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:

• Acute prostatitis
• Epididymitis
• Urinary tract infection
• Urethritis

The most common bacteria species that cause chronic prostatitis include:

• E. coli
• Enterobacter
• Klebsiella
• Proteus

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:

• Age over 30
• Certain sexual practices (such as anal sex without a condom)
• Excessive alcohol intake
• Injury to the perineum (the area between the scrotum and anus)

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.

• Blood in the urine
• Decreased urine stream
• Frequent urination
• Incontinence
• Low-grade fever
• Pain with urination
• Urinary hesitancy (delayed start of urination)

Low-grade or subtle symptoms may include:

• Low back pain
• Pain and burning with urination
• Pain in the perineum or pelvic floor
• Pain with bowel movement
• Pain with ejaculation
• Testicular pain

Note: There may be no symptoms.

A physical examination may show:

• Discharge from the urethra
• Enlarged, mildly tender prostate
• Enlarged or tender lymph nodes in the groin area
• Swelling and tenderness of the scrotum

Triple-void urine specimens may be collected for urinalysis and urine culture. Urine may be collected:

1. Initial stream
2. Mid-stream
3. After a prostate massage by examiner

Other tests may include:

• Culture of prostate secretions
• Semen analysis

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:

• Carbenicillin
• Erythromycin
• Nitrofurantoin
• Tetracycline

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.