Bacterial prostatitis

Published by Bupa's Health Information Team, April 2011.

This factsheet is for men who have bacterial prostatitis, or people who would like information about it.

Prostatitis is a swelling (inflammation) of the prostate gland. It can be caused by a bacterial infection (bacterial prostatitis) or it may have an unknown cause (chronic abacterial prostatitis).

It's estimated that half of all men have prostatitis at least once during their lifetime. However, bacterial prostatitis is rare, accounting for less than one in 20 cases of all those diagnosed.

About bacterial prostatitis

Your prostate is a gland that produces the liquid part of semen. It's about the size of a walnut and lies at the base of your bladder. The front of your prostate surrounds your urethra, the tube that carries urine from your bladder and out through your penis.

All adult men are at risk of having prostatitis. Most men with prostatitis have no obvious cause for the inflammation but in a few, it is caused by a bacterial infection in the prostate. Bacterial prostatitis can be classed as an acute or chronic infection. The terms ‘acute’ and ‘chronic’ refer to how long you have had the infection, not how serious the condition is. An acute infection is typically over quickly whereas a chronic infection can last a long time and come and go.

Most men with bacterial prostatitis have a chronic infection and are usually over 50.

Symptoms of bacterial prostatitis

Symptoms of bacterial prostatitis may include:

• a fever with shivers
• muscle and joint pain
• pain on passing urine, on ejaculation or during bowel movement
• a frequent or urgent need to pass urine
• difficulty in passing urine (urinary retention)
• pain in your lower abdomen, lower back and/or the area between your scrotum and anus (perineum), at the tip of your penis, testicles and rectum (back passage)
• feeling generally unwell

The symptoms of acute bacterial prostatitis tend to be more severe. They usually come on suddenly and can cause you to become so unwell that there is a high chance you will need to be admitted to hospital.

Symptoms of chronic bacterial prostatitis are less serious and usually last a long time (at least three months). You may find that your symptoms get better and then worse again, and there are periods when you have no symptoms at all.

These symptoms aren’t always caused by bacterial prostatitis, but if you have them, see your GP.

Complications of bacterial prostatitis

Complications of acute bacterial prostatitis are uncommon, but can include: 

• being unable to pass urine (urinary retention)
• bladder infection (cystitis)
• inflammation of the epididymis – a long, narrow tube at the back of your testicles where your sperm are stored
• blood poisoning (septicaemia)
• an abscess developing on your prostate

People who have a weakened immune system, such as those who have HIV/AIDS, or those who are taking medicines that suppress the immune system, are more likely to develop these complications.

There is also a risk of acute bacterial prostatitis developing into chronic bacterial prostatitis.

Causes of bacterial prostatitis

Bacterial prostatitis is caused by infection of your prostate with the same kinds of bacteria that cause urinary tract infections. These include Escherichia coli, Proteus, Klebsiella, Pseudomonas and Staphylococcus aureus.

Rarely, infections can spread from elsewhere in your body, such as the blood or lymphatic system, causing prostatitis.

Prostatitis can also be caused by an injury to your pelvic area or if you have had a catheter inserted into your bladder to drain urine.

Diagnosis of bacterial prostatitis

Bacterial prostatitis can be diagnosed by your GP. Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history and for a sample of your urine. Your GP may test your urine with a 'dipstick' or send the sample to a laboratory for testing.

Symptoms of acute bacterial prostatitis can be severe and if you are seriously ill, you may be admitted to hospital for emergency treatment.

Chronic bacterial prostatitis can be harder to diagnose than acute bacterial prostatitis. This is because the infection comes and goes so the bacteria may not always be present in your urine. If your GP suspects you have chronic bacterial prostatitis, he or she may need to refer you to a urologist for further hospital tests. A urologist is a doctor who specialises in identifying and treating conditions of the urinary system.

At the hospital, you will need to give a sample of your urine and blood. Your doctor may also take a swab of your urethra. To confirm a diagnosis of chronic bacterial prostatitis you may be given a prostatic massage. This is when your doctor inserts a gloved finger into your rectum to manually massage your prostate. Any fluids extracted from your penis as a result of the massage will be collected and sent to a laboratory for testing. You may also be asked to give urine samples immediately before and after the massage.

A prostatic massage isn’t recommended for acute bacterial prostatitis because of the risk of septicaemia.

Treatment of bacterial prostatitis

The type of treatment you have will depend on whether you have acute or chronic bacterial prostatitis. For both types of the condition, your doctor will advise you to rest and drink enough fluids.

Medicines

Your urologist may try several different types of medicines to manage your symptoms. Some of these are listed below.

• Antibiotics. You will usually be prescribed a four-week course of antibiotics, such as ciprofloxacin or ofloxacin. If you have acute prostatitis and your symptoms are severe or you don't respond to treatment, you may be admitted to hospital so that you can be given antibiotics via a drip. If you have chronic bacterial prostatitis and don’t respond to treatment initially, you may need to try different types of antibiotics or take them for a longer period of time.
• Alpha-blockers. These include alfuzosin and tamsulosin. Your doctor may prescribe these if you have chronic bacterial prostatitis. They work by relaxing the muscle fibres controlling tension in your prostate, helping to relieve internal pressure and allowing your bladder to empty more easily.
• If you have pain during bowel movements, you may be prescribed a laxative (eg lactulose) to help make your faeces softer and easier to pass.
• If you’re in pain or have a high temperature, you can also take over-the-counter painkillers such as paracetamol or ibuprofen to ease your symptoms.

Surgery

If you have a chronic infection and it hasn’t responded to treatment with medicines, your doctor may suggest surgical treatment. This is rare and isn’t suitable for most men – it is usually only recommended for men who have prostate stones (prostatic calculi) or prostatic obstruction thought to be causing recurrent infections.

Surgery can include an operation to remove your prostate or part of your prostate (prostatectomy), or heat therapy (minimally invasive transurethral microwave thermotherapy) to destroy part of your prostate.

However, the evidence for these treatments isn’t conclusive and more research needs to be done to prove that they are effective in treating chronic bacterial prostatitis.

Living with chronic bacterial prostatitis

Chronic bacterial prostatitis can sometimes be difficult to treat successfully. It's possible for the infection in your prostate to linger, resulting in recurrent infections. This means that symptoms come back every now and then, and you need treatment periodically in the long term. Your doctor will be able to give you help and advice on coping with chronic bacterial prostatitis. There are also support groups that you can contact for further help.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.