Prostatitis

Overview

Prostatitis is a disorder of the prostate gland usually associated with inflammation. Prostatitis often causes painful or difficult urination, as well as pain in the groin, pelvic area or genitals. Bacterial infections cause some but not all cases of prostatitis.

The prostate gland, about the size of a walnut, is located just below the bladder in men. It surrounds the top portion of the tube that drains urine from the bladder (urethra). The prostate and other sex glands produce the fluid that transports sperm during ejaculation (semen).

Types

There are generally four types of prostatitis:

• Acute bacterial prostatitis, a bacterial infection of the prostate usually with sudden, severe symptoms
• Chronic bacterial prostatitis, ongoing or recurring bacterial infection usually with less severe symptoms
• Chronic prostatitis/chronic pelvic pain syndrome, ongoing or recurring pelvic pain and urinary tract symptoms with no evidence of infection
• Asymptomatic inflammatory prostatitis, signs of an inflamed prostate with no symptoms

Symptoms

Signs and symptoms of prostatitis can vary depending on the type of disorder. They may include:

• Pain or burning sensation when urinating (dysuria)
• Difficulty urinating, such as dribbling or hesitant urination
• Frequent urination, particularly at night (nocturia)
• Urgent need to urinate
• Cloudy urine
• Blood in the urine
• Pain in the abdomen, groin or lower back
• Pain in the area between the scrotum and rectum (perineum)
• Pain or discomfort of the penis or testicles
• Painful ejaculation
• Fever, chills, muscle aches and other flu-like symptoms (with acute bacterial prostatitis)

When to see a doctor

Several conditions can contribute to the signs and symptoms associated with prostatitis. It's important to get an accurate diagnosis and treatment as soon as possible.

Get immediate care if you have any of the following:

• Inability to urinate
• Painful or difficult urination, accompanied by fever
• Blood in your urine
• Severe discomfort or pain in the pelvic area or genitals

Causes

Causes vary depending on the type of prostatitis.

• Acute bacterial prostatitis is usually caused by common strains of bacteria. The infection may have spread from other parts of the urinary or reproductive systems.
• Chronic bacterial prostatitis generally has the same cause as 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 is not well understood. Research suggests that multiple factors may collectively play a role. These include previous infection, nervous system dysfunction, immune system dysfunction, psychological stress or irregular hormone activity.
• Asymptomatic inflammatory prostatitis, which has no known cause, is generally found only during an exam for other medical conditions and is not treated.

Risk factors

Risk factors for prostatitis include:

• Young or middle-aged adulthood
• Previous prostatitis
• Infection of the urinary or reproductive system
• HIV infection or AIDS
• Use of a tube inserted into the urethra to drain the bladder (urinary catheter)
• Diagnostic sampling of prostate tissue (biopsy)

Additional risk factors for chronic prostatitis/chronic pelvic pain syndrome may include:

• Psychological stress
• Nerve damage in the pelvic region due to surgery or trauma

Complications

Complications of acute or chronic prostatitis can include:

• Bacterial infection of the blood (bacteremia)
• Inflammation of the coiled tube attached to the back of the testicle (epididymitis)
• Pus-filled cavity in the prostate (prostatic abscess)
• Infection that spreads to the upper pelvic bone or lower spine

Complications of chronic prostatitis/chronic pelvic pain syndrome may include:

• Anxiety or depression
• Sexual dysfunction, such as the inability to get and maintain an erection (erectile dysfunction)
• Changes in sperm and semen that may cause infertility

There's no direct evidence that prostatitis can lead to prostate cancer. Researchers are investigating whether chronic inflammation of the prostate is a risk factor for cancer.