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Bacterial prostatitis

Published by Bupa's health information team, May 2009.

This factsheet is for people who have bacterial prostatitis, or who would like information about it.

Prostatitis is an inflammation of the prostate gland. It can be caused by a bacterial infection (bacterial prostatitis) or it may have an unknown cause - this is referred to as chronic prostatitis or chronic pelvic pain syndrome (CPPS).

Prostatitis only occurs in men aged 18 and over - it's estimated that half of all men have at least one bout of prostatitis during their lifetime. However, bacterial prostatitis is the least common type of prostatitis, accounting for less than one in 20 of all those diagnosed.

About bacterial prostatitis
Symptoms of bacterial prostatitis
Complications of bacterial prostatitis
Causes of bacterial prostatitis
Diagnosis of bacterial prostatitis
Treatment for bacterial prostatitis
Living with chronic bacterial prostatitis
Questions and answers
Related topics
Further information
Sources

About bacterial prostatitis

The prostate is a gland that produces the majority of the liquid part of semen. It's about the size of a walnut and lies at the base of your bladder near your back passage (rectum). The front of your prostate surrounds your urethra, the tube that carries urine from your bladder and out through your penis.

Illustration showing the position of the testicles and surrounding structures
The position of the testicles and surrounding structures

Bacterial prostatitis is an infection in your prostate. This may be an acute infection which is typically over quite quickly, or it may be a chronic infection which lasts a long time and can come and go. The terms acute and chronic refer to time, not how serious the condition is.

Symptoms of bacterial prostatitis

The symptoms of acute and chronic bacterial prostatitis differ in their severity.

Symptoms of acute bacterial prostatitis usually come on suddenly and can cause you to become so unwell that you need to be admitted to hospital, they include:

a fever with shivers
aches and pains in your joints and muscles
pain when you urinate
a feeling of urgency or needing to urinate more than you usually do
blood in your urine
severe pain in your lower back, penis, rectum and/or the area between your scrotum and anus (perineum)

Symptoms of chronic bacterial prostatitis are less serious and you usually have them for a longer period of time (at least three months). You may find that your symptoms come and go in severity, and there are periods when you have no symptoms at all - this is due to the infection flaring up and then dying down. Symptoms include:

pain, most commonly in the area between your scrotum and anus (perineum), as well as in your lower abdomen, penis (especially the tip), testicles, rectum and lower back
pain or discomfort when you ejaculate
pain when you urinate
a feeling of urgency to urinate, your bladder hesitating when you try to urinate or needing to urinate more often than you usually do
poor urine stream
feeling tired with aches and pains in your joints and muscles
discomfort in the lower abdomen or at the tip of the penis

Complications of bacterial prostatitis

With acute bacterial prostatitis your prostate can swell and stop you from passing urine altogether (urinary retention). There is also a risk of developing conditions such as cystitis, epididymitis (inflammation of the epididymis), septicaemia (blood poisoning) and an abscess on your prostate. People who have a weakened immune system, for example people with HIV/AIDS or those taking immunosuppressant medicines, are most at risk of developing these complications.

Another complication is the possibility of acute bacterial prostatitis developing into chronic bacterial prostatitis. This is more likely to happen if you only have treatment (antibiotics) for less than four weeks.

Causes of bacterial prostatitis

Bacterial prostatitis is caused by the same kinds of bacteria that cause urine infections (urinary tract infections). Bacteria that cause bacterial prostatitis include Escherichia coli, Proteus, Klebsiella, Pseudomonas and Staphylococcus aureus. Your urinary tract includes your kidneys, ureters (the tubes that drain urine from your kidneys into your bladder), bladder and urethra. For this reason, men often have a urinary tract infection at the same time as having prostatitis.

It's possible for infections to spread from elsewhere in your body causing prostatitis, such as the blood or lymphatic system.

Prostatitis can also be caused by an injury to your pelvic area or if you have had a catheter (a thin, flexible tube) inserted into your bladder to drain urine.

