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\nProstatitis is a frequently painful condition that involves inflammation of the prostate and sometimes the areas around the prostate.
\nScientists have identified four types of prostatitis:
\nMen with asymptomatic inflammatory prostatitis do not have symptoms. A health care provider may diagnose asymptomatic inflammatory prostatitis when testing for other urinary tract or reproductive tract disorders. This type of prostatitis does not cause complications and does not need treatment.
\nThe prostate is a walnut-shaped gland that is part of the male reproductive system. The main function of the prostate is to make a fluid that goes into semen. Prostate fluid is essential for a man\u2019s fertility. The gland surrounds the urethra at the neck of the bladder. The bladder neck is the area where the urethra joins the bladder. The bladder and urethra are parts of the lower urinary tract. The prostate has two or more lobes, or sections, enclosed by an outer layer of tissue, and it is in front of the rectum, just below the bladder. The urethra is the tube that carries urine from the bladder to the outside of the body. In men, the urethra also carries semen out through the penis.
\n \nThe causes of prostatitis differ depending on the type.
\nChronic prostatitis or chronic pelvic pain syndrome. The exact cause of chronic prostatitis/chronic pelvic pain syndrome is unknown. Researchers believe a microorganism, though not a bacterial infection, may cause the condition. This type of prostatitis may relate to chemicals in the urine, the immune system\u2019s response to a previous urinary tract infection (UTI), or nerve damage in the pelvic area.
\nAcute and chronic bacterial prostatitis. A bacterial infection of the prostate causes bacterial prostatitis. The acute type happens suddenly and lasts a short time, while the chronic type develops slowly and lasts a long time, often years. The infection may occur when bacteria travel from the urethra into the prostate.
\nProstatitis is the most common urinary tract problem for men younger than age 50 and the third most common urinary tract problem for men older than age 50.1 Prostatitis accounts for about two million visits to health care providers in the United States each year.2
\nChronic prostatitis or chronic pelvic pain syndrome is
\nThe factors that affect a man\u2019s chances of developing prostatitis differ depending on the type.
\nChronic prostatitis/chronic pelvic pain syndrome. Men with nerve damage in the lower urinary tract due to surgery or trauma may be more likely to develop chronic prostatitis/chronic pelvic pain syndrome. Psychological stress may also increase a man\u2019s chances of developing the condition.
\nAcute and chronic bacterial prostatitis. Men with lower UTIs may be more likely to develop bacterial prostatitis. UTIs that recur or are difficult to treat may lead to chronic bacterial prostatitis.
\nEach type of prostatitis has a range of symptoms that vary depending on the cause and may not be the same for every man. Many symptoms are similar to those of other conditions.
\nChronic prostatitis/chronic pelvic pain syndrome. The main symptoms of chronic prostatitis/chronic pelvic pain syndrome can include pain or discomfort lasting 3 or more months in one or more of the following areas:
\nPain during or after ejaculation is another common symptom. A man with chronic prostatitis/chronic pelvic pain syndrome may have pain spread out around the pelvic area or may have pain in one or more areas at the same time. The pain may come and go and appear suddenly or gradually. Other symptoms may include
\nAcute bacterial prostatitis. The symptoms of acute bacterial prostatitis come on suddenly and are severe. Men should seek immediate medical care. Symptoms of acute bacterial prostatitis may include
\nChronic bacterial prostatitis. The symptoms of chronic bacterial prostatitis are similar to those of acute bacterial prostatitis, though not as severe. This type of prostatitis often develops slowly and can last 3 or more months. The symptoms may come and go, or they may be mild all the time. Chronic bacterial prostatitis may occur after previous treatment of acute bacterial prostatitis or a UTI. The symptoms of chronic bacterial prostatitis may include
\nThe complications of prostatitis may include
\nA health care provider diagnoses prostatitis based on
\nA health care provider may have to rule out other conditions that cause similar signs and symptoms before diagnosing prostatitis.
