Chronic prostatitis is inflammation of the prostate that continues for 3 months or longer. It is often painful and can affect sexual function and the ability to urinate. Many health issues, including recurrent bacterial infections and damage to the nerves or muscles in the pelvic area, can cause it.
In this article, we look at the causes and symptoms of chronic prostatitis. We also cover diagnosis, treatment, and home and alternative remedies.
The prostate is a small gland that forms part of the lower urinary tract in males. It sits under the bladder and surrounds the urethra, which is the tube that carries urine and semen out through the penis.
The prostate is part of the male reproductive system and produces one of the fluids that make up semen. The muscles of this gland also help push semen into the urethra during ejaculation.
Due to its location and function, problems with the prostate can affect urination as well as sexual function.
Prostatitis is an inflammation of the prostate that can often be painful. It can be chronic or acute:
- Chronic prostatitis develops gradually and can last for months or even years. Doctors consider prostatitis to be chronic if symptoms continue for 3 months or more. It may not respond well to the first treatments a doctor recommends.
- Acute prostatitis is a temporary condition that occurs suddenly. It may only last a few days or weeks and often responds well to treatment.
Prostatitis is the leading cause of urinary tract issues for men under 50 years of age, and the third most common urinary tract issue for men over 50 years of age.
An accurate diagnosis is key to effective treatment. However, diagnosing the cause of chronic prostatitis can sometimes prove challenging.
The causes of chronic prostatitis fall into two broad categories:
Chronic bacterial prostatitis
A bacterial infection of the prostate causes chronic bacterial prostatitis. In some people, this infection develops following a urinary tract infection or treatment for acute bacterial prostatitis.
The symptoms of chronic bacterial prostatitis are often less severe than those of acute bacterial prostatitis. A person who has previously had an acute infection might notice that their symptoms get better, but do not go away.
Some people with chronic bacterial prostatitis may find that the infection persists. This may be because the bacteria are resistant to antibiotic treatment or the antibiotic treatment course is too short. According to one study, some bacteria that infect the prostate can form biofilms in animals. Biofilms are similar to the plaque that develops on teeth and can make the infection harder to treat.
Chronic non-bacterial prostatitis, or chronic pelvic pain syndrome
This is a non-bacterial form of prostatitis that can have many causes and is harder to treat. Someone who has had a previous bacterial infection of the prostate may be at risk of developing this type of prostatitis. Other people may develop chronic pain in the prostate after a bacterial infection clears up.
Possible causes of chronic prostatitis include:
- psychological stress
- damage to the urinary tract from surgery or a physical injury
The main symptom of chronic prostatitis is pelvic or genital pain. For some people, the pain feels like a gnawing ache. For others, it is intense and sharp. The pain may come and go or always be present.
Other symptoms of chronic prostatitis include:
- needing to urinate frequently, including getting up several times at night to use the bathroom
- pain during urination
- difficulty urinating
- a sense of urgency when needing to urinate
- pain in the perineum, the space between the scrotum and rectum
- pain in the lower back, rectum, penis, or testicles
- pain when ejaculating
- difficulty ejaculating
- signs of an infection, such as fever, chills, nausea, or vomiting
People with symptoms of prostatitis should see a doctor. Bacterial prostate infections can spread, so anyone with symptoms of an infection should seek medical attention as soon as possible.
To diagnose prostatitis, a doctor will usually begin by taking the person's medical history. They may also perform a rectal exam.
During a rectal exam, a doctor inserts a finger into the person's rectum to check the prostate for swelling and inflammation. They may also look for signs of infection, such as discharge from the penis or swollen lymph nodes.
If a doctor suspects the problem is due to a bacterial infection, they may recommend antibiotics. If symptoms do not improve following antibiotic treatment, or there are no signs of an infection, other tests might be necessary, such as:
- urine, semen, or blood testing to look for signs of infection or other prostate issues
- a prostate biopsy, where a doctor uses a needle to remove a small sample of tissue from the prostate for analysis
- an ultrasound of the prostate or urethra
- a cystoscopy, where a doctor uses a small scope to look inside the bladder or urethra
Treatment for prostatitis depends on the cause. For bacterial prostatitis, a doctor or urologist will usually recommend oral antibiotics. People with chronic prostatitis or recurrent infections may need a long-term course of antibiotics, lasting up to 6 months.
If symptoms do not improve following oral antibiotics, other treatment options include:
- intravenous antibiotics for severe infections
- muscle relaxants to relieve spasm of the pelvic muscles
- non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain
- alpha blockers to treat urination difficulties
- surgery to remove scar tissue in the urethra, which can help urination difficulties
- therapy to help with psychological stress and anxiety
Kegel exercises, also known as pelvic floor exercises, can help improve urination difficulties in people with chronic prostatitis. The exercises work by strengthening the muscles around the bladder and penis.
To do these exercises, sit in a comfortable position then tighten and relax the pelvic muscles 10 to 15 times in a row. A person can locate their pelvic muscles by pretending to stop urination mid-flow.
Repeat these Kegel exercises several times a day. As a person becomes more comfortable with the exercises, they can increase the length of time they hold the muscle in, as well as the number of repetitions they do. It may take a few months before a person notices the results.
Other home and alternative remedies that may provide symptom relief for people with chronic prostatitis include:
- taking daily sitz or hip baths in warm or hot water
- relaxation exercises
- using a hot water bottle or heat pad to apply heat to the perineum or rectum
Chronic prostatitis can be painful and can cause difficulties with urination. Anyone with symptoms of prostatitis should see a doctor.
Treatment depends on the cause and symptoms, but a doctor will often prescribe a course of antibiotics. Some people may also find symptom relief from trying Kegel exercises and certain home and alternative remedies.