Bacterial prostatitis symptoms

Prostatitis – bacterial

Prostatitis is swelling of the prostate gland. Prostate tissue becomes inflamed. This problem can be caused by an infection with bacteria.

Acute prostatitis starts quickly. Long-term (chronic) prostatitis lasts for 3 months or more.

Ongoing irritation of the prostate that is not caused by bacteria is called chronic nonbacterial prostatitis.

Any bacteria that can cause a urinary tract infection can cause acute bacterial prostatitis.

Infections spread through sexual contact can cause prostatitis. These include chlamydia and gonorrhea. Sexually transmitted infections (STIs) are more likely to occur from:

• Certain sexual practices, such as having anal sex without wearing a condom
• Having many sexual partners

In men over age 35, E coli and other common bacteria most often cause prostatitis. This type of prostatitis may begin in the:

• Epididymis, a small tube that sits on top of the testes.
• Urethra, the tube that carries urine from your bladder and out through the penis.

Acute prostatitis may also be caused by problems with the urethra or prostate, such as:

• Blockage that reduces or prevent the flow of urine out of the bladder
• Foreskin of the penis that cannot be pulled back (phimosis)
• Injury to the area between the scrotum and anus (perineum)
• Urinary catheter, cystoscopy, or prostate biopsy (removing a piece of tissue to look for cancer)

Men age 50 or older who have an enlarged prostate have a higher risk for prostatitis. The prostate gland may become blocked. This makes it easier for bacteria to grow. Symptoms of chronic prostatitis can be similar to symptoms of an enlarged prostate gland.

Symptoms can start quickly, and can include:

• Chills
• Fever
• Flushing of the skin
• Lower stomach tenderness
• Body aches

Symptoms of chronic prostatitis are similar, but not as severe. They often begin more slowly. Some people have no symptoms between episodes of prostatitis.

Urinary symptoms include:

• Blood in the urine
• Burning or pain with urination
• Difficulty starting to urinate or emptying the bladder
• Foul-smelling urine
• Weak urine stream

Other symptoms that may occur with this condition:

• Pain or aching in the abdomen above the pubic bone, in the lower back, in the area between the genitals and anus, or in the testicles
• Pain with ejaculation or blood in the semen
• Pain with bowel movements

If prostatitis occurs with an infection in or around the testicles (epididymitis or orchitis), you may also have symptoms of that condition.

Exams and Tests

During a physical exam, your health care provider may find:

• Enlarged or tender lymph nodes in your groin
• Fluid released from your urethra
• Swollen or tender scrotum

The provider may perform a digital rectal exam to examine your prostate. During this exam, the provider inserts a lubricated, gloved finger into your rectum. The exam should be done very gently to reduce the risk of spreading bacteria into the blood stream.

The exam may reveal that the prostate is:

• Large and soft (with a chronic prostate infection)
• Swollen, or tender (with an acute prostate infection)

Urine samples may be collected for urinalysis and urine culture.

Prostatitis may affect the results of the prostate-specific antigen (PSA), a blood test to screen for prostate cancer.

Antibiotics are often used to treat prostate infections.

• For acute prostatitis, you will take antibiotics for 2 to 6 weeks.
• For chronic prostatitis, you will take antibiotics for at least 2 to 6 weeks. Because the infection can come back, you may need to take medicine for up to 12 weeks.

Often, the infection will not go away, even after taking antibiotics for a long time. Your symptoms may come back when you stop the medicine.

If your swollen prostate gland makes it hard to empty your bladder, you may need a tube to empty it. The tube may be inserted through your abdomen (suprapubic catheter) or through your penis (indwelling catheter).

• Urinate often and completely.
• Take warm baths to relieve pain.
• Take stool softeners to make bowel movements more comfortable.
• Avoid substances that irritate your bladder, such as alcohol, caffeinated foods and drinks, citrus juices, and hot or spicy foods.
• Drink more fluid (64 to 128 ounces or 2 to 4 liters per day) to urinate often and help flush bacteria out of your bladder.

