Chronic prostatitis is an inflammation of the prostate gland located between the bladder and penis. It causes urinary pain symptoms and painful ejaculation.
What is chronic prostatitis?
Chronic prostatitis is inflammation of the prostate gland, located between the bladder and penis, which produces fluid that nourishes and protects sperm. Chronic prostatitis is distinguished from acute prostatitis in that chronic prostatitis has caused symptoms for at least three of the last six months.
Chronic prostatitis can be caused by bacteria (chronic bacterial prostatitis) or inflammation without evidence of a bacterial infection (chronic nonbacterial prostatitis or chronic pelvic pain syndrome).
Symptoms include pain on urination, more frequent urination or urgency, difficulty urinating, pain in the pelvis or with sexual activity, erectile dysfunction, as well as low-grade fever and depression.
Treatment options include antibiotics and other medication, physical activity and physical therapy, psychological support, and surgery.
You should visit your primary care physician. Your doctor will want to make sure that you do not have any other conditions and may write a prescription for medication.
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Symptoms of chronic prostatitis
Chronic prostatitis can have symptoms related to urinary tract infections (UTIs), as well as pain in the area of the pelvis or with sexual activity, and other symptoms.
Some people with chronic prostatitis may develop the first few symptoms listed below, which are like those of a UTI. This may be due to irritation caused by inflammation of the prostate or urinary tract, or even the development of strictures in the urinary tract. Details include:
- Pain on urination (dysuria)
- Urinating more frequently than usual (polyuria)
- Feeling a need to urinate (urgency)
- Difficulty urinating: Some people with chronic prostatitis may develop difficulty urinating or feel the need to strain to urinate because the inflammation causes an obstruction of the urinary tract. Over time, prolonged inflammation can also cause the development of strictures in the urinary tract which physically obstruct the outflow of urine.
Pain in surrounding areas
Pain in the surrounding areas of the pelvis or with sexual activity is also associated with chronic prostatitis, including:
- Pain in the pelvic area: Some people with chronic prostatitis may develop dull, intermittent or constant pain in the lower abdomen or pelvic area, including in the penis, testicles, or area of skin between the scrotum and the anus. This is especially seen in people with chronic nonbacterial prostatitis.
- Pain with ejaculation
- Erectile dysfunction (ED)
Other symptoms that may be associated with chronic prostatitis include:
- Low-grade fever: Some people with chronic bacterial prostatitis may develop a low-grade fever. This is typically not seen in chronic nonbacterial prostatitis.
- Depression: Some people with chronic prostatitis may develop symptoms of depression. This may be due to the chronic pain and the limitations in daily activities that this causes.
Causes of chronic prostatitis
Specific causes of chronic prostatitis include:
- Urinary tract infection: The prostate is directly connected to the urinary tract through the urethra. Therefore, a UTI in the urethra or bladder can migrate to the prostate and cause either acute or chronic bacterial prostatitis.
- Untreated or inadequately treated acute bacterial prostatitis: This can lead to the chronic form.
- Prostate stones: These may increase the risk of developing chronic bacterial prostatitis, as the stones can harbor bacteria that lead to an infection.
- Inflammation due to trauma or an imbalanced immune system: This has been thought to contribute to the development of chronic nonbacterial prostatitis, although this has not been proven.
- Psychological stress: This includes anxiety and a fear of severe illness. These factors have been associated with chronic nonbacterial prostatitis and may contribute to developing chronic prostatitis. Psychological stress may amplify the symptoms of pain associated with chronic prostatitis.
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Treatment options and prevention for chronic prostatitis
Chronic prostatitis may not be fully cured, or it may frequently recur even if fully treated. Further treatment methods have shown promising results but are still in the early stages of testing, such as phytotherapies and alpha-blockers.
Current treatment is focused on reducing symptoms and improving quality of life. The treatment will differ depending on whether you have chronic bacterial prostatitis or chronic nonbacterial prostatitis. Specific treatment options include antibiotics, medications to treat urinary obstructions and pain, acupuncture, physical activity and physical therapy, psychological support, and surgery.
People with chronic prostatitis may be recommended to complete a prolonged course of antibiotics to treat the infection . The antibiotics are usually taken for at least six weeks to fully treat the infection. In addition, antibiotics that are used must have good penetration into the prostate. Examples of antibiotics that may be used include:
- Ciprofloxacin (Cipro)
- Levofloxacin (Levaquin)
- Trimethoprim-sulfamethoxazole (Bactrim)
- Fosfomycin (Monurol)
Medications to relieve urinary tract obstruction
Medications to relieve or reduce urinary tract obstructions are usually continued for three months or more, and commonly include methods that:
- Reduce constriction of the urinary tract: Such as tamsulosin (Flomax)
- Reduce the size of the prostate gland: Such as finasteride (Proscar) or dutasteride (Avodart)
Pain medications or acupuncture
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve), as well as medications that relieve neuropathic pain such as pregabalin (Lyrica), may provide pain relief. Acupuncture has also been shown to have a pain control benefit for patients with chronic prostatitis.
Physical activity and physical therapy
Physical activity and physical therapy have been shown to reduce pain in people with chronic prostatitis. Physical therapy focuses on relieving pelvic floor muscle spasms, which may contribute to pain in chronic prostatitis.
Because chronic prostatitis is associated with psychological symptoms and reduced quality of life, people may benefit from counseling and psychological support. This includes cognitive behavioral therapy (CBT), which focuses on cognitive strategies to manage the pain and limitations associated with chronic prostatitis.
People who develop physical obstructions of the urinary tract such as strictures may benefit from surgery by a urologist to relieve the obstruction.
When to seek further consultation for chronic prostatitis
If you develop any symptoms of chronic prostatitis, such as pelvic pain, urinary symptoms, or difficulty urinating, you should go see your physician, especially if your symptoms have persisted for more than a month. He or she can perform an exam and order appropriate tests to determine if you have chronic prostatitis and offer the appropriate treatment.
If you develop any symptoms of acute prostatitis
You should go see your physician promptly if you experience spiking fevers, severe pain with urination, and cloudy urine. He or she can start you on the appropriate treatments. If acute prostatitis is not appropriately treated, it can lead to chronic prostatitis.
Questions your doctor may ask to determine chronic prostatitis
- How would you describe your walk?
- Do you feel pain when you urinate?
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- Have you ever been diagnosed with diabetes?
- Do you wake up almost every night to urinate?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
I have a friend who is 62 years old and complains of pain deep in the perineal nerve area between anus and base of posterior scrotal sack. I've noticed it has affected his posture and he can't stand straight. He smokes medical marijuana and takes NSAIDs for the pain, which is around an (8) from objective facial expressions and body movement. He does not have insurance for a proper diagnosis and takes antibiotics (Cipro) for flareups. From reading the above information, it sounds like "Chronic bacterial prostatitis". He claims it is a sports injury from high school. Any information provided is greatly appreciated.
- Mayo Clinic. Updated May 16, 2018. Mayo Clinic Link
- Chronic prostatitis. Harvard Medical School: Harvard Health Publishing. Published August 2014. Harvard Health Publishing Link
- Prostatitis - nonbacterial. U.S. National Library of Medicine: MedlinePlus. Updated December 6, 2018. MedlinePlus Link
- Egan KJ, Krieger JN. Psychological problems in chronic prostatitis patients with pain. Clin J Pain. 1994;10(3):218-226. NCBI Link
- Sandhu J, TU HYV. Recent advances in managing chronic prostatitis/chronic pelvic pain syndrome. F1000Research. 2017;6:F1000 Faculty Rev-1747. NCBI Link