\nTaking a personal and family medical history is one of the first things a health care provider may do to help diagnose prostatitis.
\nA physical exam may help diagnose prostatitis. During a physical exam, a health care provider usually
\nA digital rectal exam, or rectal exam, is a physical exam of the prostate. To perform the exam, the health care provider asks the man to bend over a table or lie on his side while holding his knees close to his chest. The health care provider slides a gloved, lubricated finger into the rectum and feels the part of the prostate that lies next to the rectum. The man may feel slight, brief discomfort during the rectal exam. A health care provider usually performs a rectal exam during an office visit, and the man does not need anesthesia. The exam helps the health care provider see if the prostate is enlarged or tender or has any abnormalities that require more testing.
\nMany health care providers perform a rectal exam as part of a routine physical exam for men age 40 or older, whether or not they have urinary problems.
\n \nA health care provider may refer men to a urologist\u2014a doctor who specializes in the urinary tract and male reproductive system. A urologist uses medical tests to help diagnose lower urinary tract problems related to prostatitis and recommend treatment. Medical tests may include
\nUrinalysis. Urinalysis involves testing a urine sample. The patient collects a urine sample in a special container in a health care provider\u2019s office or a commercial facility. A health care provider tests the sample during an office visit or sends it to a lab for analysis. For the test, a nurse or technician places a strip of chemically treated paper, called a dipstick, into the urine. Patches on the dipstick change color to indicate signs of infection in urine.
\nThe health care provider can diagnose the bacterial forms of prostatitis by examining the urine sample with a microscope. The health care provider may also send the sample to a lab to perform a culture. In a urine culture, a lab technician places some of the urine sample in a tube or dish with a substance that encourages any bacteria present to grow; once the bacteria have multiplied, a technician can identify them.
\nBlood tests. Blood tests involve a health care provider drawing blood during an office visit or in a commercial facility and sending the sample to a lab for analysis. Blood tests can show signs of infection and other prostate problems, such as prostate cancer.
\nUrodynamic tests. Urodynamic tests include a variety of procedures that look at how well the bladder and urethra store and release urine. A health care provider performs urodynamic tests during an office visit or in an outpatient center or a hospital. Some urodynamic tests do not require anesthesia; others may require local anesthesia. Most urodynamic tests focus on the bladder\u2019s ability to hold urine and empty steadily and completely and may include the following:
\nCystoscopy. Cystoscopy is a procedure that uses a tubelike instrument, called a cystoscope, to look inside the urethra and bladder. A urologist inserts the cystoscope through the opening at the tip of the penis and into the lower urinary tract. He or she performs cystoscopy during an office visit or in an outpatient center or a hospital. He or she will give the patient local anesthesia. In some cases, the patient may require sedation and regional or general anesthesia. A urologist may use cystoscopy to look for narrowing, blockage, or stones in the urinary tract.
\nTransrectal ultrasound. Transrectal ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. The health care provider can move the transducer to different angles to make it possible to examine different organs. A specially trained technician performs the procedure in a health care provider\u2019s office, an outpatient center, or a hospital, and a radiologist\u2014a doctor who specializes in medical imaging\u2014interprets the images; the patient does not require anesthesia. Urologists most often use transrectal ultrasound to examine the prostate. In a transrectal ultrasound, the technician inserts a transducer slightly larger than a pen into the man\u2019s rectum next to the prostate. The ultrasound image shows the size of the prostate and any abnormalities, such as tumors. Transrectal ultrasound cannot reliably diagnose prostate cancer.
\nBiopsy. Biopsy is a procedure that involves taking a small piece of prostate tissue for examination with a microscope. A urologist performs the biopsy in an outpatient center or a hospital. He or she will give the patient light sedation and local anesthetic; however, in some cases, the patient will require general anesthesia. The urologist uses imaging techniques such as ultrasound, a computerized tomography scan, or magnetic resonance imaging to guide the biopsy needle into the prostate. A pathologist\u2014a doctor who specializes in examining tissues to diagnose diseases\u2014examines the prostate tissue in a lab. The test can show whether prostate cancer is present.
