There are two main types of chronic prostatitis - chronic bacterial prostatitis (caused by chronic bacterial infection) and chronic prostatitis/chronic pelvic pain syndrome (CPPS) - the cause of which is not fully understood. Chronic prostatitis typically causes pain in the lower pelvic region of men. Urinary symptoms such as frequency of passing urine and pain on passing urine may also be present. Treatment can be difficult and may include antibiotics and other drugs. Symptoms may last a long time, although they may 'come and go' or vary in severity.
The prostate gland is only found in men. It lies just beneath the bladder. It is normally about the size of a chestnut. The urethra (the tube that passes urine from the bladder) runs through the middle of the prostate. The prostate helps to make semen, but most semen is made by the seminal vesicle (another gland).
Prostatitis means that you have inflammation of your prostate gland. Prostatitis can be acute (sudden onset) or chronic (persistent). It can also be infective (caused by infection) or non-infective.
For the diagnosis of chronic prostatitis, symptoms need to have been present for at least three months. In acute prostatitis, symptoms usually come on and go away much more quickly. There are two main types of chronic prostatitis:
See separate leaflet called Acute prostatitis for further details on acute prostatitis. The rest of this leaflet is just about chronic prostatitis.
Chronic prostatitis is actually quite common. Between 1-2 men in 10 will have chronic prostatitis at some point during their life. Chronic prostatitis most commonly affects men between the ages of 30-50, but men of any age can be affected.
About 9 in 10 men with chronic prostatitis have chronic prostatitis/CPPS. About 1 in 10 men with chronic prostatitis have chronic bacterial prostatitis, so this is rare in comparison to chronic prostatitis/CPPS.
Chronic bacterial prostatitis is a type of infective prostatitis. It is caused by a chronic (persistent) bacterial infection of the prostate gland. A man with chronic bacterial prostatitis will usually have had recurring urine infections. Chronic bacterial prostatitis is usually caused by the same type of bacteria that causes the urine infections. The prostate gland can harbour infection and therefore recurring infections can occur. Chronic bacterial prostatitis is not a sexually transmitted infection.
Men with chronic bacterial prostatitis tend to have symptoms that wax and wane. During a flare-up, you can have pain and discomfort. You feel this mainly at the base of your penis, around your anus, just above your pubic bone and/or in your lower back. Pain may spread to your penis and testes. Passing stools (faeces) can be painful. You may also have symptoms from a urine infection, such as pain when you pass urine, passing urine frequently or an urgent desire to pass urine.
These symptoms are similar to the symptoms of acute bacterial prostatitis. However, men with a flare-up of chronic bacterial prostatitis tend to be less ill than those with acute prostatitis. For example, a fever (high temperature) is less likely and you are less likely to have general aches and pains.
If you have chronic bacterial prostatitis, your symptoms will generally ease when treated with antibiotics. However, unless the antibiotics completely clear the infection from the prostate gland, you are at risk of the infection coming back (flaring up) again. In between flare-ups, you may have some mild residual pain and some mild urinary symptoms (such as passing urine frequently or an urgent desire to pass urine).
Chronic prostatitis/CPPS is a chronic (persistent) discomfort or pain that you feel in your lower pelvic region - mainly at the base of your penis and around your anus. It is usually diagnosed if you have had pain for at least three months within the previous six months.
The cause of this type of chronic prostatitis is not fully understood. Many theories have been put forward as to the cause. These include: infection of the prostate with a germ that has not yet been identified; nerve problems affecting the prostate; an autoimmune problem of the prostate gland (antibodies that we normally produce to fight infection may be attacking the cells of the prostate gland for some reason); inflammation resulting from urine being forced backwards up into the prostate at the time of urination.
The term prostatitis really refers to inflammation and/or infection of the prostate gland. However, the exact cause of this form of chronic prostatitis is not known and there is a variable response to antibiotics and anti-inflammatory painkillers. For these reasons, some doctors prefer to use the term 'chronic pelvic pain syndrome'. Using this term does not necessarily imply that the problem definitely stems from a problem with the prostate gland.
Symptoms have usually been present for at least three months within the previous six months.
The symptoms include:
If your doctor suspects that you have chronic prostatitis, they may refer you to a specialist (usually a urologist) for further assessment. If you are referred to a specialist, a sample of fluid ('secretions') from the prostate may be collected to rule out infection in your prostate. To do this, a doctor can gently massage your prostate, with a gloved finger in your rectum. By doing this, fluid from the prostate is pushed out into the urethra and comes out from the penis to be collected and tested for bacteria (germs). If you have CPPS, no bacteria are found in the the prostate fluid or urine.
The treatment of chronic prostatitis can be difficult. However, in most people, symptoms improve over months or years.
If your GP suspects that you have chronic prostatitis, as mentioned above, they will usually refer you to a specialist for further assessment. In the meantime, your GP may suggest one or more of the following whilst you are waiting for your appointment with a specialist:
Reassurance and explanation are also sometimes helpful. Some people worry that they may have a serious disease such as prostate cancer. Worry and anxiety can make symptoms worse. Therefore, it may be useful to know that you have chronic prostatitis and not some other disease. However, you will have to accept that pain or discomfort are likely to persist for some time.
Various treatments have been tried for chronic prostatitis. They may benefit some people, but so far there are few research studies to confirm whether they help in most cases. They are not 'standard' or routine treatments, but a specialist may advise that you try one.
For chronic bacterial prostatitis, possible treatments may include the following:
For chronic prostatitis/CPPS, possible treatments may include the following:
Research continues to try to find better treatments for chronic bacterial prostatitis and chronic prostatitis/CPPS.
It is difficult to give a prognosis (outlook). Your symptoms may last a long time, although they may 'come and go' or vary in severity. Painkillers can keep discomfort to a minimum.
Most men diagnosed with chronic prostatitis/CPPS tend to have an improvement in their symptoms over the following six months. In one study, about a third of men had no further symptoms one year later. In another large study, one third of men showed moderate to marked improvement over two years.
An internet-based, UK-focused, organisation for information, support and campaigning related to the prostate diseases of prostatitis/chronic prostatitis/CPPS.
6 Crescent Stables, 139 Upper Richmond Road, London SW15 2TN
Tel: 020 8788 7720 Web: www.prostateuk.org