What causes prostatitis

What causes prostatitis

On the scientific level, the causes of prostatitis are not completely understood. There is controversy among the most highly regarded experts. Keep in mind that any one patient may have more than one cause operating at the same time. Or, looked at from another point of view, prostatitis could be several different diseases which present with the same or similar sets of symptoms in different individuals.

There are three main schools of thought about the causes of prostatitis. Each of the following linked pages will soon have additional information related to the potential cause.

If you’ve had prostatitis for very long and had very many appointments to try to deal with it, you’ve heard some of these theories.

Does it matter what is causing it? Will knowing the cause help you get over it? The answer would be “yes,” if only determining the cause were simple. (See the “Methods ” page for a discussion of methods of treating prostatitis.) Also, unfortunately, even doctors who are sure of the cause of prostatitis in their patients cannot cure all their patients.

If your prostatitis is caused by bacterial infection, knowing that should help your doctor treat the infection and make you better. Unfortunately, many doctors and clinics do only cursory checking for bacteria. But even doctors who do very careful checking for bacteria, and indeed find bacteria, cannot always make their patients’ symptoms go away.

Similarly, ruling out bacteria and going on one of the other hypotheses does not necessarily help either. If you thought or even knew that your prostatitis is caused by an immune disorder, does that mean there is a clear route to fixing the problem? Not likely.

There are therapies around for fixing physical problems. There are people who can teach you relaxation techniques, or muscle-strengthening techniques, to repair or ameliorate problems with your pelvic floor musculature. But there is no clear path that works for everyone.

Why can’t doctors fix you up? Well, for one thing, they aren’t trained very well in diagnosing and treating prostatitis. Urologists spend most of their time studying surgery. If prostatitis were something that could be fixed by surgery, they’d give it a try. And other doctors tell patients to “learn to live with it.”

The upshot of all this confusion is that YOU, and only you, brother, are going to have to take charge of finding out what’s causing your prostatitis . Sure, you’ll need doctors to help you, and to run tests and interpret them for you, and prescribe drugs if necessary. But YOU are going to have to be the one who is well-armed with questions and demanding enough to get your doctor to get to the bottom of things.

.
The mission of the Prostatitis Foundation is to educate the public about the prevalence of prostatitis
and encourage and support research to find the cause and a cure for prostatitis.

We’re sorry you are having to learn about prostatitis, but we’re glad you came here, because we think we can help. Please be advised that the Prostatitis Foundation does
not warrant, support, sponsor, endorse, recommend or accept responsibility for any health care provider or any treatment or protocol performed by any heath care provider.

Prostatitis

Page contents

Prostatitis is the inflammation (swelling) of the prostate gland. It can be very painful and distressing, but will often get better eventually.

The prostate is a small gland found in men that lies between the penis and bladder. It produces fluid that’s mixed with sperm to create semen.

Unlike other prostate conditions, such as prostate enlargement or prostate cancer, which usually affect older men, prostatitis can develop in men of all ages. However, it commonly affects men aged between 30 and 50.

There are two main types of prostatitis:

• chronic prostatitis – where the symptoms come and go over a period of several months; it’s the most common type; it’s not usually caused by an infection
• acute prostatitis – where the symptoms are severe and develop suddenly; it’s rare but it can be serious and requires immediate treatment; it’s always caused by an infection

Symptoms of prostatitis

Acute prostatitis

Symptoms of acute prostatitis include:

• pain, which may be severe, in or around your penis, testicles, anus, lower abdomen or lower back – passing stools (faeces) can be painful
• urinary symptoms, such as pain when peeing, needing to pee frequently (particularly at night), problems starting or “stop-start” peeing, an urgent need to pee and, sometimes, blood in your urine
• not being able to pee, which leads to a build-up of urine in the bladder known as acute urinary retention (AUR) – this needs urgent medical attention
• generally feeling unwell, with aches, pains and possibly a fever
• a small amount of thick fluid (discharge) may come out of your penis from the urethra (the tube that carries urine out of the bladder)

See your GP immediately if you have these symptoms so that the cause can be investigated and appropriate treatment recommended.

