Is prostatitis painful

Prostatitis

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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

Prostatitis

Prostatitis is a frequently painful condition that affects mostly young and middle-aged men. Doctors may have difficulty diagnosing prostatitis because the symptoms are not the same for every patient, and many of the symptoms—such as painful or burning urination and incomplete emptying of the bladder—could be signs of another disease.

What is the prostate?

The prostate is a walnut-sized gland that forms part of the male reproductive system. The gland is made of two lobes, or regions, enclosed by an outer layer of tissue. As the diagrams show, the prostate is located in front of the rectum and just below the bladder, where urine is stored. The prostate also surrounds the urethra, the canal through which urine and semen pass out of the body. The prostate squeezes fluid into the urethra to help make up semen as sperm move through during sexual climax.

1McNaughton-Collins M, Joyce GF, Wise M, Pontari MA. Prostatitis. In: Litwin MS, Saigal CS, editors. Urologic Diseases in America. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Washington, DC: U.S. Government Publishing Office, 2007; NIH Publication No. 07–5512 pp. 9–42.

What are the types of prostatitis?

Acute bacterial prostatitis is the least common of the four types and is potentially life-threatening. Fortunately, it is the easiest to diagnose and treat effectively. Men with this disease often have chills; fever; pain in the lower back and genital area; urinary frequency and urgency, often at night; burning or painful urination; body aches; and a demonstrable infection of the urinary tract as evidenced by white blood cells and bacteria in the urine. The treatment is an antimicrobial, a medicine that kills microbes—organisms that can only be seen with a microscope, including bacteria, viruses, and fungi. Antimicrobials include antibiotics and related medicines.

Chronic bacterial prostatitis, also relatively uncommon, occurs when bacteria find a spot on the prostate where they can survive. Men have urinary tract infections that seem to go away but then come back with the same bacteria. Treatment usually requires the use of antimicrobials for a prolonged period of time. However, antimicrobials do not always cure this condition.

Chronic prostatitis/chronic pelvic pain syndrome is the most common but least understood form of prostatitis. It may be found in men of any age. Its symptoms go away and then return without warning, and it may be inflammatory or noninflammatory. In the inflammatory form, urine, semen, and prostatic fluid contain the kinds of cells the body usually produces to fight infection, but no bacteria can be found. In the noninflammatory form, not even the infection-fighting cells are present.

Asymptomatic inflammatory prostatitis is the diagnosis given when the patient does not complain of pain or discomfort but has infection-fighting cells in his prostate fluid and semen. Doctors usually find this form of prostatitis when looking for causes of infertility or testing for prostate cancer.

How is prostatitis diagnosed?

A doctor performs a digital rectal exam (DRE) by inserting a gloved and lubricated finger into the patient’s rectum, just behind the prostate. The doctor can feel the prostate to see if it is swollen or tender in spots.

The doctor can diagnose the bacterial forms of prostatitis by examining a urine sample with a microscope. The sample may also be sent to a laboratory to perform a culture. In a urine culture, the bacteria are allowed to grow so they can be identified and tested for their resistance to different types of antimicrobials.

To confirm the prostate infection, the doctor may obtain two urine samples—before and after prostate massage. To perform a prostate massage, the doctor will insert a gloved and lubricated finger into the rectum, as in a DRE, and stroke the prostate to release fluids from the gland. The post-massage urine sample will contain prostate fluid. If that second urine sample contains bacteria or infection-fighting cells that were not present in the premassage urine sample, this suggests the prostate contains infection.

To diagnose chronic prostatitis/chronic pelvic pain syndrome, the doctor must rule out all other possible causes of urinary symptoms, such as kidney stones, bladder disorders, and infections. Since many different conditions must be considered, the doctor may order a full range of tests, including ultrasound or magnetic resonance imaging (MRI), biopsy, blood tests, and tests of bladder function.

If all other possible causes of a patient’s symptoms are ruled out, the doctor may then diagnose chronic prostatitis/chronic pelvic pain syndrome. To aid in understanding the symptoms and measuring the effects of treatment, the doctor may ask a series of questions from a standard questionnaire, the NIH-Chronic Prostatitis Symptom Index.

How is prostatitis treated?

The bacterial forms of prostatitis are treated with antimicrobials. Acute prostatitis may require a short hospital stay so that fluids and antimicrobials can be given through an intravenous, or IV, tube. After the initial therapy, the patient will need to take antimicrobials for 2 to 4 weeks.

