There are two main types of chronic prostatitis – chronic bacterial prostatitis (caused by chronic bacterial infection) and chronic prostatitis / chronic pelvic pain syndrome (CPPS) – whose cause is not known. Chronic prostatitis often causes pain in the lower pelvis of man. Urinary symptoms such as frequency of urination or painful urination may also be present. Treatment can be difficult and may include antibiotics and other medications. Symptoms can last a long time, even though you can "come and go" and vary in severity.
On this page
- What is the prostate?
- What is chronic prostatitis?
- Who gets chronic prostatitis?
- Chronic Bacterial Prostatitis
- Chronic prostatitis / chronic pelvic pain syndrome
- Do I have to do some analysis for chronic prostatitis?
- What is the treatment for chronic prostatitis?
- What is the outlook?
- More help and information
- References
What is the prostate?
The prostate gland is found only in men. It is located just below the bladder. It is typically the size of a walnut. The urethra (the tube that drains urine from the bladder) runs through the center of the prostate. The prostate helps make semen, semen, but most is done by the seminal vesicle (another gland).
What is chronic prostatitis?
Prostatitis means that you have inflammation of the prostate gland. Prostatitis can be acute (sudden) or chronic (persistent). It may also be infectious (caused by infection) or noninfectious.
For the diagnosis of chronic prostatitis, the symptoms must have been present for at least three months. In acute prostatitis, symptoms usually appear and disappear faster. There are two main types of chronic prostatitis:
- Chronic Bacterial Prostatitis
- Chronic prostatitis / CPPS
See separate leaflet called acute prostatitis for more information on acute prostatitis. The rest of this leaflet is only about chronic prostatitis.
Who gets chronic prostatitis?
Chronic prostatitis is actually quite common. Among men over 10 will have 1-2 chronic prostatitis at some time in their lives. The most common chronic prostatitis in men between the ages of 30-50, but men of any age can be affected.
About 9 out of 10 men with chronic prostatitis have chronic prostatitis / CPPS. About 1 in 10 men with chronic prostatitis have chronic bacterial prostatitis, so this is rare compared with chronic prostatitis / CPPS.
Chronic Bacterial Prostatitis
What causes chronic bacterial prostatitis?
Chronic bacterial prostatitis is a type of infectious prostatitis. It is caused by a chronic (persistent) bacterial infection of the prostate gland. A man with chronic bacterial prostatitis usually have recurrent urinary infections. Chronic bacterial prostatitis is usually caused by the same type of bacteria that cause urinary tract infections. The prostate gland can harbor infection and therefore recurrent 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 an asthma attack, can cause pain and discomfort. You feel this mainly at the base of his penis, around the anus, just above the pubic bone and / or lower back. The pain may spread to your penis and testicles. Passing stool (feces) can be painful. It is also possible that the symptoms of a urinary tract infection, and painful urination, frequent urination or an urgent need to urinate.
These symptoms are similar to symptoms of acute bacterial prostatitis. However, men with an outbreak of chronic bacterial prostatitis tend to be less ill than those with acute prostatitis. For example, a fever (high temperature) is less likely and less likely to have pain and malaise.
If you have chronic bacterial prostatitis, symptoms usually easier when treated with antibiotics. However, antibiotics unless completely eliminate the infection of the prostate gland, you run the risk of infection from coming back (bursting) again. Amid asthma attacks, you may have some mild pain and some mild residual urine (such as frequent urination or an urgent need to urinate).
Chronic prostatitis / chronic pelvic pain syndrome
What causes chronic prostatitis / CPPS?
Chronic prostatitis / CPPS is a chronic (persistent) pain or discomfort felt in your lower pelvic region – especially at the base of your penis and around the anus. It is usually diagnosed if you have had pain for at least three months within the past six months.
The cause of this type of chronic prostatitis is not fully understood. Many theories have been proposed regarding the causes. These include: infection of the prostate with a seed which has not yet been identified, nerve problems affecting the prostate, an autoimmune disorder of the prostate gland (which normally produce antibodies to fight infection can attack cells the prostate gland for some reason) – inflammation resulting from urine is forced back up into the prostate at the time of urination.
The term prostatitis actually 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 the term "chronic pelvic pain syndrome. The use of 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 / chronic pelvic pain syndrome?
Symptoms usually have been present for at least three months within the past six months.
Symptoms include:
- Pain – this is usually around the base of the penis, around the anus, in the lower abdomen and lower back. Sometimes the pain extends to the tip of the penis and / or testicles. Pain is the main symptom of chronic prostatitis. The pain can range in severity from day to day.
- Urinary symptoms – such as mild pain during urination, an urge to urinate, sometimes, a bit of hesitation when it comes to pass urine, poor urine flow.
- Sexual problems – may experience impotence (trouble getting an erection), ejaculation can sometimes be painful and some men have worse pain (as described above) after sex.