Get checked by your provider after you finish taking your antibiotic treatment to make sure the infection is gone.

Outlook (Prognosis)

Acute prostatitis should go away with medicine and minor changes to your diet and behavior.

It may come back or turn into chronic prostatitis.

Possible Complications

Complications may include:

• Abscess
• Inability to urinate (urinary retention)
• Spread of bacteria from the prostate to the bloodstream (sepsis)
• Chronic pain or discomfort
• Inability to have sex (sexual dysfunction)

When to Contact a Medical Professional

Call your provider if you have symptoms of prostatitis.

Chronic Prostatitis

Patient is a certified member of
The Information Standard

Reviewed by:
Dr Helen Huins, 29 Jun 2015

In this series

There are two main types of chronic prostatitis. ‘Chronic bacterial prostatitis’ is caused by persistent (chronic) infection with a germ (a bacterial infection). ‘Chronic prostatitis/chronic pelvic pain syndrome (CPPS)’ has a cause which is not fully understood. Chronic prostatitis typically causes pain in the lower pelvic region of men. Urinary symptoms such as frequency of passing urine and pain on passing urine may also be present. Treatment can be difficult and may include antibiotics and other medicines. Symptoms may last a long time, although they may ‘come and go’ or vary in severity.

In this article

• arrow-downWhat is the prostate gland?
• arrow-downWhat is chronic prostatitis?
• arrow-downWho gets chronic prostatitis?
• arrow-downChronic bacterial prostatitis
• arrow-downChronic prostatitis/chronic pelvic pain syndrome (CPPS)
• arrow-downDo I need any tests for chronic prostatitis?
• arrow-downWhat is the treatment for chronic prostatitis?
• arrow-downWhat is the outlook (prognosis)?

Chronic Prostatitis

In this article

What is the prostate gland?

The prostate gland is only found in men. It lies just beneath the bladder. It is normally about the size of a chestnut. The urethra is the tube that passes urine from the bladder and it runs through the middle of the prostate. The prostate helps to make semen but most semen is made by another gland (the seminal vesicle).

What is chronic prostatitis?

Prostatitis means that you have inflammation of your prostate gland. Prostatitis can be sudden-onset (acute) or persistent (chronic). It can also be caused by an infection (infective) or be non-infective.

For the diagnosis of chronic prostatitis, symptoms need to have been present for at least three months. In acute prostatitis, symptoms usually come on and go away much more quickly. There are two main types of chronic prostatitis:

• Chronic bacterial prostatitis.
• Chronic prostatitis/chronic pelvic pain syndrome (CPPS).

The rest of this leaflet is just about chronic prostatitis.

Who gets chronic prostatitis?

Chronic prostatitis is actually quite common. About 2 men in 10 will have chronic prostatitis at some point during their life. Chronic prostatitis most commonly affects men between the ages of 30-50 but men of any age can be affected.

About 9 in 10 men with chronic prostatitis have chronic prostatitis/chronic pelvic pain syndrome (CPPS). About 1 in 10 men with chronic prostatitis have chronic bacterial prostatitis, so this is rare in comparison to chronic prostatitis/CPPS.

Chronic bacterial prostatitis

What causes chronic bacterial prostatitis?

Chronic bacterial prostatitis is a type of infective prostatitis. It is caused by a persistent (chronic) infection with a germ (a bacterial infection) of the prostate gland. A man with chronic bacterial prostatitis will usually have had recurring urine infections. Chronic bacterial prostatitis is usually caused by the same type of germs (bacteria) that causes the urine infections. The prostate gland can harbour infection and therefore recurring infections can occur. Chronic bacterial prostatitis is not a sexually transmitted infection.

What are the symptoms of chronic bacterial prostatitis?