Chronic prostatitis

You may have chronic prostatitis if you’ve had the following symptoms for at least three months:

• pain in and around your penis, testicles, anus, lower abdomen, or lower back
• pain when peeing, a frequent or urgent need to pee, particularly at night, or “stop-start” peeing
• an enlarged or tender prostate on rectal examination, although in some cases it may be normal
• sexual problems, such as erectile dysfunction, pain when ejaculating, or pelvic pain after sex

These symptoms can have a significant impact on your quality of life. However, in most cases, they’ll gradually improve over time and with treatment.

When to get medical advice

See your GP if you have symptoms of prostatitis, such as pelvic pain, difficulty or pain when peeing, or painful ejaculation.

Your GP will ask about the problems you’re having and examine your tummy. You may also have a digital rectal examination (DRE). This is where a doctor inserts a gloved finger into your bottom to feel for abnormalities. You may experience some discomfort if your prostate is swollen or tender.

Your urine will usually be tested for signs of infection, and you may be referred to a specialist for further tests to rule out other conditions.

See your GP immediately if you develop sudden and severe symptoms of prostatitis. You may have acute prostatitis, which needs to be assessed and treated quickly because it can cause serious problems, such as suddenly being unable to pass urine.

If you have persistent symptoms (chronic prostatitis), you may be referred to a urologist (a doctor who specialises in urinary problems) for specialist assessment and management.

Treating prostatitis

Treatment for prostatitis will depend on whether you have acute or chronic prostatitis.

Acute prostatitis

Acute prostatitis (where symptoms are sudden and severe) is usually treated with painkillers and a two to four week course of antibiotics.

Hospital treatment may be needed if you’re very ill or unable to pass urine (acute urinary retention).

Chronic prostatitis

Treatment for chronic prostatitis (where symptoms come and go over several months) usually aims to control the symptoms. The following treatments may be used to help control your symptoms:

• painkillers, such as paracetamol or ibuprofen, may help relieve pain
• a medication called an alpha-blocker, such as tamsulosin, may also be prescribed if you have problems with urination; these can help relax the muscles in the prostate gland and the base of the bladder
• occasionally, a four- to six-week course of antibiotics, such as ciprofloxacin, may be prescribed even if no infection is found; this is to see if your condition improves
• if your symptoms are severe, stronger painkillers, such as amitriptyline and gabapentin, may be considered

The aim is to reduce symptoms to a level where they interfere less with day-to-day activities, rather than getting rid of the pain completely.

A referral to your local pain clinic may also be considered.

What causes prostatitis?

Acute prostatitis is usually caused when bacteria in the urinary tract enter the prostate. The urinary tract includes the bladder, kidneys, the tubes that connect the kidneys to the bladder (ureters), and the urethra.

In chronic prostatitis, signs of infection in the prostate gland can’t usually be found. In these cases, the cause of symptoms isn’t clear.

Risk factors for prostatitis

Risk factors for acute prostatitis include:

• having a urinary tract infection (UTI) in the recent past
• having an indwelling urinary catheter (a flexible tube that’s used to drain urine from the bladder)
• having a prostate biopsy
• having a sexually transmitted infection (STI)
• having HIV or AIDS
• having a problem with your urinary tract
• anal sex
• injuring your pelvis

Risk factors for chronic prostatitis include:

• being middle-aged (30-50 years of age)
• having prostatitis in the past
• having other painful abdominal conditions, such as irritable bowel syndrome (IBS)
• sexual abuse

Acute prostatitis

Acute prostatitis usually clears with a course of antibiotics. It’s important to take the full course to ensure that the infection clears completely.

Rarely, other complications of acute prostatitis can occur. These include:

• acute urinary retention – because passing urine can be very painful, urine can build up in your bladder, causing pain in your lower tummy (abdomen) and inability to pass urine at all; to relieve this, a catheter (a thin, flexible, hollow tube is needed)
• prostate abscess – if antibiotics aren’t effective in treating prostate infection, rarely an abscess can develop in your prostate gland; your doctor may suspect this if your symptoms don’t improve despite antibiotic treatment; further tests will be needed to confirm a prostate abscess, such as an ultrasound scan or CT scan of your prostate gland; if an abscess is present, you’ll need an operation to drain it

Chronic prostatitis

Chronic prostatitis can be challenging to treat because little is known about what causes it. Most men will gradually recover with treatment, but this can take several months or years.

Some men with prostatitis find their symptoms return (relapse) later on, which will require further treatment.

