Prostatitis

Overview

Prostatitis is inflammation of the prostate gland. Bacterial prostatitis (acute or chronic) is caused by infection. Chronic pelvic pain syndrome (CPPS), formerly called nonbacterial prostatitis, is the most common form and involves chronic pelvic pain without demonstrable infection. It affects men of all ages, unlike BPH.

How common is it?

Prostatitis is a common urinary problem in younger adult men. Bacterial prostatitis and chronic pelvic pain syndrome are different conditions; acute bacterial infection can be serious.

Causes and risk factors

Acute bacterial prostatitis results from ascending urinary pathogens. CPPS has a multifactorial aetiology including pelvic floor dysfunction, neurogenic inflammation, and psychological factors.

Common risk factors

• Acute bacterial: Escherichia coli, Klebsiella, Proteus (ascend from urethra or bladder)
• Chronic bacterial: same organisms, often following inadequate treatment of acute episode
• CPPS: pelvic floor hypertonia, autoimmune, neuroinflammatory, psychological (anxiety, catastrophising)
• STIs: Chlamydia trachomatis, gonorrhoea in younger men
• Urinary tract procedures or catheterisation
• Urethral stricture
• High-pressure voiding

Symptoms

• Acute bacterial: sudden severe fever and rigors, severe pelvic/perineal pain, urinary frequency and urgency, difficulty voiding, tender boggy prostate on examination
• Chronic bacterial: recurrent UTI, mild pelvic pain, urinary symptoms without systemic illness
• CPPS: chronic pelvic, perineal, testicular, or penile pain lasting 3 months or more, may include urinary and sexual dysfunction, no fever or systemic features

When to see a doctor

Arrange assessment for pelvic pain or urinary symptoms; do not wait 3 months. Seek urgent care for fever with urinary pain, inability to pass urine, or no improvement within 48 hours of antibiotics. Confusion, severe breathing difficulty or blue, grey or blotchy skin can indicate sepsis: call your local emergency number.

Diagnosis

Acute: urine culture and blood cultures. Mid-stream urine. Ultrasound if abscess suspected. Chronic: localisation cultures (pre- and post-prostatic massage urine) to distinguish chronic bacterial from CPPS. PSA may be elevated in infection.

Treatments

Self-care and lifestyle

• Warm sitz baths reduce pelvic floor muscle tension and pain
• Avoid prolonged sitting on hard surfaces (aggravates perineal symptoms)
• Avoid spicy food, caffeine, and alcohol which irritate the bladder
• Psychological support (CBT) is beneficial in chronic CPPS

Prevention

Prostatitis cannot always be prevented. Seek prompt assessment for urinary infection and take prescribed treatment as directed; there is no proven way to prevent chronic pelvic pain syndrome.