Diagnosis of bacterial prostatitis

Bacterial prostatitis can be diagnosed by your GP. He or she will ask you to give a sample of your urine and blood so that they can be tested for bacteria.

All cases of bacterial prostatitis or suspected bacterial prostatitis are referred to a urologist for further tests and possible treatment. A urologist is a doctor who specialises in identifying and treating conditions of the urinary system.

Symptoms of acute bacterial prostatitis can be severe and if you are seriously ill you may be admitted to hospital for emergency treatment.

Chronic bacterial prostatitis can be harder to diagnose than acute bacterial prostatitis, this is because the infection comes and goes so the bacteria may not always be present in your urine. Your GP or urologist will ask you about your symptoms and may carry out additional tests, such as a swab of your urethra or an ultrasound, to rule out other possible conditions.

To confirm a diagnosis of chronic bacterial prostatitis you may be given a prostatic massage at the hospital. This is when a urologist inserts a gloved finger into your rectum to manually massage your prostate. Any fluids extracted from your penis as a result of the massage will be collected and sent to a laboratory for testing. You may also be asked to give urine samples immediately before and after the massage.

Treatment for bacterial prostatitis

Acute bacterial prostatitis

Initially, you will be given a course of antibiotics, such as ciprofloxacin (eg Ciproxin) or ofloxacin and advised to rest and drink enough fluids. If your symptoms are severe or you don't respond to antibiotic treatment, you may be admitted to hospital for emergency treatment.

Once your GP has received the results of your urine and blood tests, he or she may change your antibiotic in accordance with the type of bacterium found. You will be advised to continue taking your antibiotics for at least four weeks. Always read the patient information leaflet that comes with your medicine.

If you are in pain or have a high temperature, you can take painkillers such as paracetamol or ibuprofen to ease your symptoms. It's best to take painkillers at regular intervals until the pain settles rather than every 'now and then'.

You may be prescribed a laxative (eg lactulose) to help keep your stools soft. Hard stools in your rectum can put pressure on your infected prostate, causing pain when you have a bowel movement.

Once you are feeling better, your GP will arrange for you to be referred to a urologist for further tests. These tests are to ensure that you have no further problems with your urinary tract.

Chronic bacterial prostatitis

Your GP will refer you to a urologist for further tests and treatment. While waiting for your appointment, your GP will advise you to take painkillers, such as paracetamol or ibuprofen, for any pain and may prescribe you a course of antibiotics such as ciprofloxacin or ofloxacin You will be advised to take your antibiotics for at least four weeks. Always read the patient information leaflet that comes with your medicine.

If you are getting pain when you have a bowel movement, your GP can prescribe you a laxative to help soften your stools.

Once you have completed your course of antibiotics, your urologist will ask you to provide another sample of urine to ensure that the infection has gone. If an infection is still present, you may need more tests to establish the cause of the infection or you may be given a longer course of antibiotics (three months).

If the inflammation in your prostate persists, your urologist may try several different types of treatments to manage your symptoms. Currently the most beneficial treatment for chronic prostatitis is alpha-blockers, such as alfuzosin or tamsulosin These are medicines that relax the muscle fibres controlling tension in the prostate gland, helping to relieve internal pressure and allowing your bladder to empty more easily.

In some rare cases, your urologist may advise that you have a prostatectomy. This is an operation in which the whole or part of your prostate is removed. This is only recommended if prostate stones (prostatic calculi) or prostatic obstruction are thought to be causing recurrent infections. However, the evidence for this procedure is inconclusive and further research is needed to establish how effective it is in treating men with chronic bacterial prostatitis.

Living with chronic bacterial prostatitis

Chronic bacterial prostatitis can sometimes be difficult to treat successfully. It's possible for the infection in your prostate to linger, resulting in recurrent infections. This means that you may have symptoms and require treatment periodically in the long-term. Your urologist will be able to give you help and advice on coping with chronic bacterial prostatitis. There are also support groups that you can contact for further support.