Men with chronic bacterial prostatitis tend to have symptoms that wax and wane. During a flare-up, you can have pain and discomfort. You feel this mainly at the base of your penis, around your anus, just above your pubic bone and/or in your lower back. Pain may spread to your penis and testicles (testes). Passing stools (faeces) can be painful. You may also have symptoms from a urine infection, such as pain when you pass urine, passing urine frequently or an urgent desire to pass urine.

These symptoms are similar to the symptoms of acute bacterial prostatitis. However, men with a flare-up of chronic bacterial prostatitis tend to be less ill than those with acute prostatitis. For example, a high temperature (fever) is less likely and you are less likely to have general aches and pains.

If you have chronic bacterial prostatitis, your symptoms will generally ease when treated with antibiotics. However, unless the antibiotics completely clear the infection from the prostate gland, you are at risk of the infection coming back (flaring up) again. In between flare-ups, you may have some mild residual pain and some mild urinary symptoms (such as passing urine frequently or an urgent desire to pass urine).

Chronic prostatitis/chronic pelvic pain syndrome (CPPS)

What causes chronic prostatitis/CPPS?

Chronic prostatitis/CPPS is a persistent (chronic) discomfort or pain that you feel in your lower pelvic region – mainly at the base of your penis and around your anus. It is usually diagnosed if you have had pain for at least three months within the previous six months.

The cause of this type of chronic prostatitis is not fully understood. Many theories have been put forward as to the cause. These include:

• Infection of the prostate with a germ that has not yet been identified.
• Nerve problems affecting the prostate.
• An autoimmune problem of the prostate gland (antibodies that we normally produce to fight infection may be attacking the cells of the prostate gland for some reason).
• Inflammation resulting from urine being forced backwards up into the prostate at the time of urination.

The term prostatitis really refers to inflammation and/or infection of the prostate gland. However, the exact cause of this form of chronic prostatitis is not known and there is a variable response to antibiotics and anti-inflammatory painkillers. For these reasons, some doctors prefer to use the term ‘chronic pelvic pain syndrome’ (CPPS). Using this term does not necessarily imply that the problem definitely stems from a problem with the prostate gland.

What are the symptoms of chronic prostatitis/CPPS?

Symptoms have usually been present for at least three months within the previous six months.

The symptoms include:

• Pain – this is usually around the base of the penis, around the anus, in the lower tummy (abdomen) and in the lower back. Sometimes the pain spreads down to the tip of the penis and/or into the testicles (testes). Pain is the main symptom in chronic prostatitis. The pain may vary in severity from day to day.
• Urinary symptoms – such as mild pain when you pass urine, an urgent desire to pass urine at times, some hesitancy when trying to pass urine, a poor urinary stream.
• Sexual problems – you may experience difficulty in getting an erection (impotence), ejaculation may sometimes be painful and some men have worse pain (as described above) after having sex.
• Other symptoms – you may feel tired and have general aches and pains.

Do I need any tests for chronic prostatitis?

• Examination of your prostate gland. Your doctor may examine your prostate gland, using a gloved finger in your back passage (rectum). Your prostate gland may be tender on examination in chronic prostatitis. However, this is not so in every case.
• A urine sample is usually taken to rule out urine infection. This is especially important for chronic bacterial prostatitis although, in between flare-ups, there may be no signs of infection.
• Further tests of your kidneys and urinary tract. If your doctor suspects that you have chronic bacterial prostatitis, they may suggest that you have further tests to rule out any problem with your urinary tract that may have contributed to (or caused) the infection. For example, an ultrasound scan of your kidneys to look for any abnormalities.
• Tests to exclude other causes for your symptoms, including:
  • Some swab or urine tests to exclude a sexually transmitted infection which can produce similar symptoms to chronic prostatitis. Note that chronic prostatitis is not a sexually transmitted infection itself.
  • Other tests may be advised to rule out other conditions of your prostate or nearby organs if your symptoms are not typical. For example, sometimes your doctor may suggest a blood test to exclude other problems with your prostate gland.

