PROSTATITIS – Types, Causes and Risk Factors, Clinical Manifestations, Diagnostic Evaluations and Management 

PROSTATITIS – Types, Causes and Risk Factors, Clinical Manifestations, Diagnostic Evaluations and Management

PROSTATITIS – Types, Causes and Risk Factors, Clinical Manifestations, Diagnostic Evaluations and Management

Prostatitis is inflammation of the prostate (a gland beneath the bladder that produces components of semen). This inflammation can be acute (acute prostatitis) when it is commonly due to infection, or persistent or relapsing (chronic prostatitis).


  1. Acute bacterial prostatitis: The least common form of prostatitis but it demands prompt treatment so that complications do not occur. Acute  prostatitis is usually associated with lower urinary infection spreading from the bladder or associated with sexually transmitted disease (STDs) such as gonorrhea or Chlamydia. Bacteria such as Klebsiella or Escherichia cause the symptoms. Acute bacterial prostatitis can occur after sclerotherapy for rectal prolapse. Symptoms of acute bacterial prostatitis: symptoms include fever, general pains and more specifically, pain in the lower back and genital region, the testicles, penis and the area between the scrotum and anus. Frequent trips to the rest room may be required, with pain during urination. You may feel you need to go urgently. Painful ejaculation may also be a symptom. The doctor will be able to tell if the prostate is tender and swollen
  2. Chronic Bacterial Prostatitis: chronic bacterial prostatitis is an uncommon recurrent infection with inflammation of the prostate and urinary tract. There is often an abnormality of the prostate and this need to be fixed so that the focal infections do not keep recurring. Symptoms chronic bacterial prostatitis: symptoms tend to be less severe when compared with the acute form but can include discomfort in the genital area, lower back pain and/or abdomen, painful ejaculation, fever, blood in the semen and recurrent urinary tract infections.
  3. Nonbacterial Prostatitis: as its name implies, no bacterial infection is present in the inflamed prostate but the symptoms are often the same as with other forms of prostatits. The cause is unknown but it is thought that organisms such as viruses or Chlamydia may be responsible.
  4. Chronic Prostatitis (also known as chronic pelvic pain syndrome and prostatdynia): commonly known as chronic pelvic pain syndrome where symptoms of prostatitis occur but there is no inflammation or bacterial infection. In the inflammatory form, although no infection is found there are cells in the urine, semen and other fluids that are known to be produced when infection is actually present. The non inflammatory type shows no inflammation and no immune defense cells. The cause is unknown in chronic prostatitis but like chronic pelvic pain syndrome, a virus or Chlamydia may be responsible.​


How the prostate become infected is not clear. The bacteria that cause prostatitis may get into the prostate from the urethra by backward flow of infected urine or stool from the rectum. At one time, prostatitis was believed to be a sexually transmitted disease, but more recent research suggests that only a small number of cases are passed on through sex.

Certain conditions and medical procedures increase the risk of developing prostatitis. Patient are at higher risk for getting prostatitis if:

  • Recently have had a medical instrument, such as a urinary catheter
  • Engage in rectal intercourse
  • Have an abnormal urinary tract
  • Have had a recent bladder infection
  • Have an enlarged prostate
  • Autoimmune disease (an abnormal reaction of the body to the prostate tissue)
  • Excessive alcohol intake
  • Injury to the perineum
  • Emotional factors including stress and depression



Symptoms of prostatitis are usually begun more gradually. Patients may have no symptoms in between episodes, or they may experience mild symptoms all the time.

Symptoms may include:

  • Blood in the urine
  • Blood in semen (haemospermia)
  • Decreased urinary stream
  • Delayed start of urination (urinary hesitancy)
  • Frequency or discomfort on passing urine
  • Incontinence
  • Low-grade fever
  • Pain or burning with urination


Subtle symptoms may include:

  • Low back pain
  • Pain in the perineum or pelvic floor
  • Pain with bowel movement
  • Pain with ejaculation
  • Pain with sexual intercourse
  • Testicular pain



The infection may be cultured from the urine, a swab from the urethra or, occasionally, the doctor may obtain a specimen of prostate secretions by massaging the prostate using a finger placed in the rectum.

Rectal examination of the prostate might produce discomfort or pain and the gland can feel ‘spongy’ to the doctor. A blood test may reveal a slightly raised PSA (prostate specific antigen) level but examination and tests are frequently normal. Some urologists used to attempt prostatic massage to obtain a specimen of prostate secretions by massaging the prostate using a finger placed in the rectum for examination, but this now rarely carried out.



Administer anti-inflammatory medicines along with warm sitz baths (sitting in two to three inches of warm water). This is the most conservative treatment for chronic prostatitis.

  1. Administer antibiotic medicine for infectious prostatitis. For acute infectious prostatitis, patients usually need to take antibiotic medicine for 14 days. Tetracycline antibiotics, especially doxycycline (e.g. vibramycin), erythromycin (e.g. erythrocin) or ofloxacin (e.g. tarivid) are the drugs of choice.
  2. Pain medications
  3. Muscle relaxants
  4. Surgical removal of the infected portions of the prostate gland
  5. Supportive therapies for chronic prostatitis, including stool softeners and prostate massage
  6. Other treatments for chronic noninfectious prostatitis include the use of the alpha blocker drugs such as Hytrin and Cardura. These drugs relax the muscles of the prostate and bladder to improve urine flow and decrease symptoms. Other drugs that lower hormone levels, such as proscar (finasteride), may help to shrink the prostate gland in some men


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.

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.


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