms interfere with work, leisure activities and sexual enjoyment.

If your doctor suspects prostatitis, he or she will ask you to describe your symptoms in detail. Your doctor also may ask about your general medical history, the medications you take, your intake of caffeine and alcohol, and whether you have had sexual contacts that may increase your risk of sexually transmitted diseases. Next, your doctor will examine your prostate gland by inserting a gloved and lubricated finger into your rectum. In chronic prostatitis, the gland may be swollen, firm and tender, or it may feel normal. You may experience pain or a severe need to urinate when pressure is applied to the prostate. Your doctor also will examine you to look for other problems that may be causing your symptoms.

The next step will be to examine a urine specimen for evidence of infection, such as white blood cells or bacteria. Often your doctor will ask you to produce separate urine specimens before and after your prostate gland is examined. Typical findings depend on the specific type of chronic prostatitis:

• In bacterial prostatitis, the urine will contain white blood cells and bacteria, especially after the doctor has pressed firmly on the prostate. The urine usually will contain the type of bacteria found in most urinary tract infections.



• In non-bacterial prostatitis, the urine collected after prostate massage may contain white blood cells. However, no bacteria will be seen, and a urine culture will be normal.



• In prostadynia, the urine specimen will be entirely normal, even after the doctor has pressed firmly on the prostate.

In most cases of chronic prostatitis, this simple evaluation is all that is needed to make a diagnosis and begin treatment. Occasionally, a person may have vague or unusual symptoms, and it is important to check for other conditions such as interstitial cystitis, urethritis, benign enlargement of the prostate or even prostate cancer. In such a situation, your doctor may recommend additional blood or urine tests, an ultrasound of the prostate, an examination of the bladder with a lighted telescope (cystoscopy), or a needle biopsy of the prostate.

Chronic prostatitis may last for weeks or months before it is diagnosed. Some cases of chronic prostatitis respond promptly to treatment, and symptoms disappear over several days. In other cases, symptoms may linger for weeks or months or may come and go over a period of years.

Chronic prostatitis cannot be prevented.

For many years, antibiotics have been the mainstay of treatment for chronic prostatitis. Antibiotics such as trimethoprim-sulfa (Bactrim, Septra) and the fluoroquinolones ("floxacins" sold under the brand names Floxin, Cipro, Levaquin and others) are used most often to treat chronic bacterial prostatitis. Because it is difficult for antibiotics to get into the prostate gland, they must be given at high doses for an extended period, often six or more weeks.

Antibiotics often are tried in men with chronic non-bacterial prostatitis, even though symptoms may not be caused by infection. Some men may be helped by this treatment, but in many cases, antibiotics alone will not eliminate the problem.

A variety of alternative treatments are available for those men not helped by antibiotics:

• Alpha-blocker medications, such as tamsulosin (Flomax) or terazosin (Hytrin), may be prescribed to relax the muscles that control the bladder. These may relieve symptoms of urgency, hesitancy or dribbling. Similar effects may be seen with drugs that shrink the size of the prostate, including finasteride (Proscar).



• Pain relievers, anti-inflammatories and muscle relaxants may help with pain and muscle spasms. Some men find relief with warm baths or with biofeedback programs designed to reduce tension in the pelvic muscles.



• Eliminating caffeine and alcohol may reduce irritation of the bladder and prostate.



• A variety of herbal remedies may be tried, including saw palmetto, quercetin and pollen extracts.



• Some physicians recommend reducing congestion in the prostate by ejaculating more frequently or by massaging the prostate regularly.

It is important to keep in mind that few of these treatments have been proven to be effective. Chronic prostatitis probably is caused by more than one condition, and not all men will respond to the same treatment. Some men will improve on their own or with the first treatment that is tried. Others will continue to experience symptoms despite a variety of treatments.

Contact a health care professional if you develop:

• Difficulty with urination
• Pain in the groin, testicles or back
• Pain during sexual intercourse
• An adverse reaction to an antibiotic or other medication given to treat your prostate infection

Chronic prostatitis can be very difficult to cure. Many men do not respond to one or more prolonged courses of antibiotics. Because little is understood about prostatitis that is not caused by infection, finding the right treatment may be difficult. Nonetheless, several potentially effective treatments are available.

Be sure to see a health care professional if you have ongoing symptoms of chronic prostatitis that have not responded to treatment. If you have unusual or particularly troubling symptoms, your doctor may refer you to a urologist or other specialist.

There is no evidence that chronic prostatitis increases the risk of developing prostate cancer.

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Prostatitis Foundation
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Smithshire, IL 61478
Toll-Free: 1-888-891-4200
http://www.prostatitis.org/