Prostatitis - bacterial chronic

• Alternative Names

  Chronic bacterial prostatitis

• Causes, incidence, and risk factors

  Chronic prostatitis is usually caused by a chronic bacterial infection of the prostate gland. It may occur with or follow:

  • Acute prostatitis
  • Epididymitis
  • Urinary tract infection that often returns (is recurrent)
  • Urethritis

  The most common bacteria species that cause chronic prostatitis include:

  • Escherichia coli
  • Enterobacter cloacae
  • Klebsiella pneumonia
  • Proteus species

  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.

• Symptoms

  Symptoms of chronic prostatitis are similar to those of acute prostatitis but are not as severe. They usually begin 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
  • Decreased urinary stream
  • Delayed start of urination (urinary hesitancy)
  • Frequent urination
  • 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
  • Testicular pain

  Note: There may be no symptoms.

• Signs and tests

  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

  During a physical exam, the prostate gland may feel normal, or large and soft (boggy).

  Urine specimens may be collected for urinalysis and urine culture.

  Other tests may include:

  • Culture of prostate secretions
  • Semen analysis

  Other possible tests are:

  • Pressure flow studies
  • Cystoscopy
  • Transrectal ultrasound
  • Prostate specific antigen (PSA)
• Treatment

  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 or Septra) 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.

  Sometimes small stones form in the prostate gland, making it harder to clear the infection.

  Stool softeners may be recommended to reduce discomfort with bowel movements.

  Nonsteroidal anti-inflammatory medications (NSAIDs such as Aleve and Motrin) and alpha adrenergic blockers (such as doxazosin [Cardura], tamulosin [Flomax], or terazosin [Hytra]) 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 urine flow through 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.

• Expectations (prognosis)

  It is common for symptoms to return.

• Complications

  If the prostate is very large, it can slow urine flow through the urethra and cause the backward flow (reflux) of urine toward the kidneys, which can cause kidney damage.

  If the flow of urine completely stops, it is considered an emergency.

• Calling your health care provider

  Call your health care provider if you have symptoms of chronic prostatitis.

• Prevention

  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.

• References

  Nickel JC. Inflammatory conditions of the male genitourinary tract: prostatitis and related conditions, orchitis, and epididymitis. In: Wein AJ. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 9.

  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.

Review Date: 9/30/2009

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Scott Miller, MD, Urologist in private practice in Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.