Prostatitis refers to an inflammation of the prostate that may be caused by an infection or other noninfectious sources such as chemical irritation. There are several different categories of prostatitis.
Prostatitis may be infectious (typically caused by bacteria) or noninfectious based on the cause of the inflammation. It may be acute or chronic (over 3 months) based on how long the inflammation has persisted. Most prostatitis presents with bothersome urinary symptoms and pain predominantly localized to the perineal area under the scrotum. Infectious prostatitis may also be associated with urinary tract infections and fever.
Causes and Risk Factors
Prostatitis may be caused by prior urinary tract infection, prior instrumentation or catheterization, chronic urine reflux into the prostate from dysfunctional voiding, pelvic muscle dysfunction or alterations in nerve pain signaling.
When to Speak with a Urologist about Prostatitis
You should talk to a Urologist about prostatitis if you have bothersome urinary symptoms and pain localized to the perineal area under the scrotum.
What to Expect when Seeking Treatment
In addition to a history and physical examination, initial assessment includes urinalysis, urine culture, uroflow and post void residual assessment to check for the presence of infection and voiding dysfunction. In the absence of fever and active infection, an additional urine culture may be obtained after prostatic massage to check for bacteria in prostatic secretions. Imaging with prostate ultrasound or MRI is occasionally obtained in the setting of persistent infection to assess for possible anatomic abnormalities or prostatic stones.
Infectious prostatitis is treated with a prolonged course of antibiotics that penetrate well into the prostate, such as fluoroquinolones or sulfamethoxazole-trimethoprim. Acute infectious prostatitis usually requires 4 weeks of treatment while chronic infectious prostatitis may require 6 to 12 weeks of antibiotics.
Noninfectious prostatitis can be difficult to treat. Multiple different therapies with multiple modifications may be needed to achieve symptom control. Complete resolution of chronic pain is often not achievable with only 1 in 3 patients having symptom resolution after one year. Conservative measures include dietary modification, myofascial physical therapy to relieve pelvic floor muscle tension, phytotherapies (saw palmetto, quercetin, pollen extract) and acupuncture. Additional treatments include medications to reduce urinary bother, anti-inflammatory agents, gabapentanoids or muscle relaxants. Stress and anxiety have been shown to worsen symptoms. To help improve coping skills, a referral for psychological support may be recommended.