Acute prostatitis is the sudden onset of inflammation in the prostate. The prostate gland is a small, walnut-shaped organ located at the base of the bladder, in front of the rectum. The prostate provides 70 percent of the fluid for ejaculation. Contraction of the prostate during ejaculation prevents semen from flowing backward into the bladder.
Acute prostatitis is usually caused by the same bacteria that result in urinary tract infections and sexually transmitted diseases (STDs). Bacteria can travel to the prostate from the blood, or enter the prostate during or after a procedure such as a biopsy. It can also be caused by infections in other parts of the male genitourinary tract.
Any bacterial urinary tract infection (UTI) can cause prostatitis. STDs like chlamydia and gonorrhea can also cause acute bacterial prostatitis. Bacteria that commonly cause UTIs and prostatitis are:
- E. coli
Other conditions that can cause acute bacterial prostatitis are:
- epididymitis (inflammation of the epididymis, the tube that connects the testicles and the vas deferens)
- urethritis (inflammation of the urethra)
- injury to the perineum (the area between the scrotum and the rectum)
- urinary catheters or cystoscopy
- inability to pull back the foreskin of the penis (phimosis)
- bladder outlet obstruction (can occur with an enlarged prostate or stones in the bladder)
Factors that increase the risk for conditions such as UTIs, STDs, and urethritis also increase the risk for acute prostatitis. Men who have multiple sexual partners or anal intercourse without condoms are at greater risk, too.
Other risk factors include:
- age (men over the age of 50 are more likely to have enlarged prostate glands, which predisposes them to UTIs)
- past episode(s) of prostatitis
- psychological stress
- dehydration (not drinking enough fluids)
- certain genes can predispose someone to the development of prostatitis
- pelvic injuries from bike or horseback riding
- orchitis (inflammation of the testicles)
The symptoms of acute prostatitis are:
- pelvic pain
- blood in the urine
- urinary frequency
- painful urination
- foul-smelling urine
- decreased urinary stream
- difficulty emptying the bladder
- difficulty when starting to urinate
- painful ejaculation
- blood in the semen
- discomfort with bowel movements
- pain above the pubic bone
- pain in the genitals, rectum, or testicles
Diagnosis of acute prostatitis begins with your medical history and a physical examination. Doctors will do a digital rectal examination (DRE) using a gloved, lubricated finger. The prostate is in front of the rectum, so it can be easily felt. In acute bacterial prostatitis, the prostate is usually swollen and tender.
During the DRE, the doctor may massage the prostate to force a small amount of fluid into the urethra. The fluid can be examined for signs of infection
In addition, groin lymph nodes may be enlarged and tender. There may be fluid coming from the urethra (urethral discharge). Additional tests include:
- urinalysis to test for blood, white cells, or bacteria
- urine culture to identify the cause of a UTI
- blood culture to rule out bacteria in the blood
- urethral swab to test for gonorrhea and/ or chlamydia
- cystoscopy to look at the bladder and urethra to see if they are the source of the infection.A cystoscope is a small instrument, with a camera attached.
- urodynamic tests to evaluate if there is a problem with emptying the bladder
Acute bacteria prostatitis is treated with antibiotics for four to six weeks. The treatment may last longer if you are having recurrent episodes. The type of antibiotic depends on the bacteria causing your prostatitis. To relieve your symptoms, your doctor may prescribe alpha-blockers. These drugs relax bladder muscles and decrease urinary discomfort. Examples of alpha-blockers include doxazosin, terazosin, and tamsulosin. Pain relievers such as acetaminophen and ibuprofen may help with discomfort, too.
Other treatments such as heat treatment using a microwave device, and medications from certain plant extracts are also being evaluated.
Here are other ways to lessen your discomfort:
- Avoid bicyling. Adjust your bike seat and wear padded shorts to decrease pressure on the prostate.
- Avoid alcohol, caffeine, and foods that are spicy and acidic.
- Sit on a pillow or doughnut cushion.
- Take warm (sitz) baths
Acute prostatitis usually goes away with antibiotics and lifestyle adjustments. In some cases, it may recur and become chronic prostatitis.