Prostatitis is inflammation of the prostate gland. The prostate is a walnut-sized gland in men that surrounds the urethra. The prostate produces a fluid that is part of semen.

There are four types of prostatitis:

• Category 1: acute bacterial (least common of the four types, but the most common in men under 35)
• Category 2: chronic bacterial (not very common, but affects mostly men between 40-70)
• Category 3: chronic nonbacterial/prostadynia (most common type, chronic pelvic pain)
  • Note: Prostadynia (also known as chronic pelvic pain syndrome) is a condition associated with similar symptoms as chronic nonbacterial prostatitis, but which has no evidence of prostatic inflammation.
• Category 4: asymptomatic inflammatory prostatitis

Acute and some chronic bacterial prostatitis are caused by bacteria that infect the prostate gland. The bacteria usually come from the urinary tract or rectum. The causes of nonbacterial prostatitis can be difficult to identify, but some feel this may be caused by nonbacterial pathogens such as chlamydia , virus, fungus, or mycoplasma.

The causes of prostatodynia can be even more difficult to identify. But, the condition can be associated with stress and/or disorders of pelvic floor muscle tension or conditions such as interstitial cystitis . Asymptomatic inflammatory prostatitis is found during a prostate biopsy . The cause is not clearly understood.

A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:

• Medical procedures that involve inserting a catheter or other tubing into your urethra or rectum
• Anal intercourse
• Recent bladder infection
• Abnormalities in the anatomy of the urinary tract
• Diabetes
• Suppressed immune system
• Something obstructing the bladder (eg, a tumor, a kidney stone , or enlargement of the prostate gland itself)

Symptoms of prostatitis can come on slowly or suddenly. They can be mild or quite severe. In nonbacterial prostatitis, symptoms often come and go.

Symptoms may include:

• Needing to urinate frequently and/or urgently (especially at night)
• Pain or burning while urinating
• Difficulty urinating
• Blood in the urine
• Psychological stress
• Lower abdominal pain or pressure
• Rectal or perineal discomfort
• Lower back pain
• Fever or chills
• Painful ejaculation
• Impotence (due to inflammation around the gland)

The doctor will ask about your symptoms and medical history, and perform a physical exam. Diagnosis of prostatitis is usually based on the symptoms and massaging the prostate gland. In this test, the doctor places a lubricated, gloved finger into the rectum to feel the back wall of the prostate. In prostatitis, the prostate is usually tender and soft.

Other tests may include:

• Analysis of urine and prostate fluid expressed after massaging the prostate gland
• Bladder function tests

Treatment depends on the type of prostatitis:

Acute bacterial prostatitis is treated with oral antibiotics for 1-2 weeks. The commonly used drugs include quinolones (norfloxacin, ciprofloxacin, levofloxacin) or trimethoprim. In severe cases, treatment with intravenous antibiotics may be necessary. Chronic bacterial prostatitis is also treated with oral antibiotics for 4-12 weeks. Other medications include:

• Stool softeners
• Anti-inflammatory medications
• Other analgesics or pain medications
• Alpha-blockers such as Flomax
• 5-alpha reductase inhibitors such as Proscar or Avodart

Your doctor may recommend that you alcohol and caffeinated beverages.

Often patients are initially given a course of antibiotics. This is just in case an infectious cause was missed. Other treatments include:

• Alpha-blockers such as Flomax
• 5-alpha reductase inhibitors such as Proscar or Avodart
• Anti-inflammatory medications such as ibuprofen
• Pain killers
• Warm sitz baths
• Repeated prostate massages