Prostatitis isn’t prostate cancer and there’s currently no clear evidence that it increases your chances of developing cancer of the prostate.

Page last reviewed: 03/03/2017
Next review due: 03/03/2020

Chronic Nonbacterial Prostatitis

Chronic nonbacterial prostatitis, also known as chronic pelvic pain syndrome, is a common condition that affects men. It causes pain and inflammation in the prostate, pelvis, and the lower urinary tract. The prostate gland is located right below the bladder in men. It produces fluid that helps transport sperm. In the United States, chronic nonbacterial prostatitis affects around 10 to 15 percent of men.

Symptoms can cause ongoing pain, discomfort, and urinary issues, such as:

• difficulty urinating or straining to urinate
• frequent or urgent need to urinate
• blood in semen
• pain or burning with urination
• pain with bowel movement
• pain with ejaculation
• pain in the low back and pelvis, above the pubic bone, between the genitals and anus, on the tip of the penis, or in the urethra
• sexual dysfunction
• genital pain after urination

Don’t ignore any of the symptoms of chronic nonbacterial prostatitis. Instead, make an appointment with your doctor. There are a variety of treatments that may help.

The National Institutes of Health (NIH) describes four categories of prostatitis:

• Acute bacterial prostatitis happens when bacteria, like sexually transmitted organisms, cause an infection in the prostate. Symptoms typically develop suddenly, and usually respond well to antibiotics.
• Chronic bacterial prostatitis is an ongoing problem. It’s also more difficult to treat. It’s often associated with ongoing urinary tract infections.
• Asymptomatic inflammatory prostatitis has no symptoms. It’s usually discovered while undergoing other tests. It appears to be more common in men who smoke and drink regularly.
• Chronic (nonbacterial) prostatitis/chronic pelvic pain syndrome is the most common type of prostatitis. But the exact cause is unknown. It causes a variety of symptoms that can be difficult to treat. Doctors suspect it may be due to a prior infection or a small injury that causes inflammation.

The cause of chronic nonbacterial prostatitis is unknown. This makes it difficult to predict who is at risk for this condition. However, research into the cause is ongoing. Once a cause is discovered, doctors will be able to identify risk factors and target treatment.

Your doctor will review your medical history and likely ask you to fill out a questionnaire about your symptoms. They will also perform a prostate exam. And they will likely request a urine sample to look for infection.

During a prostate exam, your doctor will insert a lubricated, gloved finger into your rectum. They do this so they can feel for a tender, soft, or swollen prostate, which indicates inflammation or infection. Depending on the results of your exam, your doctor may perform the following:

• prostate ultrasound
• tests to rule out a sexually transmitted infection
• studies to evaluate urine flow
• further evaluation of the urinary tract

The goal of treatment is to help improve symptoms. Taking antibiotics to treat this condition is controversial.

Some doctors don’t give antibiotics because the condition may be chronic and not caused by an active infection. Some doctors will prescribe antibiotics, thinking it could help treat an infection that may not be easily identified.

Other common treatments include:

• medications to relax the prostate muscles called alpha-adrenergic blockers — the same medications used to treat other prostate conditions, like BPH (benign prostate hypertrophy)
• other medications like muscle relaxants or tricyclic antidepressants to help with pain
• prescription pain medication or nonsteroidal anti-inflammatory drugs to reduce pain and swelling
• plant extracts, like some herbal supplements (pollen extract cernilton and bioflavonoid quercetin) that have evidence of effectiveness

Alternative and natural remedies that may reduce ongoing pain include:

• warm baths
• acupuncture
• relaxation exercises
• using a cushion or pillow when sitting for long periods
• massage therapy
• avoiding spicy foods, caffeine, and alcohol that can irritate the bladder
• biofeedback, a relaxation technique

Talk to your doctor before taking any herbal supplements. Some combinations of herbs may reduce the effectiveness of certain medications.

Chronic nonbacterial prostatitis/chronic pelvic pain syndrome can be an ongoing, painful condition. Exercise and pelvic floor physical therapy may improve your symptoms. According to the American Urological Association, having prostatitis does not increase your risk of prostate cancer.

To cope with anxiety or depression triggered by chronic pain and inflammation, talk with your doctor about treatments to improve your mental health. Other treatments may include anxiety medication and antidepressants. Joining a support group, getting private counseling, or participating in behavioral therapy can also help you cope with the condition.