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Prostatitis - bacterial

Chronic prostatitis - bacterial; Acute prostatitis

 

Prostatitis is swelling of the prostate gland. Prostate tissue becomes inflamed. This problem can be caused by an infection with bacteria.

Acute prostatitis starts quickly and chronic prostatitis lasts for 3 months or more.

Ongoing irritation of the prostate that is not caused by bacteria is called chronic nonbacterial prostatitis.

Causes

 

Any bacteria that can cause a urinary tract infection can cause acute bacterial prostatitis.

Infections spread through sexual contact can cause prostatitis. These include chlamydia and gonorrhea. Sexually transmitted infections (STIs) are more likely to occur from:

  • Certain sexual practices, such as having anal sex without wearing a condom
  • Having many sexual partners

In men over age 35, E. coli and other common bacteria most often cause prostatitis. This type of prostatitis may begin in the:

  • Epididymis, a small tube that sits on top of the testes
  • Urethra, the tube that carries urine from your bladder and out through the penis

Acute prostatitis may also be caused by problems with the urethra or prostate, such as:

  • Blockage that reduces or prevent the flow of urine out of the bladder
  • Foreskin of the penis that cannot be pulled back (phimosis)
  • Injury to the area between the scrotum and anus (perineum)
  • Urinary catheter, cystoscopy, or prostate biopsy (removing a piece of tissue to look for cancer)

Men age 50 or older who have an enlarged prostate have a higher risk for prostatitis. The prostate gland may become blocked. This makes it easier for bacteria to grow. Symptoms of chronic prostatitis can be similar to symptoms of an enlarged prostate gland.

 

Symptoms

 

Symptoms can start quickly, and can include:

  • Chills
  • Fever
  • Flushing of the skin

Symptoms of chronic prostatitis are similar, but not as severe. They often begin more slowly. Some people have no symptoms between episodes of prostatitis.

Urinary symptoms include:

  • Blood in the urine
  • Burning or pain with urination
  • Difficulty starting to urinate or emptying the bladder
  • Foul-smelling urine
  • Weak urine stream

Other symptoms that may occur with this condition:

  • Pain or achiness in the abdomen above the pubic bone, in the lower back, in the area between the genitals and anus, or in the testicles
  • Pain with ejaculation or blood in the semen
  • Pain with bowel movements

If prostatitis occurs with an infection in or around the testicles (epididymitis or orchitis), you may also have symptoms of that condition.

 

Exams and Tests

 

During a physical exam, your health care provider may find:

  • Enlarged or tender lymph nodes in your groin
  • Fluid released from your urethra
  • Swollen or tender scrotum

The provider may perform a digital rectal exam to examine your prostate. During this exam, the provider inserts a lubricated, gloved finger into your rectum. The exam should be done very gently to reduce the risk of spreading bacteria into the blood stream.

The exam may reveal that the prostate is:

  • Large and soft (with a chronic prostate infection)
  • Warm, soft, swollen, or tender (with an acute prostate infection)

Urine samples may be collected for urinalysis and urine culture.

Prostatitis may affect the results of the prostate-specific antigen (PSA), a blood test to screen for prostate cancer.

 

Treatment

 

Antibiotics are often used to treat prostate infections.

  • For acute prostatitis, you will take antibiotics for 2 to 6 weeks.
  • For chronic prostatitis, you will take antibiotics for at least 2 to 6 weeks. Because the infection can come back, you may need to take medicine for up to 12 weeks.

Often, the infection will not go away even after taking antibiotics for a long time. Your symptoms may come back when you stop the medicine.

If your swollen prostate gland makes it hard to empty your bladder, you may need a tube to empty it. The tube may be inserted through your abdomen (suprapubic catheter) or from inside your body (indwelling catheter).

To care for prostatitis at home:

  • Urinate often and completely.
  • Take warm baths to relieve pain.
  • Take stool softeners to make bowel movements more comfortable.
  • Avoid substances that irritate your bladder, such as alcohol, caffeinated foods and drinks, citrus juices, and hot or spicy foods.
  • Drink more fluid (64 to 128 ounces per day) to urinate often and help flush bacteria out of your bladder.

Get checked by your provider after you finish taking your antibiotic treatment to make sure the infection is gone.

 

Outlook (Prognosis)

 

Acute prostatitis should go away with medicine and minor changes to your diet and behavior.

Acute prostatitis may come back or turn into chronic prostatitis.

 

Possible Complications

 

Complications may include:

  • Abscess
  • Inability to urinate (urinary retention)
  • Spread of bacteria from the prostate to the bloodstream (sepsis)

 

When to Contact a Medical Professional

 

Call your provider if you have symptoms of prostatitis.

 

Prevention

 

Not all types of prostatitis can be prevented.

Practice safe sex behaviors.

 

 

References

Kaplan SA. Benign prostatic hyperplasia and prostatitis. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 129.

Nickel JC. In: Wein AJ, ed. Prostatitis and related conditions, orchitis, and epididymitis. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 11.

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        Review Date: 8/31/2015

        Reviewed By: Jennifer Sobol, DO, urologist at the Michigan Institute of Urology, West Bloomfield, MI. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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