Prostatitis

Prostatitis is inflammation of the prostate, a small gland below the bladder that surrounds the tube carrying urine out of the body (the urethra) and that helps make semen. When the prostate becomes inflamed it can swell and cause pain in the pelvis, genitals, or lower back, along with problems passing urine.

Prostatitis can affect men of any age, including younger and middle-aged men, which makes it different from prostate enlargement that mainly affects older men. Importantly, prostatitis is not prostate cancer and does not mean a man will develop cancer, although it can cause worrying symptoms.

There are several types. Acute bacterial prostatitis is a sudden bacterial infection of the prostate that causes severe symptoms and needs prompt treatment. Chronic bacterial prostatitis is a longer-lasting or recurring bacterial infection.

The most common form is chronic prostatitis, also called chronic pelvic pain syndrome, where there is ongoing pelvic pain and urinary symptoms but often no infection can be identified. There is also a form found by chance during tests for other reasons that causes no symptoms. Knowing the type matters because treatment differs.

Symptoms can include pain or discomfort in the area between the scrotum and back passage, the lower abdomen, the lower back, or the penis and testicles, and pain when passing urine or during or after ejaculation. There may also be a need to pass urine more often or urgently, difficulty or weak flow when urinating, and sometimes blood in the urine or semen.

Acute bacterial prostatitis tends to come on quickly and severely, often with a high temperature, chills, feeling generally unwell, and significant difficulty or inability to pass urine. Chronic prostatitis tends to develop more gradually and persists or comes and goes over months.

Bacterial prostatitis is caused by bacteria infecting the prostate, sometimes spreading from a urinary tract infection. Anything that allows bacteria to reach the prostate, such as a urinary catheter or certain procedures, can increase the risk.

In chronic prostatitis or chronic pelvic pain syndrome, the cause is often unclear and no infection is found. Possible factors include previous infection, nerve or muscle problems in the pelvic floor, inflammation, and stress, though the exact mechanism is not fully understood. This makes it a condition that often needs a broader management approach rather than antibiotics alone.

Diagnosis usually involves a discussion of symptoms and a physical examination, which may include a gentle examination of the prostate through the back passage. A urine sample is commonly tested to look for infection, and blood tests may be done.

Further tests are sometimes needed, particularly for ongoing symptoms, and may include additional urine studies, blood tests, or imaging. Men with persistent symptoms may be referred to a specialist. The aim is to identify the type of prostatitis and rule out other causes of the symptoms so that treatment can be targeted.

Treatment depends on the type. Acute bacterial prostatitis is treated with antibiotics, often started promptly, and sometimes requires hospital care if symptoms are severe or urine cannot be passed. Chronic bacterial prostatitis is usually treated with a longer course of antibiotics.

Chronic prostatitis or chronic pelvic pain syndrome, where no infection is found, often needs a combination approach. This may include pain relief, medicines that relax the muscles around the prostate and bladder, physiotherapy for the pelvic floor, and support for stress where relevant. Symptoms can take time to settle, and care is often tailored to the individual and adjusted over time.

Acute bacterial prostatitis usually responds well to prompt antibiotic treatment, although it is important to complete the course and follow up to make sure the infection has cleared. Chronic forms can be more persistent, and some men have symptoms that come and go, but a combined treatment plan can substantially improve comfort and quality of life.

There is no guaranteed way to prevent prostatitis, but treating urinary infections promptly and staying generally healthy may help. Because symptoms overlap with other conditions, anyone with ongoing pelvic or urinary symptoms should seek advice rather than assume the cause.

Seek urgent medical help if you have severe pain in the pelvis or genitals, a high temperature or chills, feel very unwell, or cannot pass urine at all, as these can indicate acute bacterial prostatitis or a serious infection that needs immediate treatment.

Get emergency help straight away if you develop signs of sepsis, such as confusion, slurred speech, rapid breathing, severe shivering, or a rash, as a serious infection can become life-threatening and needs treatment without delay.