Chronic bacterial prostatitis requires a longer course of therapy. The doctor may prescribe a low dose of antimicrobials for 6 months to prevent recurrent infection. If a patient has trouble emptying his bladder, the doctor may recommend medicine or surgery to correct blockage.

Antimicrobials will not help nonbacterial prostatitis. Each patient will have to work with his doctor to find an effective treatment. Changing diet or taking warm baths may help. The doctor may perscribe a medicine called an alpha blocker to relax the muscle tissue in the prostate. No single solution works for everyone with this condition.

No treatment is needed for asymptomatic inflammatory prostatitis.

What is Prostatitis?

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The prostate is a walnut-sized gland that all men have. It’s found below your bladder and in front of your rectum. The job of the prostate is to make fluid that contains sperm (semen). This fluid protects the sperm when they travel toward a female’s egg.

If your prostate becomes swollen, tender, and inflamed, you have a condition called “prostatitis.” This isn’t cancer, and it’s different from having an “enlarged prostate.”

Symptoms of Prostatitis

There are four types of prostatitis. Each has its own set of symptoms and causes. These include:

Acute bacterial prostatitis. Your urinary tract is made up of your kidneys, bladder, and the tubes that pass between them. If bacteria from here finds its way into your prostate, you can get an infection.

This type of prostatitis comes on quickly. You might suddenly have:

• High fever
• Chills
• Muscle aches
• Joint pain
• Pain around the base of your penis or behind your scrotum
• Lower back pain
• Feeling like you need to have a bowel movement
• Trouble peeing
• Weak urine stream

Acute bacterial prostatitis is a severe condition. If you notice these symptoms, seek medical care right away.

Chronic bacterial prostatitis. This is more common in older men. It’s a milder bacterial infection that can linger for several months. Some men get it after they’ve had a urinary tract infection (UTI) or acute bacterial prostatitis.

The symptoms of chronic bacterial prostatitis often come and go. This makes them easy to miss. With this condition, you might sometimes have:

• An urgent need to pee, often in the middle of the night
• Painful urination
• Pain after you ejaculate (release semen at orgasm)
• Lower back pain
• Rectum pain
• A “heavy” feeling behind your scrotum
• Blood in your semen
• A UTI
• Urinary blockage (no urine comes out)

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). This is the most common type of prostatitis. It shares many of the same signs as bacterial prostatitis. The difference is that when tests are run, no bacteria are present with this type.

Doctors aren’t sure what causes CP/CPPS. Triggers include stress, nearby nerve damage, and physical injury. Chemicals in your urine or a UTI you had in the past may play a role. CP/CPPS has also been linked to immune disorders like chronic fatigue syndrome and irritable bowel syndrome (IBS).

The main sign of CP/CPPS is pain that lasts more than 3 months in at least one of these body parts:

• Penis (often at the tip)
• Scrotum
• Between your scrotum and rectum
• Lower abdomen
• Lower back

You may also have pain when you pee or ejaculate. You might not be able to hold your urine, or you may have to pee more than 8 times a day. A weak urine stream is another common symptom of CP/CPPS.

Asymptomatic prostatitis. Men who have this type of prostatitis have an inflamed prostate but no symptoms. You may only learn you have it if your doctor does a blood test that checks your prostate health. Asymptomatic prostatitis doesn’t need any treatment, but it can lead to infertility.

Prostatitis Risk Factors

You’re more likely to have problems with your prostate if:

• You’re between the ages of 36 and 50
• You’ve had a UTI
• You’ve had a groin injury
• You use a urinary catheter
• You’ve had a prostate biopsy
• You have HIV/AIDS
• You’ve had prostatitis before

An inflamed or infected prostate gland is common in men of all ages.

If you have prostatitis, your doctor can help you find ways to manage your symptoms and control your pain. Researchers are also trying to better understand what causes it. This will allow them to find more treatments that work.

Mayo Clinic: “Prostatitis.”

Urology Care Foundation: “What are Prostatitis and Related Chronic Pelvic Pain Conditions?”

National Institute of Diabetes and Digestive Kidney Diseases: “Prostatitis: Inflammation of the Prostate.”

Harvard Medical School + Harvard Health Publications: “Prostatitis: inflamed prostate can be a vexing health problem.”

NHS Choices: “Prostatitis.”

Cleveland Clinic: “Prostatitis.”

Prostate Cancer UK: “Prostatitis: A guide to infection and inflammation of the prostate.”