HEALTH CONDITION

Prostatitis

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. But it commonly affects men aged between 30 and 50.

There are 2 main types of prostatitis:

  • chronic prostatitis – where the symptoms come and go over a period of several months; it's the most common type and not usually caused by an infection
  • acute prostatitis – where the symptoms are severe and develop suddenly; it's rare, but can be serious and requires immediate treatment, and is 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 poo 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 – 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 a GP straight away 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 have had the following symptoms for at least 3 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.

But in most cases, they'll gradually improve over time and with treatment.

When to get medical advice

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

They'll ask about the problems you're having and examine your tummy.

You may also have a digital rectal examination. 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 a GP straight away 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 doctor who specialises in urinary problems (a urologist) 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 2- to 4-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.

Your doctor may suggest the following treatments:

  • painkillers, such as paracetamol or ibuprofen, may help relieve pain
  • a medication called an alpha-blocker 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, antibiotics may be prescribed even if no infection is found; this is to see if your condition improves

The aim is to reduce symptoms to a level where they interfere less with day-to-day activities.

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 cannot usually be found. In these cases, the cause of symptoms is not clear.

Risk factors for prostatitis

Risk factors for acute prostatitis include:

Risk factors for chronic prostatitis include:

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

Outlook

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.

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 not being able to pass urine at all.

To relieve this, a catheter (a thin, flexible, hollow tube) is needed.

Prostate abscess 

If antibiotics are not effective in treating prostate infection, rarely an abscess can develop in your prostate gland.

Your doctor may suspect this if your symptoms do not improve despite antibiotic treatment.

Further tests will be needed to confirm this, such as an ultrasound scan or a 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 is not prostate cancer and there's currently no clear evidence that it increases your chances of developing cancer of the prostate.


Page last reviewed: Tue Mar 2020 Next review due: Tue Mar 2020

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