\nSemen analysis. Semen analysis is a test to measure the amount and quality of a man\u2019s semen and sperm. The man collects a semen sample in a special container at home, a health care provider\u2019s office, or a commercial facility. A health care provider analyzes the sample during an office visit or sends it to a lab for analysis. A semen sample can show blood and signs of infection.
\nTreatment depends on the type of prostatitis.
\nChronic prostatitis/chronic pelvic pain syndrome. Treatment for chronic prostatitis/chronic pelvic pain syndrome aims to decrease pain, discomfort, and inflammation. A wide range of symptoms exists and no single treatment works for every man. Although antibiotics will not help treat nonbacterial prostatitis, a urologist may prescribe them, at least initially, until the urologist can rule out a bacterial infection. A urologist may prescribe other medications:
\nAlternative treatments may include
\nTo help ensure coordinated and safe care, people should discuss their use of complementary and alternative medical practices, including their use of dietary supplements, with their health care provider. Read more at www.nccih.nih.gov.
\nFor men whose chronic prostatitis/chronic pelvic pain syndrome symptoms are affected by psychological stress, appropriate psychiatric treatment and stress reduction may reduce the recurrence of symptoms.
\nTo help measure the effectiveness of treatment, a urologist may ask a series of questions from a standard questionnaire called the National Institutes of Health (NIH) Chronic Prostatitis Symptom Index. The questionnaire helps a urologist assess the severity of symptoms and how they affect the man\u2019s quality of life. A urologist may ask questions several times, such as before, during, and after treatment.
\nAcute bacterial prostatitis. A urologist treats acute bacterial prostatitis with antibiotics. The antibiotic prescribed may depend on the type of bacteria causing the infection. Urologists usually prescribe oral antibiotics for at least 2 weeks. The infection may come back; therefore, some urologists recommend taking oral antibiotics for 6 to 8 weeks. Severe cases of acute prostatitis may require a short hospital stay so men can receive fluids and antibiotics through an intravenous (IV) tube. After the IV treatment, the man will need to take oral antibiotics for 2 to 4 weeks. Most cases of acute bacterial prostatitis clear up completely with medication and slight changes to diet. The urologist may recommend
\nChronic bacterial prostatitis. A urologist treats chronic bacterial prostatitis with antibiotics; however, treatment requires a longer course of therapy. The urologist may prescribe a low dose of antibiotics for up to 6 months to prevent recurrent infection. The urologist may also prescribe a different antibiotic or use a combination of antibiotics if the infection keeps coming back. The urologist may recommend increasing intake of liquids and avoiding or reducing intake of substances that irritate the bladder.
\nA urologist may use alpha blockers that treat chronic prostatitis/chronic pelvic pain syndrome to treat urinary retention caused by chronic bacterial prostatitis. These medications help relax the bladder muscles near the prostate and lessen symptoms such as painful urination. Men may require surgery to treat urinary retention caused by chronic bacterial prostatitis. Surgically removing scar tissue in the urethra often improves urine flow and reduces urinary retention.
\nMen cannot prevent prostatitis. Researchers are currently seeking to better understand what causes prostatitis and develop prevention strategies.
\nResearchers have not found that eating, diet, and nutrition play a role in causing or preventing prostatitis. During treatment of bacterial prostatitis, urologists may recommend increasing intake of liquids and avoiding or reducing intake of substances that irritate the bladder. Men should talk with a health care provider or dietitian about what diet is right for them.
\nThe National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.
\nClinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.
\nClinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.
\nThis content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:
Mark Litwin, M.D., University of California at Los Angeles; Anthony Schaeffer, M.D., Northwestern University; Michael P. O\u2019Leary, M.D., M.P.H., Harvard Medical School