Reviewed By David C. Dugdale III, MD, Professor of Medicine, Division of General Medicine, Department… of Medicine, University of Washington School of Medicine; and Scott Miller, MD, Urologist in private practice in Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.more »
Definition
Chronic bacterial prostatitis is swelling and irritation (inflammation) of the prostate gland that develops slowly and continues for a long period of time. It is a chronic infection of the prostate gland.
The most common bacteria species that cause chronic prostatitis include:
Escherichia coli
Enterobacter cloacae
Klebsiella pneumonia
Proteus species
Risks include:
Age over 30
Certain sexual practices (such as anal sex without a condom)
Excessive alcohol intake
Injury to the perineum (the area between the scrotum and anus)
These factors may cause congestion of the prostate gland, which produces a breeding ground for bacteria.
Other possible causes are related to stress and tightness of the pelvic muscles.
Symptoms
Symptoms of chronic prostatitis are similar to those of acute prostatitis but are not as severe. They usually begin more gradually. Patients may have no symptoms in between episodes, or they may experience mild symptoms all the time.
Treatment options for chronic prostatitis include a combination of medication, surgery, and lifestyle changes.
MEDICATIONS
Chronic prostatitis is treated with a long course (6 - 12 weeks or longer) of antibiotics. Trimethoprim-sulfamethoxazole (Bactrim or Septra) and ciprofloxacin (Cipro) are commonly used. Other antibiotics that may be used include:
Most antibiotics do not get into the prostate tissue well. Often, the infection continues even after long periods of treatment. After antibiotic treatment has ended, it is common for symptoms to return.
Sometimes small stones form in the prostate gland, making it harder to clear the infection.
Stool softeners may be recommended to reduce discomfort with bowel movements.
Nonsteroidal anti-inflammatory medications (NSAIDs such as Aleve and Motrin) and alpha adrenergic blockers (such as doxazosin [Cardura], tamulosin [Flomax], or terazosin [Hytra]) may also be used.
Prostate massage and myofascial release are other treatments that may help this condition.
OTHER THERAPY:
Frequent and complete urination is recommended to decrease the symptoms of urinary urgency. If the swollen prostate restricts urine flow through the urethra, the bladder may not empty. Inserting a suprapubic catheter, which allows the bladder to drain through the abdomen, may be necessary.
Avoid substances that irritate the bladder, such as alcohol, caffeinated beverages, citrus juices, and hot or spicy foods.
Increasing the intake of fluids (64 - 128 ounces per day) encourages frequent urination. This will help flush bacteria from the bladder.
MONITORING:
See your health care provider for an exam after you finish taking antibiotics to make sure that the infection is gone.
Expectations (prognosis)
It is common for symptoms to return.
Complications
If the prostate is very large, it can slow urine flow through the urethra and cause the backward flow (reflux) of urine toward the kidneys, which can cause kidney damage.
If the flow of urine completely stops, it is considered an emergency.
Calling your health care provider
Call your health care provider if you have symptoms of chronic prostatitis.
Nickel JC. Inflammatory conditions of the male genitourinary tract: prostatitis and related conditions, orchitis, and epididymitis. In: Wein AJ. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 9.
Barry MJ, McNaughton-Collins M. Benign prostate disease and prostatitis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 130.
