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Prostatitis is the most common urologic diagnosis in men under 50 and the third most common in men over 50. In fact, five percent of men between the ages of 20 to 50 suffer from prostatitis or have had it once and 2 million visits occur annually in the United States for prostatitis.
In this article we’re going to cover everything you need to know about prostatitis. We’re going to talk about symptoms, the different types of prostatitis, the diagnosis and the treatment.
Symptoms most commonly include pain and where can that pain be? Well, it can be in the lower part of your belly, in the penis itself, in the testicles, in the perineum (the area between the scrotum and the anus) or when you’re urinating.
Sometimes if you have what we call acute prostatitis, this can be accompanied by other symptoms like fever, nausea or vomiting. So, it’s a pretty uncomfortable and sometimes serious condition.
There are multiple different types of prostatitis.
The first step is to determine if there is any evidence of a bacterial infection and if it’s acute or chronic.
If you have acute bacterial prostatitis, usually you can be sick. You can have fevers, chills, nausea, vomiting and sometimes you can also have difficulty emptying your bladder in addition to having difficulty urinating.
Sometimes people can feel symptoms like having to go very often, needing to go frequently and not being able to hold off going to the bathroom.
The other type of bacterial prostatitis is when it’s chronic. So sometimes you’ll have these symptoms for a prolonged period of time, but you won’t be as sick. You won’t necessarily have fevers, chills, nausea or vomiting but you may have all the other symptoms of prostatitis.
Sometimes this can follow an acute episode. So, if you had an episode where you got really sick and got treated but the symptoms never went away, it could become a chronic problem.
Risk factors can include a history of diabetes, because of having a recent sort of procedure or surgery on the urinary tract, having issues with urination not emptying completely or even just having a larger prostate than normal.
The other kind of prostatitis, the other half of it is non-bacterial prostatitis and this can be chronically due to inflammation or a non-inflammatory process. But again, symptoms can be very similar.
If you fall into this category of a non-bacterial prostatitis and you’ve had symptoms for three of the last six months and these have been ruled out for any sort of infectious cause, you may have what’s called chronic pelvic pain syndrome. This is essentially all the symptoms mentioned earlier and sometimes also symptoms of sexual dysfunction like premature ejaculation or erectile dysfunction.
A lot of the times, prostatitis is caused by bacterial infection and one of the reasons people get bacterial infections is something we call intraprostatic ductal reflux.
What that is, is instead of having urine flow forward out the urethra, it actually refluxes or goes back into the prostate causing potentially bacteria to get into the prostate that way.
Some things that can potentially put you at risk for this are prior transurethral surgery, having foreskin that doesn’t retract can allow urine to get trapped and form a high-pressure system and sometimes unprotected anal intercourse can also be a higher risk for getting prostatitis.
Having a catheter or even a condom catheter can put you at higher risk for this ductal reflux and lastly, if you have abnormal bladder function either due to having an enlarged prostate where you’re constantly trying to push urine out in a high pressure way and it’s having difficulty emptying, or if you have a neurologic condition sometimes that makes this pressure in the bladder and urine flowing through the prostate more elevated, that can also put you at higher risk.
Other potential causes might be issues with the immune system, issues with the pelvic floor musculature, such as high tone pelvic floor which can cause difficulty in emptying your bladder and lots of issues with pain, and sometimes psychological factors as well.
When you come to the doctor, they’ll ask you a lot of questions. Where is the pain? When does it happen? How long have you had it? Have you ever had any sexually transmitted infections? What is your urination normally like? How often do you urinate? Do you have any symptoms of needing to go very often or having to rush to the bathroom? Do you wake up at night? Do you ever feel like you must wait till your bladder empties? Does it stop and start? Do you have a weak stream, or sometimes do you feel like you don’t empty your bladder?
Of course, they’ll also ask if you’ve had any recent procedures. One thing that is not quite common in the United States but may be common in other countries is if you’ve had tuberculosis, this can also actually infect the prostate and cause symptoms as well.
