Chronic prostatitis is inflammation of the prostate that lasts for at least 3 months.
Prostatitis may be caused by a bacterial infection, but in many cases the cause of the condition is unknown. It can produce uncomfortable symptoms such as burning during urination, a frequent need to urinate, and pain in the lower back.
When chronic prostatitis is caused by a bacterial infection, it can be treated with antibiotics. When the cause is unknown, treatment of the symptoms may be the best course of action.
Even when the condition can’t be cured, men who receive treatment for chronic prostatitis are usually able to find relief from their symptoms.
There are two types of chronic prostatitis, which differ by the cause of the condition.
Chronic bacterial prostatitis
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) produces similar symptoms to the bacterial form of the condition, but its causes are unknown. It was previously called chronic nonbacterial prostatitis.
CP/CPPS is the more common type of chronic prostatitis. According to a 2016 study, CP/CPPS cases make up at least 90 percent of chronic prostatitis cases.
The symptoms of both the bacterial form of chronic prostatitis and CP/CPPS are very similar. They usually start out mild and build in intensity over time.
- a constant urge to urinate
- burning pain when urinating
- difficulty starting urination, followed by an uneven flow
- blood in the urine
- feeling as if the bladder isn’t fully emptied after urination
- painful ejaculation
- pain in the following locations:
Conditions with similar symptoms
Conditions that can cause some of the same symptoms as chronic prostatitis include:
- prostate cancer, which can lead to urinary symptoms or sexual dysfunction
- urinary retention
- bladder stones, which can lead to urinary symptoms or pain in the lower abdomen
Seek medical attention if you have any of these symptoms. Your doctor can rule out serious conditions or help you get started on an appropriate therapy, if necessary.
Both types of chronic prostatitis have multiple possible causes.
Chronic bacterial prostatitis
Chronic bacterial prostatitis is caused by bacteria getting to the prostate through the urethra. The urethra channels urine out of the body.
A bacterial infection can also be caused by an infection originating in the bladder or a contaminated urinary catheter inserted into the bladder. A urinary catheter is a small, flexible tube that’s placed in the body to collect and drain urine from the bladder.
Some bacterial infections contribute to the formation of prostate stones that aren’t expelled during urination.
Prostate stones are about the size of a poppy seed and aren’t always detectable in a physical examination. Infected prostate stones are a common cause of recurring urinary tract infections (UTIs), and make curing chronic bacterial prostatitis very difficult.
The causes of CP/CPPS are often unknown and can vary depending on the individual case. Possible causes include:
To diagnose your condition, your doctor will begin with a survey of your symptoms.
If your symptoms indicate a type of chronic prostatitis, a digital rectal examination (DRE) may be needed.
Digital rectal exam (DRE)
During this exam, the doctor inserts a gloved and lubricated finger into the rectum to feel the prostate. This can help them determine if the prostate is tender or enlarged.
A DRE may cause temporary pain or discomfort in men with prostatitis.
In some cases, a pelvic MRI may be used. An MRI can help your doctor:
- view your pelvic anatomy in great detail
- rule out prostate cancer as the cause of your symptoms
- detect areas of prostate inflammation
Once a diagnosis of chronic prostatitis is confirmed, your doctor will want to do further tests to determine the type and the cause, if possible.
A test of your urine can help your doctor diagnose chronic bacterial prostatitis.
The presence of bacteria is considered conclusive. However, if no bacteria are present in your urine, you still may have CP/CPPS.
Your doctor may then wish to perform further tests to look for a cause, or they may refer you to a doctor who specializes in diseases of the urinary tract.
Further tests may include:
- the examination of fluid excreted by the prostate
- a blood test
- cystoscopy, or the insertion of a small camera into the urethra for examination of the bladder, prostate, and urethra
Treatment for chronic bacterial prostatitis will depend on the type of infection you’re diagnosed with.
A long-term course of fluoroquinolones, a class of antibiotics, is usually the first treatment.
You may be required to take antibiotics for 4 to 12 weeks. About 75 percent of chronic bacterial prostatitis cases clear up with antibiotic treatment.
In most cases of CP/CPPS, the cause of the condition is unknown. This means that treatment typically involves using medications to reduce or eliminate symptoms. Muscle relaxers, pain relievers, and anti-anxiety medications are commonly prescribed for pain.
Other common treatments include nonsteroidal anti-inflammatory drugs (NSAIDs) and alpha-blockers such as tamsulosin (Flomax). NSAIDs help reduce inflammation, and alpha-blockers help provide relief from certain urinary symptoms.
In some cases, prostatic massage can help drain fluid that’s causing the inflammation. Hot baths and heat therapies such as a heating pad can also help relieve discomfort.
Your doctor may recommend cutting certain spicy foods or acidic beverages from your diet, as they can make symptoms worse.
Bacterial forms of chronic prostatitis can be prevented with good hygiene. When the penis is kept clean, the risk of bacteria entering the urethra is lower. Learn more about penis health.
You can also prevent chronic bacterial prostatitis by drinking plenty of fluids to encourage regular urination, and by treating urinary tract or bladder infections as soon as they arise.