ConditionMen's health
Prostatitis
Prostatitis is inflammation of the prostate, the walnut-sized gland below the bladder in men. It is the most common urology diagnosis in men under 50. There are four types: acute bacterial prostatitis, a sudden infection with fever that needs urgent antibiotics; chronic bacterial prostatitis, with recurring urinary infections; chronic prostatitis/chronic pelvic pain syndrome, the most common form, with long-term pelvic pain without infection; and asymptomatic inflammation found on tests. Treatment depends on the type.
Also called: Prostate inflammation, chronic pelvic pain syndrome (CPPS), acute bacterial prostatitis, prostate infection
At a glance
- What it is
- Inflammation of the prostate gland, with or without infection.
- Four types (NIH)
- I acute bacterial; II chronic bacterial; III chronic prostatitis/chronic pelvic pain syndrome; IV asymptomatic inflammatory.
- Symptoms
- Pelvic, perineal, testicular or penile pain; painful or frequent urination; pain with ejaculation; fever in acute cases.
- Diagnosis
- Symptoms, exam, urine tests and cultures; PSA can be temporarily raised.
- Treatment
- Antibiotics for bacterial types; multimodal therapy (alpha-blockers, pelvic floor therapy, pain relief) for CPPS.
When to get help
Call 911 or go to the ER
- Unable to pass urine, with a painful, swollen lower belly
- High fever, shaking chills, confusion, a racing heart or low blood pressure with urinary symptoms (possible sepsis)
See a doctor within a day or two
- Sudden fever above 38 °C (100.4 °F) with pain between the scrotum and anus, burning urination and feeling unwell (possible acute prostatitis)
- Urinary symptoms with fever that are not improving after 48 hours of antibiotics (possible prostate abscess)
- Painful, swollen testicle with fever
Book a routine appointment
- Pelvic, perineal or genital pain lasting more than 3 months
- Repeated urinary tract infections in a man
- Pain with ejaculation, or blood in the semen
- Ongoing weak stream, frequency or urgency
The four types of prostatitis
| NIH category | Name | Key features | How common |
|---|---|---|---|
| I | Acute bacterial prostatitis | Sudden fever, chills, pelvic pain, urinary symptoms; very tender prostate | Uncommon |
| II | Chronic bacterial prostatitis | Recurrent UTIs with the same bacteria, mild pelvic symptoms between episodes | Uncommon |
| III | Chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS) | Pelvic pain for 3 months or more without proven infection | About 90% of cases |
| IV | Asymptomatic inflammatory prostatitis | Inflammation found on tests done for other reasons | Common; no treatment needed |
Causes and risk factors
Bacterial prostatitis
Usually caused by bacteria from the urinary tract, most often E. coli. Risk factors:
- urinary tract infections
- urinary catheters or recent procedures, including prostate biopsy
- an enlarged prostate or urethral stricture causing incomplete emptying
- sexually transmitted infections in younger men
- weakened immunity, including diabetes and HIV
Chronic pelvic pain syndrome
The cause is not fully understood and is likely a mix of:
- pelvic floor muscle tension and spasm
- nerve sensitization (similar to other chronic pain conditions)
- previous infection or inflammation
- psychological stress, which amplifies pain
- possible immune or hormonal factors
It is not contagious and does not increase the risk of prostate cancer.
Symptoms
Acute bacterial prostatitis
- sudden high fever, chills and body aches
- pain in the perineum (between scrotum and anus), lower back, lower belly or penis
- burning, frequent or urgent urination
- difficulty passing urine, weak stream, or urinary retention
- cloudy urine, sometimes blood in the urine
Chronic prostatitis / CPPS
- pain or discomfort in the perineum, testicles, tip of the penis, lower belly or lower back
- pain during or after ejaculation
- painful or frequent urination, urgency
- sexual problems, including erectile dysfunction
- symptoms that come and go over months, worsened by stress, sitting or cycling
Diagnosis
- history and symptom score: the NIH Chronic Prostatitis Symptom Index (NIH-CPSI) measures severity
- physical exam: abdomen, genitals and a gentle digital rectal exam. In acute prostatitis, prostate massage is avoided
- urine tests and urine culture
- STI testing in sexually active men
- two-glass or four-glass test: compares urine before and after prostate massage to look for bacteria in chronic bacterial prostatitis
- post-void residual bladder scan for retention
- blood tests: blood count, blood cultures in severe infection. PSA can rise temporarily with prostatitis, so it is not checked for cancer screening during an episode
- ultrasound or MRI if a prostate abscess is suspected
Doctors also consider other conditions such as benign prostatic hyperplasia, bladder problems, epididymitis, hernia and pudendal nerve entrapment.
Treatment
Acute bacterial prostatitis
- antibiotics, usually for 2 to 4 weeks, chosen by culture results (commonly fluoroquinolones or trimethoprim-sulfamethoxazole, depending on resistance and allergies)
- hospital admission with IV antibiotics if very unwell
- a catheter (often through the lower belly) if urine retention develops
- pain relief, fluids and stool softeners
- drainage of a prostate abscess if present
Chronic bacterial prostatitis
- longer antibiotic courses, often 4 to 6 weeks, chosen for good prostate penetration
- treating underlying causes such as an obstruction
Chronic prostatitis / CPPS
No single treatment works for everyone. Guidelines recommend a multimodal approach tailored to symptoms (the UPOINT system):
- alpha-blockers (such as tamsulosin) for urinary symptoms
- pelvic floor physical therapy and myofascial release for muscle tension
- anti-inflammatories and neuromodulators (such as amitriptyline or pregabalin) for pain
- a trial of antibiotics only when infection is suspected; repeated courses without evidence of infection are not recommended
- psychological support: CBT and stress management
- lifestyle: avoiding prolonged sitting or cycling, warm baths, regular exercise, reducing alcohol, caffeine and spicy food if they trigger symptoms
- phytotherapy (quercetin, pollen extract) has modest evidence
Outlook
Acute bacterial prostatitis usually resolves fully with prompt treatment. Chronic bacterial prostatitis may recur. CPPS can be long-lasting with ups and downs, but most men improve with a combined treatment plan.
Frequently asked questions
What are the symptoms of prostatitis?
Common symptoms are pain in the area between the scrotum and anus, lower belly, penis or testicles; painful, frequent or urgent urination; and pain with ejaculation. Acute bacterial prostatitis also causes fever, chills and feeling very unwell.
What causes prostatitis?
Bacterial prostatitis is caused by bacteria, usually from the urinary tract. The most common type, chronic pelvic pain syndrome, is not caused by infection and likely involves pelvic muscle tension, nerve sensitivity, past inflammation and stress.
How is prostatitis treated?
Bacterial prostatitis is treated with antibiotics for several weeks. Chronic pelvic pain syndrome is treated with a combination of alpha-blockers, pain-relieving medicines, pelvic floor physical therapy, stress management and lifestyle changes.
Can prostatitis cause cancer?
No. Prostatitis does not cause prostate cancer. It can temporarily raise PSA levels, so PSA tests are usually delayed until the inflammation has settled.
Sources
This guide was written from current patient and clinical guidance, including:
- American Urological Association: Urologic Diseases: Prostatitis (Urology Care Foundation)
- NIDDK: Prostatitis: Inflammation of the Prostate
- European Association of Urology: Guidelines on Urological Infections and Chronic Pelvic Pain
- American Academy of Family Physicians: Prostatitis: Diagnosis and Treatment
- MedlinePlus: Prostatitis