If your doctor suspects that you have chronic prostatitis, they may refer you to a specialist (usually a urologist) for further assessment. If you are referred to a specialist, a sample of fluid (‘secretions’) from the prostate may be collected to rule out infection in your prostate. To do this, a doctor can gently massage your prostate, with a gloved finger in your rectum. By doing this, fluid from the prostate is pushed out into the urethra and comes out from the penis to be collected and tested for germs (bacteria). If you have chronic pelvic pain syndrome (CPPS), no bacteria are found in the the prostate fluid or urine.

What is the treatment for chronic prostatitis?

The treatment of chronic prostatitis can be difficult. However, in most people, symptoms improve over months or years.

If your GP suspects that you have chronic prostatitis, as mentioned above, they will usually refer you to a specialist for further assessment. In the meantime, your GP may suggest one or more of the following whilst you are waiting for your appointment with a specialist:

• Painkillers such as paracetamol or ibuprofen may ease the pain.
• Laxatives may be helpful if it is painful or difficult to pass stools.
• Antibiotics. A four-week course may be helpful. Antibiotics are usually advised if you have had a urinary tract infection or an episode of acute prostatitis within the previous year. This is to be absolutely sure that no infection is present.

Reassurance and explanation are also sometimes helpful. Some people worry that they may have a serious disease such as prostate cancer. Worry and anxiety can make symptoms worse. Therefore, it may be useful to know that you have chronic prostatitis and not some other disease. However, you will have to accept that pain or discomfort are likely to continue for some time.

Treatments that a specialist may suggest

Various treatments have been tried for chronic prostatitis. They may benefit some people but so far there are few research studies to confirm whether they help in most cases. They are not ‘standard’ or routine treatments but a specialist may advise that you try one.

For chronic bacterial prostatitis, possible treatments may include the following:

• A longer course of antibiotics. If the specialist suspects that you have chronic bacterial prostatitis and your symptoms have not cleared after a four-week course of antibiotics, they may suggest a longer course. Sometimes a course of up to three months is used.
• Removal of the prostate (prostatectomy) may be considered if you have small stones (calculi) in the prostate. It is not clear how much this may help but it has been suggested that these small stones may be a reason why some people have recurrent infections in chronic bacterial prostatitis. However, this is not commonly carried out and is not suitable in everyone. Your specialist will advise.

For chronic prostatitis/chronic pelvic pain syndrome (CPPS), possible treatments may include the following:

• Antibiotics – these may be tried initially, although the evidence for their effectiveness is limited. It may be that some antibiotics have anti-inflammatory properties as well or that they may clear some germs (bacteria) that are difficult to find when your urine is tested.
• Alpha-blockers – are medicines that are used to treat prostate gland enlargement. They relax the muscle tissue of the prostate and the outlet of the bladder. There are several different brands. There is some evidence that they help in CPPS and one may be worth a try.
• Other medicines – for example, bioflavonoids (such as quercetin) and finasteride (a medicine which may ‘shrink’ the prostate).
• Stress management – this and other pain-relieving techniques are sometimes tried to help cope with the persistent pain.

Research continues to try to find better treatments for chronic bacterial prostatitis and chronic prostatitis/CPPS.

What is the outlook (prognosis)?

It is difficult to give an outlook (prognosis). Your symptoms may last a long time, although they may ‘come and go’ or vary in severity. Painkillers can keep discomfort to a minimum.

Most men diagnosed with chronic prostatitis/chronic pelvic pain syndrome (CPPS) tend to have an improvement in their symptoms over the following six months. In one study, about a third of men had no further symptoms one year later. In another large study, one third of men showed moderate to marked improvement over two years.

Acute Prostatitis: Causes, Symptoms, and Diagnosis

Acute prostatitis happens when your prostate gland becomes suddenly inflamed. The prostate gland is a small, walnut-shaped organ located at the base of the bladder in men. It secretes fluid that nourishes your sperm. When you ejaculate, your prostate gland squeezes this fluid into your urethra. It makes up a large portion of your semen.

