Prostatitis

Prostatitis is the inflammation (swelling) of the prostate gland. It can be very painful and distressing, but will often get better eventually.

The prostate is a small gland found in men that lies between the penis and bladder. It produces fluid that's mixed with sperm to create semen.

Unlike other prostate conditions, such as prostate enlargement or prostate cancer, which usually affect older men, prostatitis can develop in men of all ages. However, it commonly affects men aged between 30 and 50.

There are two main types of prostatitis:

• chronic prostatitis – where the symptoms come and go over a period of several months; it's the most common type; it's not usually caused by an infection
• acute prostatitis – where the symptoms are severe and develop suddenly; it's rare but it can be serious and requires immediate treatment; it's always caused by an infection

Symptoms of prostatitis

Acute prostatitis

Symptoms of acute prostatitis include:

• pain, which may be severe, in or around your penis, testicles, anus, lower abdomen or lower back – passing stools (faeces) can be painful
• urinary symptoms, such as pain when peeing, needing to pee frequently (particularly at night), problems starting or "stop-start" peeing, an urgent need to pee and, sometimes, blood in your urine
• not being able to pee, which leads to a build-up of urine in the bladder known as acute urinary retention (AUR) – this needs urgent medical attention
• generally feeling unwell, with aches, pains and possibly a fever
• a small amount of thick fluid (discharge) may come out of your penis from the urethra (the tube that carries urine out of the bladder)

See your GP immediately if you have these symptoms so that the cause can be investigated and appropriate treatment recommended.

Chronic prostatitis

You may have chronic prostatitis if you've had the following symptoms for at least three months:

• pain in and around your penis, testicles, anus, lower abdomen, or lower back
• pain when peeing, a frequent or urgent need to pee, particularly at night, or "stop-start" peeing
• an enlarged or tender prostate on rectal examination, although in some cases it may be normal
• sexual problems, such as erectile dysfunction, pain when ejaculating, or pelvic pain after sex

These symptoms can have a significant impact on your quality of life. However, in most cases, they'll gradually improve over time and with treatment.

When to get medical advice

See your GP if you have symptoms of prostatitis, such as pelvic pain, difficulty or pain when peeing, or painful ejaculation.

Your GP will ask about the problems you're having and examine your tummy. You may also have a digital rectal examination (DRE). This is where a doctor inserts a gloved finger into your bottom to feel for abnormalities. You may experience some discomfort if your prostate is swollen or tender.

Your urine will usually be tested for signs of infection, and you may be referred to a specialist for further tests to rule out other conditions.

See your GP immediately if you develop sudden and severe symptoms of prostatitis. You may have acute prostatitis, which needs to be assessed and treated quickly because it can cause serious problems, such as suddenly being unable to pass urine.

If you have persistent symptoms (chronic prostatitis), you may be referred to a urologist (a doctor who specialises in urinary problems) for specialist assessment and management.

Treating prostatitis

Treatment for prostatitis will depend on whether you have acute or chronic prostatitis.

Acute prostatitis

Acute prostatitis (where symptoms are sudden and severe) is usually treated with painkillers and a two to four week course of antibiotics.

Hospital treatment may be needed if you're very ill or unable to pass urine (acute urinary retention).

Chronic prostatitis

Treatment for chronic prostatitis (where symptoms come and go over several months) usually aims to control the symptoms. The following treatments may be used to help control your symptoms:

• painkillers, such as paracetamol or ibuprofen, may help relieve pain
• a medication called an alpha-blocker, such as tamsulosin, may also be prescribed if you have problems with urination; these can help relax the muscles in the prostate gland and the base of the bladder
• occasionally, a four- to six-week course of antibiotics, such as ciprofloxacin, may be prescribed even if no infection is found; this is to see if your condition improves
• if your symptoms are severe, stronger painkillers, such as amitriptyline and gabapentin, may be considered

The aim is to reduce symptoms to a level where they interfere less with day-to-day activities, rather than getting rid of the pain completely.

A referral to your local pain clinic may also be considered.

What causes prostatitis?

Acute prostatitis is usually caused when bacteria in the urinary tract enter the prostate. The urinary tract includes the bladder, kidneys, the tubes that connect the kidneys to the bladder (ureters), and the urethra.

In chronic prostatitis, signs of infection in the prostate gland can't usually be found. In these cases, the cause of symptoms isn't clear.

Risk factors for prostatitis

Risk factors for acute prostatitis include:

• having a urinary tract infection (UTI) in the recent past
• having an indwelling urinary catheter (a flexible tube that's used to drain urine from the bladder)
• having a prostate biopsy
• having a sexually transmitted infection (STI)
• having HIV or AIDS
• having a problem with your urinary tract
• anal sex
• injuring your pelvis

Risk factors for chronic prostatitis include:

• being middle-aged (30-50 years of age)
• having prostatitis in the past
• having other painful abdominal conditions, such as irritable bowel syndrome (IBS)
• sexual abuse

Outlook

Acute prostatitis

Acute prostatitis usually clears with a course of antibiotics. It's important to take the full course to ensure that the infection clears completely.

Rarely, other complications of acute prostatitis can occur. These include:

• acute urinary retention – because passing urine can be very painful, urine can build up in your bladder, causing pain in your lower tummy (abdomen) and inability to pass urine at all; to relieve this, a catheter (a thin, flexible, hollow tube is needed)
• prostate abscess – if antibiotics aren't effective in treating prostate infection, rarely an abscess can develop in your prostate gland; your doctor may suspect this if your symptoms don't improve despite antibiotic treatment; further tests will be needed to confirm a prostate abscess, such as an ultrasound scan or CT scan of your prostate gland; if an abscess is present, you'll need an operation to drain it

Chronic prostatitis

Chronic prostatitis can be challenging to treat because little is known about what causes it. Most men will gradually recover with treatment, but this can take several months or years.

Some men with prostatitis find their symptoms return (relapse) later on, which will require further treatment.

Prostatitis isn't prostate cancer and there's currently no clear evidence that it increases your chances of developing cancer of the prostate.