Prostatitis - bacterial

 

Alternative Names

Chronic prostatitis - bacterial; Acute prostatitis

Definition

Prostatitis is swelling and irritation of the prostate gland. The condition is called bacterial prostatitis when it is caused by an infection with bacteria.

  • Acute bacterial prostatitis starts quickly.
  • Chronic bacterial prostatitis lasts for 3 months or more.

Ongoing irritation of the prostate that is not caused by bacteria is called chronic nonbacterial prostatitis.

Causes

Prostatitis is most often caused by a bacterial infection of the prostate gland. Any bacteria that can cause a urinary tract infection can cause acute bacterial prostatitis.

Some sexually transmitted diseases (STDs) can cause bacterial prostatitis. These include chlamydia and gonorrhea. STDs are more likely to occur from:

  • Certain sexual practices, such as having anal sex without wearing a condom
  • Having many sexual partners

In men over age 35, E. coli and other common bacteria usually cause prostatitis. This type of prostatitis may occur after:

Acute prostatitis may also be caused by problems with the urethra or prostate, such as:

Men age 50 or older who have an enlarged prostate (benign prostatic hyperplasia) have a higher risk for prostatitis. The prostate gland may become blocked. This makes it easier for bacteria to grow. Symptoms of chronic prostatitis can be similar to symptoms of an enlarged prostate gland.

Symptoms

Symptoms of acute prostatitis can start quickly, and can include:

  • Chills
  • Fever
  • Flushing of the skin

Symptoms of chronic prostatitis are similar, but not as severe. They often begin more slowly. Some people have no symptoms between episodes of prostatitis.

Urinary symptoms include:

  • Blood in the urine
  • Burning or pain with urination (dysuria)
  • Difficulty starting to urinate or emptying the bladder
  • Foul-smelling urine
  • Weak urine stream

Other symptoms that may occur with this condition:

  • Pain or achiness in the abdomen above the pubic bone, in the lower back, in the area between the genitals and anus, or in the testicles
  • Pain with ejaculation or blood in the semen
  • Pain with bowel movements

If prostatitis occurs with an infection in or around the testicles (epididymitis or orchitis), you may also have symptoms of that condition.

Exams and Tests

During a physical exam, your health care provider may find:

  • Enlarged or tender lymph nodes in your groin
  • Fluid released from your urethra
  • Swollen or tender scrotum

The health care provider will perform a digital rectal exam to examine your prostate. During this exam, the provider inserts a lubricated, gloved finger into your rectum.

The exam may reveal that the prostate is:

  • Large and soft (with a chronic prostate infection)
  • Warm, soft, swollen, or tender (with an acute prostate infection)

Your doctor may do a prostatic massage to see whether you have an infection. To do this exam:

  • The health care provider will rub a gloved finger over the prostate gland a few times to release fluid from the urethra
  • The fluid will be examined for signs of an infection

Urine samples may be collected for urinalysis and urine culture.

Prostatitis may affect the results of the prostate-specific antigen (PSA), a blood test used to screen for prostate cancer.

Treatment

Antibiotics are often used to treat prostate infections.

  • For acute prostatitis, you will take antibiotics for 4 to 6 weeks.
  • For chronic prostatitis, you will take antibiotics for at least 4 to 6 weeks. Because the infection can come back, you may need to take medicine for up to 12 weeks.

Often, the infection will not go away even after taking antibiotics for a long time. Your symptoms may come back when you stop the medicine.

If your swollen prostate gland makes it hard to empty your bladder, you may need a tube to empty it. The tube may be inserted through your abdomen (suprapubic catheter) or from inside your body (indwelling catheter).

To care for prostatitis at home:

  • Urinate often and completely.
  • Take warm baths to relieve pain.
  • Take stool softeners to make bowel movements more comfortable.
  • Avoid substances that irritate your bladder, such as alcohol, caffeinated foods and drinks, citrus juices, and hot or spicy foods.
  • Drink more fluid (64 - 128 ounces per day) to urinate often and help flush bacteria out of your bladder.

Get checked by your health care provider after you finish taking your antibiotic treatment to make sure the infection is gone.

Outlook (Prognosis)

Acute prostatitis should go away with medicine and minor changes to your diet and behavior.

Acute prostatitis may come back or turn into chronic prostatitis.

Possible Complications

  • Abscess
  • Inability to urinate (urinary retention)
  • Spread of bacteria from the prostate to the bloodstream (sepsis)

When to Contact a Medical Professional

Call your health care provider if you have symptoms of prostatitis.

Prevention

Not all types of prostatitis can be prevented.

You can prevent STD infections with safe sex behaviors.

References

Nickel JC. In: Wein AJ, ed. Prostatitis and related conditions, orchitis, and epididymitis. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 11.

Barry MJ, McNaughton-Collins M. Benign prostatic hyperplasia and prostatitis. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 131.

Review Date: 10/2/2013
Reviewed By: Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

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