Prostatitis (Infection of the Prostate)

According to the National Institute of Health (NIH), prostatitis exists on a spectrum with pelvic pain. The type of symptoms, the length of time you have had those symptoms and testing will help your doctor pinpoint the type of prostatitis or pelvic pain you have.

There are four types of prostatitis:

• Acute Bacterial Prostatitis (ABP)
• Chronic Bacterial Prostatitis (CBP)
• Nonbacterial Prostatitis
• Chronic prostatitis/chronic pelvic pain syndrome (CP/
  CPPS)

Acute (Sudden) Bacterial Prostatitis (ABP)

Acute bacterial prostatitis is an infection of the prostate due to bacteria. Symptoms can come on quickly and include:

• Fever
• Chills
• Urinary changes
• Ejaculatory pain
• Pain in the pelvis or nearby zones

Treatment with antibiotics often leads to quick relief.

Chronic Bacterial Prostatitis (CBP)

Chronic bacterial prostatitis occurs from a bacterial infection. Symptoms are often more gradual and may take longer to treat. Fever and chills are not common but pain in the pelvis is still felt along with urinary symptoms and/or ejaculatory pain.

Nonbacterial Prostatitis

Nonbacterial Prostatitis is inflammation of the prostate that causes pain. It is not due to a bacterial infection and may be from injuries, past urinary tract infections, or prior procedures on the prostate, such as biopsies for cancer. This form of prostatitis has no signs of bacteria in the urine
or semen. But, it can cause a rise in the Prostate Specific Antigen (PSA), a test used to screen for prostate cancer.

Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)

CP/CPPS is s a condition that describes discomfort or pain in the area between the scrotum and the anus. It can be from inflammation of the prostate or muscles in that area, which are called the pelvic floor. Nerves that are in the pelvic floor, or go to that area (like from the spine) can also be the cause. Pain from CP/CPPS can last for weeks to months to years. This is NOT an infection but symptoms may be like those in men with CBP.

The cause for prostatitis or pelvis pain is not always known. Some things can raise the risk of a bacterial infection of the prostate like a bladder infection, catheter, sexually transmitted infection (STI), or recent procedure involving the penis, bladder or prostate. It can also happen from a
problem in the urinary tract not related to an infection. But, pelvic pain may not be from prostatitis. Even stress and anxiety can cause symptoms.

Other reasons for pelvic pain are:

• Pelvic muscle tightness
• Prostate or bladder stones
• Benign prostatic hyperplasia (BPH)
• Urethral stricture (a narrowing or scar of the tube that drains the bladder and runs through the penis)
• Prostate cancer
• Bladder cancer
• Back issues, such a disc herniation or pinched nerve

Your health care provider may start by asking you questions about your pain to find out what’s wrong. A digital rectal exam (DRE) may be done to check the prostate. Your doctor may do a transrectal ultrasound to look at your prostate or do a test called cystoscopy to check your urinary system.

You may also be asked to get lab tests to look for bacteria in your urine or prostate fluid, and check your PSA. A urine flow study or urodynamics test may be done to look for a block in your urinary system.

Each type of prostatitis calls for a different treatment. Your doctor will want to know exactly what is causing your symptoms. To find the answers, more than one type of test may be used.

Diagram of Digital Rectal Exam of the Prostate

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Your treatment will depend on your symptoms, lab tests and findings during your visit. Patients may need many treatments.

Antibiotics: often used as a first step to kill any bacteria.

Alpha-blockers: drugs that may help to relax the muscles around the prostate and at the base of the bladder.

Anti-inflammatory Agents: non-steroidal drugs to reduce pain from inflammation in the prostate or muscles.

Prostatic Massage: helps to ease pressure in the prostate. It is done by draining fluid from the prostate ducts.

Pelvic Floor Physical Therapy: a way to learn how to relax certain muscles in your pelvis. It is done with an expert to help you lessen tension in your pelvic floor muscles. This can include trigger point release.

Home Care: there are many things that can be done at home to help reduce pain. These include hot baths, hot water bottles, heating pads and a donut-shaped pillow. Unfortunately, supplements have not helped when tested in medical studies.

Lifestyle Changes: such as weight loss and diet changes, learning to relax, stretches that focus on the pelvic floor and exercise can ease symptoms and help you get relief.

Acupuncture: involves an expert placing very thin needles through the skin at many depths and points on your body to help reduce pain.

Surgery: on either the urethra or prostate may be needed in rare cases. The medical work up must show a problem that can be fixed. Sometimes, the surgery needed is of the lower back and would be determined by a spine specialist.

Questions to Ask Your Healthcare Provider

• How do you know if I have prostatitis?
• What type of prostatitis do you think it is?
• What are the best treatment options for me?
• What are the side effects of each treatment?
• Can treatment cure my prostatitis, or is this something I’ll need to manage for a long time?
• If I feel better, can I stop treatment?
• If I don’t feel better with treatment, what are my next steps?
• Can I have sex as usual?

Most cases of acute bacterial prostatitis are cured with treatment.

Sometimes prostatitis can come back even after you've been cured. Your health care provider may use more than one treatment at a time. Some men have to manage living with the symptoms until the inflammation goes away.

Updated August 2024.