Once they’ve gotten your history, they’ll then do an examination which includes a digital rectal exam. If you are very, very ill and have a fever and chills and they suspect very highly that you have acute bacterial prostatitis, they may skip that step or do it extremely gently because doing any sort of aggressive massage or pressing on that area can cause bacteria to then translocate or get into the bloodstream and cause you to get even more sick.
They will also check a urinalysis and urine culture. They may also check a post-void residual with a bladder ultrasound to see how well you’re emptying the bladder and if you’re having testicular pain, they may also order a scrotal ultrasound to make sure there’s no masses or lesions in the testes.
Other things depending on your presentation, if you have a lot of abdominal pain or back pain, they may order some imaging of the abdomen as well as MRIs of the spine.
Acute bacterial prostatitis is treated antibiotics. Typically, if you are in the hospital, you get intravenous antibiotics. If you’re an outpatient and you’re not extremely sick, you can be treated oral antibiotics tailored to the urine culture results.
Urine cultures allow doctors to see exactly what bacteria grows as well as what antibiotics will be sensitive or will be able to treat those bacteria. Typically, different from having a bladder infection or urinary tract infection, prostate infections need to be treated for a longer period, usually between four to six weeks to make sure that the antibiotic penetrates through the prostate completely.
Similarly, for chronic bacterial prostatitis, you may be put on a longer course of antibiotics. If, however, you don’t improve on those antibiotics and your urine culture is negative, then giving you more antibiotics is not likely to help and then your doctor will consider a non-bacterial cause of the prostatitis.
The most common treatment for nonbacterial prostiaits is often alpha blocker medications, such as tamsulosin or alfuzosin. These work by relaxing the prostate as well as relaxing the bladder neck. This helps reduce that high pressure urination we talked about earlier and hopefully helps alleviate some of these symptoms.
In addition to this, we can sometimes use a short course of anti-inflammatory medications such as non-steroidal anti-inflammatories which commonly include ibuprofen or naproxen. Sometimes people can use things like steroids or immunosuppressive medications, although those are less commonly used.
There’s also some data to suggest that 5-alpha reductase inhibitors may help and the way these work is by reducing the conversion of testosterone to intraprostatic DHT or dihydrotestosterone and because of that cause shrinkage of the prostate.
One of the causes that sometimes may result in these symptoms is high tone pelvic floor dysfunction. Pelvic floor physical therapy or going to a certified physical therapist to help teach patients how to relax those muscles can be tremendously helpful.
Prostate massage used to be the mainstay of treatment for prostatitis. It used to be that you’d go to your urologist and get a prostate massage for 10 minutes three times a week. The reason they thought this would work is because massaging the prostate would help drain some of those ducts that may be occluded, allow better penetration of antibiotics, and potentially improve circulation to the prostate. Initial studies showed this was beneficial, but more modern studies have not shown a benefit.
Other therapies that have some little bit of data on them but are not widely used include posterior tibial nerve stimulation, acupuncture, extracorporeal shock wave therapy, and using some tricyclic antidepressants like nortriptyline or amitriptyline have been shown to have some benefit as well as some bioflavonoids and pollen extracts have been looked at in exceedingly small studies as well.
Prostate massage Prostatitis is a challenging issue for a lot of people that can cause a lot of discomfort and a lot of stress. It is important to talk to your doctor if you are experiencing any of the symptoms mentioned in this article. Your doctor will be able to help you determine the cause and the best treatment for your particular situation.
There are a variety of treatments available for prostatitis, including antibiotics, alpha blocker medications, anti-inflammatory medications, 5-alpha reductase inhibitors, pelvic floor physical therapy, posterior tibial nerve stimulation, acupuncture, extracorporeal shock wave therapy, and tricyclic antidepressants. It is important to talk to your doctor to determine which treatment is best for you.
Prostate massage used to be the mainstay of treatment for prostatitis, but more modern studies have not shown a benefit. It is important to talk to your doctor before trying any of these treatments
Prostatitis is the most common urologic diagnosis in men under 50 and the third most common in men over 50. In fact, five percent of men between the ages of 20 to 50 suffer from prostatitis or have had it once and 2 million visits occur annually in the United States for prostatitis.
