Prostatitis/Inflamed Prostate

There are several types of prostatitis:

• Acute bacterial prostatitis is a severe bacterial infection characterized by fevers and chills.
• Chronic bacterial prostatitis is similar to acute bacterial prostatitis but the symptoms develop gradually and are less severe.
• Chronic prostatitis/chronic pelvic pain syndrome/nonbacterial prostatitis /prostatodynia is the most common non-bacterial form. Symptoms may resolve and then flare up without warning.
• Asymptomatic inflammatory prostatitis is prostatitis without symptoms, despite an inflammation of the prostate.

While the exact cause of prostatitis is not fully known, there are several clinically-proven factors that contribute to the condition:

• Bacterial infection caused by backward flow of infected urine into prostate ducts
• Medical procedures such as catheterization or cystoscope
• Abnormality of urinary tract
• Recent bladder or urinary tract infection
• Injury or trauma to the perineum
• Enlarged prostate
• Chemical or immunological reaction to an injury or infection
• Nerves and muscles in the pelvis
• Rectal intercourse
• Chlamydia, mycoplasma, ureaplasma
• Prostatitis is not a sexually transmitted disease but can result from one

Symptoms depend on the type of prostatitis. Some men do not notice any symptoms, while others experience symptoms similar to those of a urinary tract infection. Symptoms include:

• Urinary frequency and/or urgency
• Burning or stinging during urination
• Painful urination
• Reduced stream during urination
• Rectal pain and/or pressure
• Fever and chills (usually with an acute infection only)
• Lower back and/or pelvic pain
• Painful bladder
• Painful ejaculation
• Discharge through the urethra during bowel movements
• Sexual dysfunction and/or loss of libido
• Throbbing sensations in the rectal and/or genital area

Effective treatment varies depending upon the type of prostatitis, so it is important that the diagnosis be accurate. In addition to a complete medical history and physical examination, your urologist may complete the following diagnostic tests and procedures:

• National Institutes of Health Chronic Prostatitis Symptom Index, a patient questionnaire about prostatitis symptoms to determine the most effective treatment.
• Digital rectal examination (DRE), a procedure in which the doctor inserts a gloved finger into the rectum to examine the rectum and the prostate gland.
• Semen culture, a microscopic evaluation of semen to look for infection.
• Prostate massage, a procedure usually performed during a DRE, involves the doctor "stripping" the prostate gland to drain fluid into the urethra. The fluid is examined under a microscope to detect inflammation and/or infection.
• Urine culture, often used in collaboration with the prostate stripping procedure involves a three-glass urine collection method to evaluate prostatic fluid and urine for white blood cells and bacteria.
• Cystoscopy enables an urologist to view the inside of the bladder and urethra via a thin tube.
• Urine flow studies measure the strength of urine flow and assess obstructions.
• Transrectal ultrasound provides a picture of the prostate gland.
• PSA test to determine risk for prostate cancer.

Treatment for prostatitis depends on the type of prostatitis. Your urologist will discuss recommended treatment methods with you.

• Acute bacterial prostatitis requires antibiotics for a minimum of 14 days, sometimes given intravenously in the hospital. A catheter may also be required. Almost all acute infections are cured with this treatment.
• Chronic bacterial prostatitis requires antibiotics for longer, up to four to 12 weeks. Seventy-five percent of chronic bacterial prostatitis resolves with this treatment. Long-term, low dose antibiotic therapy is recommended for difficult cases. Other medications, treatments and surgery may also be necessary.
• Chronic pelvic pain syndrome is common, difficult to diagnosis and requires trial and error treatment. Antibiotics, alpha-blockers anti-inflammatory drugs, pain medications, muscle relaxants and plant extracts may be prescribed. Repetitive prostatic massages help release fluid that causes prostate pressure.

Hot sitz baths or other heat methods relieve discomfort as do pillows, biofeedback and relaxation exercises. Discontinuing spicy foods, caffeinated drinks and activities that exacerbate the problem also help.

You will receive a thorough diagnostic evaluation and receive clinically-proven treatment by a board-certified urologist who specializes in prostatitis. Our goal is to alleviate symptoms so you can return to every life. Appointments are confidential and private.

Brigham and Women's Hospital practices a multidisciplinary approach to patient care, routinely collaborating with colleagues in other medical specialties. If your urologist discovers that an underlying illness has contributed to your prostatitis, you will be referred to an appropriate BWH physician for an evaluation.

Go to our online health library to learn more about urology diseases and tests.

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