Acute prostatitis is usually caused by the same bacteria that cause urinary tract infections (UTIs) or sexually transmitted diseases (STDs). Bacteria can travel to your prostate from your blood. It can enter your prostate during or after a medical procedure, such as a biopsy. It can also be caused by infections in other parts of your genitourinary tract.

If you have acute prostatitis, you may develop:

• chills
• a fever
• pelvic pain
• painful urination
• blood in your urine
• foul-smelling urine
• a decreased urinary stream
• difficulty emptying your bladder
• difficulty starting to urinate
• increased frequency of urination
• painful ejaculation
• blood in your semen
• discomfort during bowel movements
• pain above your pubic bone
• pain in your genitals, testicles, or rectum

Any bacteria that causes UTIs can cause prostatitis. Bacteria that commonly cause UTIs and prostatitis include:

Some bacteria that cause STDs, such as chlamydia and gonorrhea, can also cause acute bacterial prostatitis. Other conditions that can lead to acute bacterial prostatitis include:

• urethritis, or inflammation of your urethra
• epididymitis, or inflammation of your epididymis, which is the tube that connects your testicles and vas deferens
• phimosis, which is the inability to pull back the foreskin of your penis
• injury to your perineum, which is the area between your scrotum and rectum
• bladder outlet obstruction, which can occur due to an enlarged prostate or stones in your bladder
• urinary catheters or cystoscopy

Factors that increase your risk of UTIs, STDs, and urethritis also increase your risk of acute prostatitis. For example, these risk factors include:

• not drinking enough fluids
• using a urinary catheter
• having multiple sexual partners
• having unprotected vaginal or anal intercourse

Other risk factors include:

• being over the age of 50
• having a UTI
• having a history of prostatitis
• having certain genes that can make you more susceptible to prostatitis
• having pelvic injuries from bike riding or horseback riding
• having orchitis, or inflammation of your testicles
• having HIV
• having AIDS
• being under psychological stress

Your doctor will likely start by asking questions about your medical history. They’ll also conduct a physical examination.

They’ll probably conduct a digital rectal examination (DRE). During this procedure, they’ll gently insert a gloved and lubricated finger into your rectum. Your prostate is located in front of your rectum, where your doctor can easily feel it. If you have acute bacterial prostatitis, it will likely be swollen and tender.

During a DRE, your doctor may also massage your prostate to squeeze a small amount of fluid into your urethra. They can collect a sample of this fluid for testing. Laboratory technicians can check it for signs of infection

Your doctor may also feel the lymph nodes in your groin, which may be enlarged and tender.

They may also conduct or order additional tests, such as:

• a blood culture to rule out bacteria in your blood
• a urinalysis or a urine culture to test your urine for blood, white cells, or bacteria
• a urethral swab to test for gonorrhea or chlamydia
• urodynamic tests to learn if you have problems emptying your bladder
• a cystoscopy to examine the inside of your urethra and bladder for signs of infection

Your doctor will likely prescribe antibiotics for four to six weeks to treat acute bacterial prostatitis. Your treatment may last longer if you have recurrent episodes. The specific type of antibiotic will depend on the bacteria causing your condition.

Your doctor may also prescribe alpha-blockers to help relieve symptoms. These drugs relax your bladder muscles. They can help decrease urinary discomfort. Examples include doxazosin, terazosin, and tamsulosin. Your doctor may also recommend over-the-counter pain relievers, such as acetaminophen and ibuprofen.

Your doctor may advise you to adjust your daily habits to help relieve symptoms. For example, they may encourage you to:

• avoid bicycling or wear padded shorts to decrease pressure on your prostate
• avoid alcohol, caffeine, and foods that are spicy and acidic
• sit on a pillow or donut cushion
• take warm baths

Acute prostatitis usually goes away with antibiotics and lifestyle adjustments. In some cases, it may recur and become chronic prostatitis. Ask your doctor for more information about your specific condition, treatment options, and outlook. They may advise you to take certain steps to lower your risk of recurring infections.