Greater Boston Urology Blog

What is Prostatitis?

Prostatitis is a condition where the prostate gland becomes inflamed. The prostate is a small walnut-shaped gland located just below the bladder in men and people assigned male at birth. The prostate is responsible for producing fluid that helps transport sperm during ejaculation. 

We asked Urline Gregoire, a nurse practitioner in our Easton Care Center, to share her insights about prostatitis, including risk factors, symptoms, diagnosis, and treatment options. 

As with all content on our blog, the following is educational, not medical advice. Always consult your physician regarding your unique healthcare needs. 

We gave a brief description of prostatitis in our introduction. How do you explain prostatitis to patients? 

URLINE GREGOIREAs stated above, the prostate is a small walnut-shaped gland that is part of the male reproductive system. The prostate is in front of the rectum, just below the bladder. The primary function of the prostate is to make fluid that helps transport sperm during ejaculation. Prostate fluid is essential for men's fertility.

Prostatitis is a painful condition that involves inflammation of the prostate and sometimes the areas around the prostate. According to the National Institutes of Health (NIH), prostatitis is the most common urinary tract problem for men younger than 50 and the third most common urinary tract problem for men older than 50.

What are the different types of prostatitis? 

URLINE GREGOIRE: There are four types of prostatitis:

  1. Acute bacterial prostatitis is a bacterial infection of the prostate usually manifested by sudden, severe symptoms. This type of prostatitis happens suddenly and lasts only for a short time. The infection might occur when bacteria travel from the urethra into the prostate.
  1. Chronic bacterial prostatitis also occurs when bacteria travel to the prostate. It is an ongoing or recurring bacterial infection that develops slowly and often lasts a long time (in many cases, three or more months). This type of prostatitis usually has less severe symptoms.
  1. Chronic prostatitis/chronic pelvic pain syndrome is an ongoing or recurring pelvic pain and urinary tract symptoms with no evidence of infection. The exact cause of this type of prostatitis is unknown. Researchers believe a non-bacterial microorganism may cause the condition. Or it could be due to chemicals in the urine, the immune system's response to a previous urinary tract infection (UTI), or nerve damage to the pelvic area.
  1. Asymptomatic inflammatory prostatitis is classified by signs of an inflamed prostate with no symptoms usually found during a man's physical exam.

What are the
leading causes and risk factors of prostatitis? 

URLINE GREGOIRE: Causes of prostatitis differ depending on the type. For example, acute bacterial prostatitis is usually caused by common strains of bacteria. The infection often spreads from other parts of the urinary or reproductive systems to the prostate.

Chronic bacterial prostatitis generally has the same cause as an acute bacterial infection. It may occur when treatment for an acute infection isn't long enough or fails to kill all the bacteria.

Chronic prostatitis/chronic pelvic pain syndrome, as stated above, is not well understood. Multiple factors, like a previous infection or even psychological stress, might be at play.

Asymptomatic inflammatory prostatitis is generally found only during an exam for other medical conditions and is not treated.

Risk factors for prostatitis include the following:

  • Infection of the urinary or reproductive system
  • Sexually transmitted infections (STIs)
  • Use of a tube inserted into the urethra to drain the bladder, such as a urinary catheter
  • Diagnostic sampling of prostate tissue collected during a prostate biopsy
  • Young or middle-aged adulthood and previous prostatitis
  • Urinary tract infection (UTI)
  • Bladder stones
  • Prostate stones

Additional risk factors for chronic prostatitis/chronic pelvic pain syndrome may include psychological stress and nerve damage in the pelvic region due to surgery or trauma.

How is prostatitis diagnosed? 

URLINE GREGOIRE:  The healthcare provider usually takes the patient's personal and family history. Then, the provider performs a physical exam that usually includes a digital rectal exam.

A digital rectal exam is a physical exam of the prostate. This exam helps the healthcare provider determine if the prostate is enlarged or tender or has any other abnormalities that may warrant further testing.

Other types of testing include the following:

  • A urinalysis, which tests urine samples, can also help diagnose prostatitis or any lower urinary tract problems.
  • Blood tests can show signs of infection and other prostate problems, like an elevated prostate-specific antigen (PSA).
  • Urodynamic studies show how well the bladder and urethra store and release urine.
  • Cystoscopy allows healthcare providers to examine your bladder's lining.
  • Transrectal ultrasound will show the size of the prostate or any abnormalities such as tumors.
  • Biopsies involve taking a small piece of the prostate tissue for examination with a microscope. A biopsy will show whether prostate cancer is present.
  • Semen analysis can show blood or signs of infection.

Is prostatitis the same thing as a urinary tract infection (UTI)? 