In this article we’re going to cover everything you need to know about prostatitis. We’re going to talk about symptoms, the different types of prostatitis, the diagnosis and the treatment.
Symptoms most commonly include pain and where can that pain be? Well, it can be in the lower part of your belly, in the penis itself, in the testicles, in the perineum (the area between the scrotum and the anus) or when you’re urinating.
Sometimes if you have what we call acute prostatitis, this can be accompanied by other symptoms like fever, nausea or vomiting. So, it’s a pretty uncomfortable and sometimes serious condition.
There are multiple different types of prostatitis.
The first step is to determine if there is any evidence of a bacterial infection and if it’s acute or chronic.
If you have acute bacterial prostatitis, usually you can be sick. You can have fevers, chills, nausea, vomiting and sometimes you can also have difficulty emptying your bladder in addition to having difficulty urinating.
Sometimes people can feel symptoms like having to go very often, needing to go frequently and not being able to hold off going to the bathroom.
The other type of bacterial prostatitis is when it’s chronic. So sometimes you’ll have these symptoms for a prolonged period of time, but you won’t be as sick. You won’t necessarily have fevers, chills, nausea or vomiting but you may have all the other symptoms of prostatitis.
Sometimes this can follow an acute episode. So, if you had an episode where you got really sick and got treated but the symptoms never went away, it could become a chronic problem.
Risk factors can include a history of diabetes, because of having a recent sort of procedure or surgery on the urinary tract, having issues with urination not emptying completely or even just having a larger prostate than normal.
The other kind of prostatitis, the other half of it is non-bacterial prostatitis and this can be chronically due to inflammation or a non-inflammatory process. But again, symptoms can be very similar.
If you fall into this category of a non-bacterial prostatitis and you’ve had symptoms for three of the last six months and these have been ruled out for any sort of infectious cause, you may have what’s called chronic pelvic pain syndrome. This is essentially all the symptoms mentioned earlier and sometimes also symptoms of sexual dysfunction like premature ejaculation or erectile dysfunction.
A lot of the times, prostatitis is caused by bacterial infection and one of the reasons people get bacterial infections is something we call intraprostatic ductal reflux.
What that is, is instead of having urine flow forward out the urethra, it actually refluxes or goes back into the prostate causing potentially bacteria to get into the prostate that way.
Some things that can potentially put you at risk for this are prior transurethral surgery, having foreskin that doesn’t retract can allow urine to get trapped and form a high-pressure system and sometimes unprotected anal intercourse can also be a higher risk for getting prostatitis.
Having a catheter or even a condom catheter can put you at higher risk for this ductal reflux and lastly, if you have abnormal bladder function either due to having an enlarged prostate where you’re constantly trying to push urine out in a high pressure way and it’s having difficulty emptying, or if you have a neurologic condition sometimes that makes this pressure in the bladder and urine flowing through the prostate more elevated, that can also put you at higher risk.
Other potential causes might be issues with the immune system, issues with the pelvic floor musculature, such as high tone pelvic floor which can cause difficulty in emptying your bladder and lots of issues with pain, and sometimes psychological factors as well.
When you come to the doctor, they’ll ask you a lot of questions. Where is the pain? When does it happen? How long have you had it? Have you ever had any sexually transmitted infections? What is your urination normally like? How often do you urinate? Do you have any symptoms of needing to go very often or having to rush to the bathroom? Do you wake up at night? Do you ever feel like you must wait till your bladder empties? Does it stop and start? Do you have a weak stream, or sometimes do you feel like you don’t empty your bladder?
Of course, they’ll also ask if you’ve had any recent procedures. One thing that is not quite common in the United States but may be common in other countries is if you’ve had tuberculosis, this can also actually infect the prostate and cause symptoms as well.
