What is Prostatitis?
Prostatitis is infection or inflammation of the prostate gland. Prostatitis makes up almost a quarter of urology consultations so is an important disease for both patients and doctors, although similar symptoms can also be caused by other conditions which are non-inflammatory and these days also known as ‘pelvic pain syndrome.’ Prostatitis can affect men from the age of 18 but most commonly affects men between the ages of 30 and 50.
- Acute bacterial prostatitis (ABP) is the least common type of prostatitis. It is swelling and irritation of the prostate that is caused by a bacterial infection. Symptoms occur suddenly, can be very severe and cause a lot of pain. Although this can affect any age group, it is more common in younger and middle-age men.
- Chronic bacterial prostatitis (CBP) Although it is not common, it means that there is infection, swelling or inflammation in the prostate. It can be present for years before symptoms develop. Symptoms develop slowly over a longer period of time and are generally less severe than the acute condition but can relapse and recur. Some men develop chronic bacterial prostatitis after a bout of acute bacterial prostatitis. This can affect any age but is more common in the 30-50 age group.
- Chronic pelvic pain syndrome (CPPS) This is the most common form of prostatitis and can affect men from any age group and be quite weakening. It means that bacteria (germs) have not been found in urine. Symptoms of a constant ache or cramp-like feeling or pain around the penis, back passage, lower back or perineum (the area between the scrotum and back passage). CPPS is usually the diagnosis made when the man has had symptoms for at least 3 months out of the past 6 months.
- Asymptomatic inflammatory prostatitis. Although the prostate is inflamed, these men do not have any symptoms and it’s generally found when the man is having tests or investigations for another condition.
Once your urologist/doctor has diagnosed your symptoms as prostatitis there are many treatments available and the outlook tends to be good. It may be reassuring to know that prostatitis is neither connected with prostate cancer nor does it mean there is an increased risk of developing prostate cancer, but it can cause worrying symptoms.
We have some publications that might be helpful that you can download for more information:
- Prostatitis – a straightforward guide Prostatitis Useful for those coming new to the topic.
- Prostatitis Explained A more in depth guide when diagnosed with prostatitis.
Prostatitis Foundation www.prostatitis.org.Please note Prostate Scotland is not responsible for content of external websites.
Acute bacterial prostatitis
- High temperature, fever and chills;
- Pain in the lower back, back passage, genital area and penis;
- Frequent, painful or burning urination sometimes with blood in the urine;
- Pain during or after ejaculation and there may be some blood;
- Feeling or being sick.
Acute Bacterial Prostatitis can present as a sudden, severe illness that makes the man generally unwell and may mean he is completely unable to pass urine. This is a serious problem so the man should see the GP, contact NHS 24 on 111 or be seen at an accident and emergency department. It might result in him being admitted to hospital with antibiotics being given through a drip and a catheter put into his bladder to drain urine.
Symptoms common to CBP and CPPS
Symptoms vary from man to man; he might have mild symptoms all the time or symptoms might go away for a time and then flare up again
- Pain – this might be pain in the lower back, around the penis, between scrotum and back passage, when you move your bowels , pass urine or when you ejaculate.
- Passing urine – you might pass urine more often during the day and night, have a burning feeling, have a weaker stream of urine or see some blood in your urine
- Intimacy – you might find a lack of interest in having intercourse or be unable to get and maintain an erection
Prostatitis most frequently affects men aged between 30 and 50. Causes include:
- A urinary tract infection that is left untreated or frequent urinary tract infections;
- Having a catheter in your bladder for a prolonged period of time;
- Anal intercourse without a condom;
- Infection by bacteria that normally live in the bowel;
- Biopsy or surgery of the prostate.
However, many men who get prostatitis do not have any risk factors.
Investigations and tests
Your doctor will most likely take a medical history and examine you. The examination may include checking your abdomen and pelvic area for tenderness.
You may be asked to complete a medical questionnaire (called an International Prostate Symptom Score or IPSS) that asks about your symptoms and helps doctors understand more about your symptoms and how these are affecting your quality of life. It may help your doctor if you complete the symptom self- test link here and print off the results to take with you to your GP.
You may be asked for a urine sample that your GP may be able to test there and then but the sample may be sent to the lab for further testing to check for infection.
Digital rectal examination (DRE) of your prostate.
During a DRE, your doctor will manually examine your prostate gland by gently sliding a gloved finger into your back passage. If your prostate seems swollen, hot and tender to the touch, you may have prostatitis. If the prostate is too painful and inflamed the doctor may not undertake a DRE and wait until symptoms have settled.
If there is a possibility of having a sexually transmitted disease (STD) then referral to a Genito-Urinary medicine (GUM) clinic may be done for further tests and treatment.
The doctor may send a sample of blood off to the lab to check for any signs of infection.
