Health Encyclopedia

Prostatitis - chronic

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:

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:

Initial stream
Mid-stream
After a prostate massage by examiner

Other tests may include:

Culture of prostate secretions
Semen analysis

Treatment

Treatment options for chronic prostatitis include a combination of medication, surgery, and lifestyle changes.

MEDICATIONS

Chronic prostatitis is treated with a long course (6 - 12 weeks or longer) of antibiotics. Trimethoprim-sulfamethoxazole (Bactrim) and ciprofloxacin (Cipro) are commonly used. Other antibiotics that may be used include:

Carbenicillin
Erythromycin
Nitrofurantoin
Tetracycline

Most antibiotics do not get into the prostate tissue well. Often, the infection continues even after long periods of treatment. After antibiotic treatment has ended, it is common for symptoms to return.

Stool softeners may be recommended to reduce discomfort with bowel movements.

Nonsteroidal anti-inflammatory medications (NSAIDs such as Aleve and Motrin) and alpha blockers (such as Hytrin, Flomax, and Cardura) may also be used.

SURGERY

Transurethral resection of the prostate may be necessary if antibiotic therapy is unsuccessful or the condition keeps returning. This surgery is usually not performed on younger men because it carries a risk of retrograde ejaculation, which can lead to sterility, impotence, and incontinence.

Prostate massage and myofascial release are other treatments that may help this condition.

OTHER THERAPY:

Frequent and complete urination is recommended to decrease the symptoms of urinary urgency. If the swollen prostate restricts the urethra, the bladder may not empty. Inserting a suprapubic catheter, which allows the bladder to drain through the abdomen, may be necessary.

DIET:

Avoid substances that irritate the bladder, such as alcohol, caffeinated beverages, citrus juices, and hot or spicy foods.

Increasing the intake of fluids (64 - 128 ounces per day) encourages frequent urination. This will help flush bacteria from the bladder.

MONITORING:

See your health care provider for an exam after you finish taking antibiotics to make sure that the infection is gone.

Expectations (prognosis)

It is common for symptoms to return.

Complications

If the enlarged prostate severely restricts the flow of urine through the urethra, urinary retention may cause kidney damage.

Calling your health care provider

Call your health care provider if you have symptoms of chronic prostatitis.

Prevention

Avoiding urinary tract infections and sexually transmitted diseases can help prevent chronic prostatitis. Finish the full course of antibiotic treatment to reduce the chance of the condition returning.

References

Barry MJ, McNaughton-Collins M. Benign prostate disease and prostatitis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 130.

Review Date:9/7/2008
Reviewed By:David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Louis S. Liou, MD, PhD, Assistant Professor of Urology, Department of Surgery, Boston University School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

ADAM Quality A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial process. A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The Agency for Health Care Administration (Agency) and this website do not claim the information on, or referred to by, this site is error free. This site may include links to websites of other government agencies or private groups. Our Agency and this website do not control such sites and are not responsible for their content. Reference to or links to any other group, product, service, or information does not mean our Agency or this website approves of that group, product, service, or information.

Additionally, while health information provided through this website may be a valuable resource for the public, it is not designed to offer medical advice. Talk with your doctor about medical care questions you may have.