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Chronic prostatitis is swelling and irritation (inflammation) of the prostate gland that develops slowly and continues for a long period of time.
Chronic prostatitis is usually not caused by a bacterial infection. When it is caused by bacteria, chronic prostatitis may occur with or follow:
The most common bacteria species that cause chronic prostatitis include:
The disorder is diagnosed in 5 of every 1,000 outpatient visits. As many as 35% of men over age 50 may have chronic prostatitis.
Risks include:
These factors may cause congestion of the prostate gland, which produces a breeding ground for bacteria.
Other possible causes are related to stress and tightness of the pelvic muscles.
Low-grade or subtle symptoms may include:
Note: There may be no symptoms.
A physical examination may show:
Triple-void urine specimens may be collected for urinalysis and urine culture. Urine may be collected:
Other tests may include:
Treatment options for chronic prostatitis include a combination of medication, surgery, and lifestyle changes.
MEDICATIONS
Chronic prostatitis is treated with a long course (6 - 12 weeks or longer) of antibiotics. Trimethoprim-sulfamethoxazole (Bactrim) and ciprofloxacin (Cipro) are commonly used. Other antibiotics that may be used include:
Most antibiotics do not get into the prostate tissue well. Often, the infection continues even after long periods of treatment. After antibiotic treatment has ended, it is common for symptoms to return.
Stool softeners may be recommended to reduce discomfort with bowel movements.
Nonsteroidal anti-inflammatory medications (NSAIDs such as Aleve and Motrin) and alpha blockers (such as Hytrin, Flomax, and Cardura) may also be used.
SURGERY
Transurethral resection of the prostate may be necessary if antibiotic therapy is unsuccessful or the condition keeps returning. This surgery is usually not performed on younger men because it carries a risk of retrograde ejaculation, which can lead to sterility, impotence, and incontinence.
Prostate massage and myofascial release are other treatments that may help this condition.
OTHER THERAPY:
Frequent and complete urination is recommended to decrease the symptoms of urinary urgency. If the swollen prostate restricts the urethra, the bladder may not empty. Inserting a suprapubic catheter, which allows the bladder to drain through the abdomen, may be necessary.
DIET:
Avoid substances that irritate the bladder, such as alcohol, caffeinated beverages, citrus juices, and hot or spicy foods.
Increasing the intake of fluids (64 - 128 ounces per day) encourages frequent urination. This will help flush bacteria from the bladder.
MONITORING:
See your health care provider for an exam after you finish taking antibiotics to make sure that the infection is gone.
It is common for symptoms to return.
If the enlarged prostate severely restricts the flow of urine through the urethra, urinary retention may cause kidney damage.
Call your health care provider if you have symptoms of chronic prostatitis.
Avoiding urinary tract infections and sexually transmitted diseases can help prevent chronic prostatitis. Finish the full course of antibiotic treatment to reduce the chance of the condition returning.
Barry MJ, McNaughton-Collins M. Benign prostate disease and prostatitis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 130.