- Other symptoms – you may feel tired and have pain and malaise.
Do I have to do some analysis for chronic prostatitis?
- The examination of the prostate gland. Your doctor may examine your prostate with a gloved finger into the rectum. The prostate may be tender on examination in chronic prostatitis. However, this is not true in all cases.
- A urine sample is usually taken to rule out a urinary tract infection. This is particularly important for chronic bacterial prostatitis although outbreaks in between can be no sign of infection.
- More evidence of the kidneys and urinary tract. If your doctor suspects you have chronic bacterial prostatitis, may suggest that you have other tests to rule out any problems in the urinary tract that may have contributed to (or cause) of infection. For example, an ultrasound of the kidneys to detect any abnormalities.
- Tests to rule out other causes of your symptoms, including:
- Chronic prostatitis can produce symptoms similar to a sexually transmitted infection. For this reason, if you are at risk of a sexually transmitted infection, your doctor may suggest that you have some swab or urine tests to exclude this. But keep in mind, chronic prostatitis is not a sexually transmitted infection.
- Other tests may be advised to rule out other diseases of the prostate or nearby organs if their symptoms are not typical. For example, sometimes the doctor may suggest a blood test to rule out other problems with your prostate gland.
If your doctor suspects you have chronic prostatitis, who may refer you to a specialist (usually a urologist) for further evaluation. If you are referred to a specialist, a liquid sample ("discharge") of the prostate can be collected to rule out prostate infection. To do this, the doctor can gently massage your prostate with a gloved finger into the rectum. By doing this, the prostate fluid is pushed out into the urethra and out of the penis to be collected and tested for bacteria (germs). If you have CPPS, bacteria not found in 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 doctor suspects you have chronic prostatitis, as mentioned above, usually refer you to a specialist for further evaluation. Meanwhile, your doctor may suggest one or more of the following whilst you're waiting for your appointment with a specialist:
- Analgesics such as paracetamol or ibuprofen may relieve pain.
- Laxatives can be helpful if it is painful or difficult to pass stools.
- Antibiotics. A four-week course can be useful. Antibiotics are usually recommended if you have had a urinary tract infection or an episode of acute prostatitis during the previous year. This is to be absolutely sure there is no infection.
The tranquility and explanation are also sometimes help. Some people worry that they may have a serious disease such as prostate cancer. Worry and anxiety can worsen symptoms. Therefore, it can be helpful to know that you have a chronic prostatitis and other diseases. However, you will have to accept that the pain or discomfort is likely to persist for some time.
Treatments that may suggest a specialist
Several treatments have been tested for chronic prostatitis. It may benefit some people, but so far there is little research to confirm if they help in most cases. There are 'standard' or routine, but a specialist can advise that a try.
For chronic bacterial prostatitis, possible treatments may include the following:
- A longer course of antibiotics. If the specialist suspects you have chronic bacterial prostatitis and its symptoms have not gone away after a four-week course of antibiotics, may suggest a course more. Sometimes, a course of three months is used.
- The removal of the prostate (prostatectomy) can be considered if you have small stones (calculi) in the prostate. It is not clear how it can help, but it has been suggested that these small stones may be one reason why some people get recurrent infections in chronic bacterial prostatitis. However, this is not done and is not suitable commonly worldwide. Your specialist will advise.
For chronic prostatitis / CPPS, possible treatments may include the following:
- Antibiotics – these can be tried initially, although evidence of their effectiveness is limited. Some antibiotics may have anti-inflammatory as well or can clarify some bacteria that are difficult to find when urine tests.
- Alpha blockers – are drugs used to treat enlargement of the prostate. They relax the muscle tissue of the prostate and the bladder outlet. There are several different brands. There is some evidence that it helps in the CPPS, and one may be worth a try.
- Other drugs – for example, bioflavonoids (such as quercetin) and finasteride (a drug that can 'reduce' the prostate).
- Stress management – these and other techniques to relieve pain sometimes tried to help deal with persistent pain.
Research continues to try to find better treatments for chronic bacterial prostatitis and chronic prostatitis / CPPS.
What is the outlook?
It is difficult to give a prognosis (outlook). Your symptoms can last a long time, even though you can "come and go" and vary in severity. Analgesics can keep inconvenience to a minimum.
Most men diagnosed with chronic prostatitis / CPPS tend to have an improvement in their symptoms over the next six months. In one study, about a third of the men had no more symptoms a year later. In another large study, a third of the men showed a moderate to marked improvement over two years.
More help and information
British Prostatitis Support Association (BPSA)
Web: www.bps-assoc.org.uk
An Internet-based E-focused, organization of information, support and campaigns related to prostate diseases of chronic prostatitis / chronic prostatitis / CPPS.
Prostate UK
6 Crescent Stables, 139 Upper Richmond Road, London SW15 2TN
Tel: 020 8788 7720 Web: www.prostateuk.org