URLINE GREGOIRE: Prostatitis and UTIs both affect the urinary tract. Even though prostatitis and UTIs share many similar symptoms, they are different. Prostatitis is an inflammation of the prostate gland, and a UTI is an infection of any part of the urinary system, such as the bladder, urethra, or kidney.

What treatment options are available, and how effective are they? 

URLINE GREGOIRE:  Treatment for prostatitis depends on the specific type of prostatitis. Acute bacterial prostatitis is usually treated with oral antibiotics for about two weeks. Severe cases of acute prostatitis may require a short hospital stay so that the patient can receive fluids and intravenous (IV) antibiotics.

Chronic prostatitis is also treated with antibiotics. However, treatment might require a longer course of therapy. The provider may prescribe a low dose for up to six months to prevent recurrence.

Chronic prostatitis/chronic pelvic pain syndrome treatment aims to decrease pain, discomfort, and inflammation. Oral antibiotics are also prescribed as an initial treatment until the provider can rule out a bacterial infection. Healthcare providers can prescribe other medications to help ease pain and urinary symptoms. And some over-the-counter meds, like aspirin and ibuprofen, might also help.

Alternative treatments may include warm sitz baths, relaxation exercises, and pelvic floor physical therapy. Some men with chronic prostatitis and pelvic pain syndrome might also be affected by psychological stress. Mental health treatment and stress reduction management could be helpful in those cases.

Does prostatitis always require treatment? Or can it ever resolve on its own? 

URLINE GREGOIRE: All bacterial infections require treatments to kill the bacteria. However, for nonbacterial prostatitis, the inflammation or tenderness may self-resolve.

Can prostatitis affect a man's sexual and reproductive health? 

URLINE GREGOIRE: Currently, there isn't any strong evidence showing a link between prostatitis and infertility. However, one of the complications of untreated prostatitis is changes in sperm and semen that may cause infertility. Some men with prostatitis might also have pain with ejaculation and achieving and maintaining an erection.

What are the potential complications of prostatitis if left untreated? 

URLINE GREGOIRE: In addition to potential sexual dysfunction, as I mentioned above, some other complications of prostatitis, if left untreated, are bacterial infection in the bloodstream, prostatic abscess, and inflammation of the reproductive organs near the prostate.

 How long does it usually take to recover from prostatitis, and what can be done to prevent recurrence? 

URLINE GREGOIRE: The duration of symptoms depends on the types of prostatitis. For example, symptoms of acute bacterial prostatitis usually occur suddenly and last for only a short time.

On the other hand, symptoms of chronic bacterial prostatitis might last longer (in some cases, up to three months or more). Recovery would take longer in these cases as well. Patients who experience complications from prostatitis may also experience a longer recovery time.

Here are some things patients can do to prevent the recurrence of prostatitis:

  • If you are sexually active, always use a condom during every sexual encounter. Having safe sex can prevent prostatitis that results from STIs.
  • Another approach that will help prevent recurrence is to treat other infections. Prompt treatment of other infections, such as UTIs, may keep an infection from spreading to the prostate.

Can lifestyle changes
like diet, exercise, stress management, and hygiene help with prostatitis? 

URLINE GREGOIRE: Lifestyle changes can help manage prostatitis. Patients should drink plenty of water to help flush bacteria from the bladder. Limit or avoid alcohol, caffeine, spicy or acidic foods, which can irritate the bladder. Performing Kegel or stretching exercises is recommended to help with the pelvic floor muscles. Alternative management also includes sitting on a donut-shaped pillow to help with the pain. Patients should also avoid activities that may increase pain, such as riding a bike.

 What common myths or misconceptions about prostatitis would you like to clarify? 

URLINE GREGOIRE: There are many different myths about prostatitis. One of the most common is that frequent urination and pain are signs of prostatitis. This is not true for all patients; these signs might be symptoms of other medical conditions, such as UTIs.

Another myth is prostatitis is an incurable disease. Patients struggling with prostatitis for many years might feel like it is incurable. However, effective treatments exist.

Lastly, another common myth is that prostatitis only affects older men. This is false! Prostatitis can affect younger men.

Is there anything else you want to make sure we convey? 

URLINE GREGOIRE: Symptoms of prostatitis may signal more serious conditions, such as prostate cancer. Therefore, I would highly encourage any men with prostatitis symptoms to immediately see a health care provider. Moreover, a person may also have urinary symptoms unrelated to prostatitis caused by bladder problems such as UTIs or benign prostatic hyperplasia (BPH).

Remember, your health matters. Men should seek immediate medical care if they're unable to urinate or if they experience painful, frequent, urgent urination—especially if fever and chills, blood in the urine, or extreme discomfort or pain in the lower abdomen and urinary tract accompany such pain.

Bottom line: If you're experiencing symptoms, talk to your doctor. 

You can also request an appointment with one of our world-class urologists, nurse practitioners, or physician assistants to discuss your prostate health. 


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