PSA test (Prostate Specific Antigen). Your doctor may undertake a simple blood test called a PSA test. If there is infection or inflammation in your prostate, the PSA level will most likely be raised. For more information on PSA see our booklets:
- psa-testing -get the knowledge. An introduction to PSA for those coming new to the topic.
- PSA Explanatory-booklet. A more in depth explanation of PSA.
Tests which the urologist may undertake
TRUS (trans-rectal ultrasound scan)
To get a better picture of the prostate and urinary tract a trans-rectal ultrasound scan (known as TRUS) may be done. A small ultrasound device about the size of a thumb is gently slid into the back passage. Ultrasound waves are then used to obtain a picture of your prostate.
Urine flow test
The urine flow test measures how fast you pass urine and how well the bladder empties.
A small tube with a camera on the ends is passed into your urethra to examine your bladder and urethra. This should only take a few minutes. Afterwards there may be a bit of discomfort, a burning feeling when passing urine and a little blood in the urine but this should settle after a few days.
This is similar to having a DRE. The urologist slides a gloved finger into the back passage then gently massages the prostate to release the fluid or secretion. This fluid collected and tested for any signs of infection. It’s not usually done if the prostate is very inflamed.
Treatment will depend on the type of prostatitis diagnosed.
Acute Bacterial Prostatitis (ABP)
An attack of acute bacterial prostatitis will require treatment with antibiotics and these should be started as soon as possible. Antibiotics for ABP are usually given intravenously (through a drip) so will most likely involve a stay in hospital. Antibiotics by mouth may be prescribed for the man to take at home for a few weeks to avoid the infection returning.
If pain is persistent, doctors may advise that paracetamol or ibuprofen are taken every few hours but this should be done only with medical advice. If there is difficulty or pain in moving the bowels then doctors may prescribe a mild laxative or stool softener to help pass motions.
Chronic Bacterial Prostatitis (CBP) and Chronic Pelvic Pain Syndrome (CPPS)
A course of antibiotics will probably be given for about four weeks and this may be extended for up to 12 weeks. The doctor may also change the type of antibiotic prescribed. The length of time on antibiotics will depend on individual circumstances, the type of prostatitis and which antibiotic has been prescribed.
In some cases, alpha-blockers may be used to relax the muscles in the prostate and bladder neck to reduce the resulting pressure within the prostate and on the urethra and relieve any spasms or muscle tightness that contribute to pain.
If pain is persistent, doctors may advise that paracetamol or ibuprofen are taken every few hours but this should be done only with medical advice.
If there is difficulty or pain in moving the bowels then doctors may prescribe a mild laxative or stool softener to help pass motions.
This is similar to having a digital rectal examination. A gloved finger is slipped into the back passage and the prostate is massaged to release prostate fluid which reduces pressure inside the prostate and may help with pain. This would not be undertaken if the prostate is very inflamed or painful.
The man with CBP or CPPS may be referred to an experienced and specialist physiotherapist for assessment and treatment.
Warm baths or Sitz baths
Having a warm bath may help with some of the pain around the penis, perineum (skin between scrotum and back passage) and back passage. Alternatively a Sitz bath can be purchased. This is a shallow bath/basin which is filled with warm water that you sit on. It can help relax muscles and so help relieve pain in the bottom and genital area.
Tips to help relieve prostatitis
- If you think you might have a urinary tract infection then it’s best to see your GP as soon as possible. You may be able to obtain a small (3 day) supply of antibiotics from your local chemist after speaking with the pharmacist;
- You should drink enough fluid to stop you becoming dehydrated and help flush any bacteria (germs) from your bladder;
- A warm bath or Sitz bath may help.
- It may help if you avoid foods and drinks that can irritate your bladder such as alcohol, drinks with caffeine such as tea and coffee, energy shots and performance drinks, citrus fruits and juices, hot and spicy foods.
- Wash your hands thoroughly after a bowel movement. Practice good hygiene by keeping your penis clean.
- Wear a condom during sexual intercourse especially anal intercourse
- Try to have some exercise every day. This could be as simple as going for a 30 minute brisk walk. If you haven’t exercised for a long time then check with your doctor and build up gradually.
- If constipation is a problem then ask your doctor or pharmacist about a mild laxative or stool softener. Having plenty of fresh fruit and vegetables may also help.
- Trying to relax is important and some men find that deep breathing, yoga, pilates or body massage may help.
What the medical words mean, abbreviations that you might hear and medical staff that you might meet.
When you have been diagnosed with any disease or condition, unavoidably, there will medical words and abbreviations that doctors, nurses and other medical staff will use that you have never heard of and will perhaps not know what they mean and prostate disease and prostate cancer are no different.
A helpful list of terms you might come across is provided here in alphabetical order.