Once they’ve gotten your history, they’ll then do an examination which includes a digital rectal exam. If you are very, very ill and have a fever and chills and they suspect very highly that you have acute bacterial prostatitis, they may skip that step or do it extremely gently because doing any sort of aggressive massage or pressing on that area can cause bacteria to then translocate or get into the bloodstream and cause you to get even more sick.
They will also check a urinalysis and urine culture. They may also check a post-void residual with a bladder ultrasound to see how well you’re emptying the bladder and if you’re having testicular pain, they may also order a scrotal ultrasound to make sure there’s no masses or lesions in the testes.
Other things depending on your presentation, if you have a lot of abdominal pain or back pain, they may order some imaging of the abdomen as well as MRIs of the spine.
Acute bacterial prostatitis is treated antibiotics. Typically, if you are in the hospital, you get intravenous antibiotics. If you’re an outpatient and you’re not extremely sick, you can be treated oral antibiotics tailored to the urine culture results.
Urine cultures allow doctors to see exactly what bacteria grows as well as what antibiotics will be sensitive or will be able to treat those bacteria. Typically, different from having a bladder infection or urinary tract infection, prostate infections need to be treated for a longer period, usually between four to six weeks to make sure that the antibiotic penetrates through the prostate completely.
Similarly, for chronic bacterial prostatitis, you may be put on a longer course of antibiotics. If, however, you don’t improve on those antibiotics and your urine culture is negative, then giving you more antibiotics is not likely to help and then your doctor will consider a non-bacterial cause of the prostatitis.
The most common treatment for nonbacterial prostiaits is often alpha blocker medications, such as tamsulosin or alfuzosin. These work by relaxing the prostate as well as relaxing the bladder neck. This helps reduce that high pressure urination we talked about earlier and hopefully helps alleviate some of these symptoms.
In addition to this, we can sometimes use a short course of anti-inflammatory medications such as non-steroidal anti-inflammatories which commonly include ibuprofen or naproxen. Sometimes people can use things like steroids or immunosuppressive medications, although those are less commonly used.
There’s also some data to suggest that 5-alpha reductase inhibitors may help and the way these work is by reducing the conversion of testosterone to intraprostatic DHT or dihydrotestosterone and because of that cause shrinkage of the prostate.
One of the causes that sometimes may result in these symptoms is high tone pelvic floor dysfunction. Pelvic floor physical therapy or going to a certified physical therapist to help teach patients how to relax those muscles can be tremendously helpful.
Prostate massage used to be the mainstay of treatment for prostatitis. It used to be that you’d go to your urologist and get a prostate massage for 10 minutes three times a week. The reason they thought this would work is because massaging the prostate would help drain some of those ducts that may be occluded, allow better penetration of antibiotics, and potentially improve circulation to the prostate. Initial studies showed this was beneficial, but more modern studies have not shown a benefit.
Other therapies that have some little bit of data on them but are not widely used include posterior tibial nerve stimulation, acupuncture, extracorporeal shock wave therapy, and using some tricyclic antidepressants like nortriptyline or amitriptyline have been shown to have some benefit as well as some bioflavonoids and pollen extracts have been looked at in exceedingly small studies as well.
Prostatitis is a challenging issue for a lot of people that can cause a lot of discomfort and a lot of stress. It is important to talk to your doctor if you are experiencing any of the symptoms mentioned in this article. Your doctor will be able to help you determine the cause and the best treatment for your particular situation.
There are a variety of treatments available for prostatitis, including antibiotics, alpha blocker medications, anti-inflammatory medications, 5-alpha reductase inhibitors, pelvic floor physical therapy, posterior tibial nerve stimulation, acupuncture, extracorporeal shock wave therapy, and tricyclic antidepressants. It is important to talk to your doctor to determine which treatment is best for you.
Prostate massage used to be the mainstay of treatment for prostatitis, but more modern studies have not shown a benefit. It is important to talk to your doctor before trying any of these treatments.
Contact Dr. Malik for speaking engagements, press, partnerships, or collaborations
Quick Links
Out-of-State telehealth provider for Florida
