Prostatitis: Could This Common Condition Be Causing Your Chronic Pelvic Pain?
Key takeaways:
Prostatitis is inflammation of the prostate gland. It causes pelvic pain and pain with ejaculation and urination.
The most common type of prostatitis is called chronic prostatitis/chronic pelvic pain syndrome. It’s treated with medications and exercises to strengthen the pelvic floor.
Acute and chronic bacterial prostatitis are less common types of prostatitis. Bacteria that cause UTIs (urinary tract infections), gonorrhea, and chlamydia can lead to these types of prostatitis.
Prostatitis is inflammation of the prostate — an organ about the size of a ping pong ball that sits below the bladder.
When the prostate gets inflamed, it becomes swollen and tender, leading to pelvic pain. A swollen prostate will push on nearby structures, too. This can lead to symptoms like pain with ejaculation and trouble with urination.
Prostatitis is very common. Experts estimate that half of all men develop prostatitis during their lifetime. If you’ve been experiencing pelvic pain, prostatitis could be the reason. Here’s what you should know about prostatitis and how to get lasting pain relief.
What are the different types of prostatitis?
Prostatitis is a general term that refers to inflammation of the prostate. But there are actually four types of prostatitis.
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Chronic prostatitis/chronic pelvic pain syndrome
This is the most common type of prostatitis and accounts for most cases of the condition.
It’s not clear why people develop chronic prostatitis/chronic pelvic pain syndrome.
It might be caused by the immune system attacking the prostate.
Another possibility is nerve damage. People who have had surgery in their pelvic area are more likely to develop chronic prostatitis. Experts think that surgery might lead to chronic nerve irritation, causing the nerves to misfire and trigger a pain response.
There’s no evidence that bacteria causes chronic prostatitis/chronic pelvic pain syndrome.
Acute bacterial prostatitis
Acute bacterial prostatitis is an infection of the prostate caused by bacteria, most often by E. Coli.
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This is the same bacteria that usually causes UTIs (urinary tract infections) in men, but people with UTIs don’t usually develop acute prostatitis. You’re more likely to develop acute bacterial prostatitis after having a pelvic surgery, like a prostate biopsy, or if you have urethral strictures or other conditions that affect your urinary tract.
In general, acute bacterial prostatitis isn’t very common, but keep in mind that it can be caused by the sexually transmitted diseases chlamydia and gonorrhea. If you’re sexually active, condoms can protect you from this painful condition.
Chronic bacterial prostatitis
Chronic bacterial prostatitis is also a bacterial infection of the prostate. E. Coli is once again the most common cause.
The difference between acute and chronic bacterial prostatitis is how long the condition lasts. Chronic bacterial prostatitis lasts longer.
Asymptomatic inflammatory prostatitis
Asymptomatic inflammatory prostatitis is a condition that isn’t completely understood. It’s not even clear if it’s a medical condition at all.
People with this type of prostatitis have an inflamed prostate but no symptoms. The condition is often found by accident when people have their urine tested for other reasons.
What are the symptoms of prostatitis?
People with chronic prostatitis/chronic pelvic pain can experience:
Pain in their pelvis, genitals, and lower back
Pain with urination and stooling
Trouble urinating and emptying the bladder
Feeling the need to urinate more often
Erectile dysfunction and pain during ejaculation
People with acute bacterial prostatitis have additional symptoms, including:
Fever
Body aches
Nausea
Chills
How do you diagnose prostatitis?
A healthcare provider can diagnose prostatitis by asking about your symptoms. They'll also check your urine for bacteria and signs of inflammation. If you’re sexually active, you might also need testing for STIs like chlamydia and gonorrhea.
Your healthcare provider may also need to do a digital rectal exam. During this exam, the healthcare provider inserts a gloved, lubricated finger into your rectum to check your prostate for pain.
How is prostatitis treated?
Your treatment plan depends on what kind of prostatitis you have.
Treatment for chronic prostatitis/chronic pelvic pain
Treatment for chronic prostatitis/chronic pelvic pain can vary from person to person. What works for you may not work for someone else.
Studies show that people often get long-lasting relief when they use several treatments together:
Alpha-blockers: Alpha-blockers can make it easier to urinate and empty your bladder. Experts recommend 0.4 mg of tamsulosin (Flomax) once a day for about six weeks.
Pain relievers: Experts recommend a short burst of an anti-inflammatory medication like ibuprofen. Medications like pregabalin (Lyrica) can also soothe irritated nerves.
5-alpha-reductase inhibitors: These medications can help lessen pain with urination. But they can affect semen volume, so they’re not recommended if you’re currently trying to have children.
Pelvic floor exercises: Pelvic floor exercises are a very important part of treatment. They help you engage your pelvic floor muscles so that you’re able to use the bathroom and have sex with less pain. Massage therapy can be used along with pelvic floor exercises for extra relief. A physical therapist can help you perfect your pelvic floor exercises.
Complementary and Alternative medicine (CAM): Several types of CAM can help with chronic pelvic pain, including biofeedback and acupuncture.
Phosphodiesterase-5 inhibitors: These medications include sildenafil (Viagra). They can help if you have erectile dysfunction from your chronic pelvic pain.
You may need to change your treatment plan over time if certain things stop working for you. Keep working with your healthcare provider to find the best options for you.
Treatment for acute and chronic bacterial prostatitis
Antibiotics treat both acute and chronic bacterial prostatitis. The most commonly used antibiotics for these conditions are:
Ciprofloxacin (Cipro), at a dosage of 500 mg twice a day
Levofloxacin (Levaquin), at a dosage of 500 mg once a day
Trimethoprim-sulfamethoxazole (Bactrim DS), at 1 tablet twice a day
You’ll take these antibiotics for 4 to 12 weeks, depending on whether you have acute or chronic bacterial prostatitis.
Treatment for asymptomatic prostatitis
People with asymptomatic prostatitis don’t need any treatment.
The bottom line
There are four types of prostatitis. The most common type is chronic prostatitis/chronic pelvic pain syndrome. It causes pelvic pain, trouble with urination, pain with sex, and erectile dysfunction. Half of all men experience prostatitis during their lives. But there are treatments that can relieve symptoms and pain. Treatments include medications, pelvic floor exercises and biofeedback.
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References
Habermacher, G. M., et al. (2006). Prostatitis / chronic pelvic pain syndrome. Annual Review of Medicine.
Lee, S. W. H., et al. (2008). Adverse impact of sexual dysfunction in chronic prostatitis / chronic pelvic pain syndrome. Urology.
Magistro, G., et al. (2016). Contemporary management of chronic prostatitis / chronic pelvic pain syndrome. European Urology.
MedlinePlus. (2021). Prostatitis - bacterial.
