Chronic prostatitis is an inflammation of the prostate gland. The prostate is a small gland located below a man’s bladder. It surrounds the urethra and produces most of the fluid in semen.
Prostatitis may be caused by a bacterial infection—about one in 10 cases of prostatitis is caused by bacteria (Cigna, 2011). In many cases, the cause of the condition is unknown. It can produce uncomfortable symptoms such as burning during urination, a frequent need to urinate, and pain in the lower back.
When chronic prostatitis is caused by a bacterial infection, it can be treated with antibiotics. When the cause is unknown, treatment of the symptoms may be the best course of action. Even when the condition cannot be cured, men who receive treatment for chronic prostatitis are usually able to find relief from symptoms.
There are two different types of chronic prostatitis, which differ by the cause of the condition.
Chronic Bacterial Prostatitis
Chronic bacterial prostatitis is an inflammation of the prostate that is caused by a bacterial infection. This type of prostatitis can affect men of any age, but is seen more often in younger and middle-aged men (AUAF, 2011).
Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)
CP/CPPS produces similar symptoms to the bacterial form of the condition, but its causes are unknown. This is the most common type of prostatitis and can cause similar symptoms to the bacterial form.
The symptoms of both the bacterial form of chronic prostatitis and CP/CPPS are very similar. They usually start out mild and build in intensity over time, and may be accompanied by fever or chills. Symptoms include:
- constant urge to urinate
- burning pain when urinating
- difficulty starting urination, followed by an uneven flow
- feeling as if the bladder is not fully emptied after urination
- pain in the lower back, lower abdomen, above the pubic area, or between the testicles and anus
- painful ejaculation
Chronic bacterial prostatitis is caused by a bacterial infection. Bacteria get to the prostrate through the urethra. The urethra is the tube that channels urine out of the body.
The infection can also be caused by an infection originating in the bladder, or by a contaminated catheter inserted into the bladder. A urinary catheter is a small, flexible tube that is placed in the body to collect and drain urine from the bladder. Some bacterial infections contribute to the formation of prostate stones that are not expelled during urination. Prostate stones are small (about the size of a poppy seed) and are not always detectable in a physical examination. Infected prostate stones are a common cause of recurring urinary tract infections, and make curing chronic bacterial prostatitis very difficult (Cigna, 2011).
The causes of CP/CPPS are often unknown, but can depend on the individual case. Possible causes include:
- a blockage of the flow of urine
- microorganisms from sexually transmitted diseases such as chlamydia
- an immune system attack on the prostate
- uric acid, a compound in urine, causing irritation in the prostate
- abnormal functioning of nerves or muscles
To diagnose chronic prostatitis, your doctor will begin with a survey of your symptoms. If your symptoms indicate a type of chronic prostatitis, a digital rectal examination may be needed as well. This involves the insertion of a gloved and lubricated finger into the rectum to feel the prostate. This can help your doctor determine if the prostate is tender or enlarged. This examination may cause temporary pain or discomfort in men with prostatitis.
If the examination is inconclusive, your doctor may need to perform an ultrasound which produces an image of the prostate. Once chronic prostatitis is diagnosed, your doctor will want to do further tests to determine the type and the cause, if possible.
A test of your urine can diagnose chronic bacterial prostatitis. The presence of bacteria is considered conclusive. If no bacteria are present in your urine, you still may have CP/CPPS. Your doctor may then wish to perform further tests to look for a cause or may refer you to a urologist, which is a doctor that specializes in diseases of the urinary tract. Further tests may include examination of fluid excreted by the prostate, a blood test, or the insertion of a small scope into the urethra for examination of the bladder, prostate, and urethra (cystoscopy).
Treatment will depend on the type of infection you are diagnosed with. For chronic bacterial prostatitis, a long-term course of antibiotics is usually the first treatment. You may be required to take antibiotics for up to 12 weeks; 75 percent of chronic bacterial prostatitis cases clear up with antibiotic treatment (AUAF).
In most cases of CP/CPPS, the cause of the condition is unknown. This means that treatment typically involves using medications to reduce or eliminate symptoms. Muscle relaxers, painkillers, and anti-anxiety medications are commonly prescribed for pain.
In some cases prostatic massage can help drain fluid that is causing the inflammation. Hot baths and heat therapies (such as a heating pad) can also help relieve discomfort. Your doctor may recommend cutting certain spicy foods or acidic beverages from your diet, as they can make symptoms worse.
Bacterial forms of chronic prostatitis can be prevented with good hygiene. By keeping the penis clean, the risk of bacteria entering the urethra is lower. You can also prevent prostatitis by drinking plenty of fluids to encourage regular urination, and by treating urinary tract or bladder infections as soon as they arise.