Inflammation of the Prostate: Symptoms, Causes, and Treatment Options

Inflammation is part of the body’s response to injury and infection. It causes swelling, redness, and pain. While inflammation is part of a healthy immune response, it can also cause unwanted symptoms. Inflammation of the prostate — called prostatitis — can cause many symptoms and potential complications, including pain, difficulty urinating, and sexual dysfunction.

What is the prostate?

The prostate is a small, walnut-sized gland that wraps around the urethra as it travels from the bladder to the penis. The fluid produced by the prostate gland lubricates the urethra and mixes with sperm to create semen. The prostate can become enlarged due to infection, chronic inflammation, benign prostatic hyperplasia (BPH), or prostate cancer. An enlarged prostate can cause pain, urinary symptoms, and sexual dysfunction.

What is prostatitis?

Prostatitis is inflammation of the prostate caused by acute infection, chronic infection, or chronic inflammation.

Acute bacterial prostatitis (ABP) causes sudden and painful symptoms, while symptoms of chronic bacterial prostatitis (CBP) develop more slowly. Chronic bacterial prostatitis is more common than acute bacterial prostatitis, but they have similar symptoms and treatments.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a chronic pain condition that leads to inflammation of the prostate without bacterial infection. CP/CPPS is poorly understood and can be difficult to treat. Both CBP and CP/CPPS involve chronic inflammation which can lead to chronic pain, lower urinary tract symptoms, and sexual dysfunction.

Symptoms

Prostatitis can cause many symptoms, but the main symptoms are pain and lower urinary tract symptoms.

Because the urethra travels through the prostate, inflammation, or enlargement of the prostate can interfere with normal urination. Urinary and reproductive tract symptoms of prostatitis include:

• Pain and/or burning during urination
• Difficulty urinating, hesitancy, starting and stopping, dribbling
• Frequent urination
• Difficulty emptying your bladder
• Cloudy or bloody urine
• Pain in the penis, testicles, bladder, or perineum
• Painful ejaculation

General symptoms can include:

• Fever and chills
• Muscle aches
• Flu-like symptoms
• Pain in the lower abdomen or lower back

If you are having any of the following symptoms, you should seek immediate medical care:

• Unable to urinate
• Pain during urination plus fever
• Blood in the urine
• Severe discomfort or pain in the pelvis, penis, or testicles

Causes

Prostatitis can be caused by a bacterial infection, chronic inflammation, or both. Acute bacterial prostatitis and chronic bacterial prostatitis are both caused by infection. Bacteria can spread from urinary tract infections, including bladder infections, to the prostate. Sexually transmitted infections (STIs) can also cause prostatitis. Chronic prostatitis/chronic pelvic pain syndrome and nonbacterial prostatitis are caused by chronic inflammation and other factors, such as nerve damage.

Risk factors for prostatitis

Risk factors for prostatitis include:

• Age: young adulthood through middle age
• Previous prostatitis
• Urinary or reproductive tract infection
• Using a urinary catheter
• Prostate biopsy
• HIV/AIDS

CP/CPPS is caused by chronic inflammation and not a bacterial infection. CP/CPPS is a condition marked by chronic prostate pain that can last for years. Many factors influence the risk of developing CP/CPPS, including:

• Previous prostatitis or infection
• Nerve damage from injury or surgery
• Nervous system dysfunction
• Immune system dysfunction
• Psychological stress
• Irregular hormone levels

Complications and impact on sexual health

Prostatitis can lead to several complications. Bacterial prostatitis can sometimes spread from the prostate to the testicles, causing epididymitis — a painful infection of the testicles. Chronic bacterial prostatitis and CP/CPPS, like other chronic medical conditions, can lead to depression and anxiety.

CBP, CP/CPPS, repeated infections, and prostatitis that is not treated properly can have long-term effects on your sexual health. CBP and CP/CPPS can lead to male infertility by affecting sperm and semen production. They can also cause sexual dysfunction, including erectile dysfunction and pain during intercourse or ejaculation.

Diagnosis

Diagnosing prostatitis involves a thorough medical history, physical exam, blood tests, and other clinical tests. Your doctor will ask about your current symptoms and any history of UTIs, STIs, and related problems. During a physical exam, your doctor will likely perform a digital rectal exam (DRE) by inserting a gloved and lubricated finger into the rectum to feel the prostate. During the DRE, your doctor may massage the prostate to collect a small amount of fluid.

Additionally, your doctor may order:

• Blood tests to look for signs of infection
• Analysis of urine and fluid from the prostate
• Ultrasound of the prostate or other imaging tests
• Cystoscopy to see inside the urethra and bladder
• Urine flow studies

Many conditions can cause the same symptoms as prostatitis, and some of them are life-threatening. It is important to seek a proper medical diagnosis and receive the right treatment for your condition.

Treatment

Treating prostatitis involves medications and procedures to treat infection, relieve pain, and improve urination. Treating bacterial prostatitis requires taking antibiotics for two to four weeks (ABP) or four to twelve weeks (CBP). Severe difficulty urinating can be treated by inserting a urinary catheter or by prescribing alpha-blockers to relax muscles in and around the prostate.

The pain of prostatitis is treated with non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil or Motrin). Prostate massage, heating pads, and donut cushions or pillows can also help relieve pain. Chronic pain from prostatitis can also improve by using pelvic floor physical therapy, biofeedback, acupuncture, and herbal remedies, including rye grass pollen extract and bee pollen. In some severe cases, surgery may be required to improve urination and relieve pain.

Prostatitis in a nutshell

Prostatitis is a common, painful, and often chronic condition that affects men. Chronic forms of prostatitis can cause long-term complications, including chronic pain, sexual dysfunction, and infertility. However, these long-term complications may be avoided with proper diagnosis and treatment. Antibiotics, NSAIDs, alpha-blockers, and other medications, as well as complementary medicine, can be used to treat prostatitis.

Urinary tract symptoms and pain are the hallmarks of prostatitis, but other conditions can cause the same symptoms. If you are having any symptoms of pain or difficulty urinating, you should seek medical care sooner rather than later. Early diagnosis and treatment are important to improve outcomes with prostatitis and other conditions.