Prostatitis - chronic Health Article

Definition

Chronic prostatitis is swelling and irritation (inflammation) of the prostate gland that develops slowly and continues for a long period of time.

Alternative Names

Chronic bacterial prostatitis; Chronic pelvic pain syndrome

Causes, incidence, and risk factors

Chronic prostatitis is usually not caused by a bacterial infection. When it is caused by bacteria, chronic prostatitis may occur with or follow:

• Acute prostatitis
• Epididymitis
• Urinary tract infection
• Urethritis

The most common bacteria species that cause chronic prostatitis include:

• E. coli
• Enterobacter
• Klebsiella
• Proteus

The disorder is diagnosed in 5 of every 1,000 outpatient visits. As many as 35% of men over age 50 may have chronic prostatitis.

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

• Blood in the urine
• Decreased urine stream
• Frequent urination
• Incontinence
• Low-grade fever
• Pain with urination
• Urinary hesitancy (delayed start of urination)

Low-grade or subtle symptoms may include:

• Low back pain
• Pain and burning with urination
• Pain in the perineum or pelvic floor
• Pain with bowel movement
• Pain with ejaculation
• Testicular pain

Note: There may be no symptoms.

Signs and tests

A physical examination may show:

• Discharge from the urethra
• Enlarged, mildly tender prostate
• Enlarged or tender lymph nodes in the groin area
• Swelling and tenderness of the scrotum

Triple-void urine specimens may be collected for urinalysis and urine culture. Urine may be collected:

1. Initial stream
2. Mid-stream
3. After a prostate massage by examiner

Other tests may include:

• Culture of prostate secretions
• Semen analysis