Prostatitis Causes More Than Pain

In the vast majority of cases, prostatitis isn't the result of an infected prostate. Rather, it's a syndrome that encompasses a variety of symptoms and requires a multimodal treatment approach.


There comes a time in every man's life when he will have "issues" with the walnut-sized gland that rests beneath the bladder and surrounds the ureter. Prostatitis is one of them.

Historically, a man complaining of pelvic pain, urinary problems, and other hallmark signs of prostatitis would visit his doctor and receive repeated, prolonged courses of antibiotics. The thought was that a bacterial infection was the underlying culprit. We now know that such infections occur in only a small percentage of men with prostatitis, thus rendering antibiotics ineffective in most cases. Fact is, in many instances, doctors cannot pinpoint prostatitis causes.

We also know that the complications of prostatitis can extend beyond the prostate. Oftentimes, prostatitis causes a broad array of symptoms that vary from person to person, and the most common type of prostatitis—chronic pelvic pain syndrome, or CPPS—can have dramatic effects on a man’s quality of life.

Given the variety of problems that prostatitis causes, only a multifaceted treatment approach provides relief for most men with the disease.

When Bacteria Are to Blame for Prostatitis

You experience a sudden onset of fever, chills, and other flu-like symptoms. You’re fatigued and have pain in your lower back, abdomen, or genitals. It hurts when you urinate, ejaculate, or move your bowels, and you have difficulty urinating and emptying your bladder completely. These are the signs of acute bacterial, or Category 1, prostatitis.

Category 2 (chronic bacterial) prostatitis causes similar symptoms, although they tend to develop more slowly and are less severe. Chronic bacterial prostatitis is characterized by recurrent urinary tract infections due to bacteria that linger in the prostate.

In these first two categories, the cause of prostatitis (a bacterial infection) is understood. Both types of bacterial prostatitis also share risk factors: a recent urinary tract infection, use of a urinary catheter, sexually transmitted diseases, habitually starting and stopping during urination, and unprotected sex, especially anal sex.

Likewise, the treatment of acute and chronic bacterial prostatitis is clear: antibiotic therapy. For acute bacterial prostatitis, a treatment course of up to eight weeks may be prescribed to prevent recurrences that can lead to chronic prostatitis. Typically, a longer course of antibiotics, up to 12 weeks or more, is prescribed for chronic bacterial prostatitis, while some men with this condition may require permanent low-dose antibiotic therapy.

The CPPS Enigma

Unfortunately, only about one in 10 cases of prostatitis has a clear-cut bacterial origin. Most men with prostatitis suffer from the more nebulous Category 3, or CPPS, perhaps the most challenging of the four types of prostatitis. (A fourth category, acute asymptomatic inflammatory prostatitis, causes no symptoms, requires no treatment, and is usually discovered incidentally during tests for other conditions.)

Affecting an estimated 17 percent of all men, CPPS is characterized by prostatic inflammation with no known cause. This type of prostatitis causes urinary problems (such as increased urinary frequency or urgency), pain in the prostate, bladder, or outside the pelvis and abdomen, muscle tenderness/spasm, chronic fatigue, neurological problems, and irritable bowel syndrome.

This broad spectrum of symptoms associated with CPPS necessitates an array of treatments that differ from patient to patient. For instance, one man may have only urinary problems and prostatic inflammation that can be treated successfully with anti-inflammatory drugs and medications to manage his urinary symptoms. Another man with CPPS may suffer from chronic neuromuscular pain outside the pelvis that won’t respond to treatment aimed solely at the prostate.

Alpha-blocker medications—alfuzosin (Uroxatral) silodosin (Rapaflo) or tamsulosin (Flomax)—or anticholinergic drugs like tolterodine (Detrol) or oxybutynin (Ditropan) are commonly used to treat urinary symptoms associated with CPPS. Along with taking pain medications, sitting on a doughnut-shaped cushion or soaking in a warm sitz bath can help relieve CPPS-related pelvic muscle spasms and pain. (A sitz is a shallow bath that cleanses the perineum, the space between the rectum and the scrotum.)

Some physicians recommend quercetin (an antioxidant) and bee pollen for patients with inflammation and pain localized to the prostate that is affected by bladder emptying and refilling. Some of these patients with bladder-specific symptoms may be prescribed drugs such as amitriptyline (Elavil) and pentosan (Elmiron), or undergo neuromodulation, using an implantable device that regulates nerves controlling the bladder.

For CPPS patients with chronic fatigue and pain outside the pelvis and abdomen, neuroleptic drugs—such as amitriptyline, nortriptyline (Pamelor), and pregabalin (Lyrica)—or acupuncture may be recommended. And, antibiotics are necessary for the small percentage of CPPS patients with an underlying bacterial infection.

Find the Help You Need

Just as CPPS often warrants multiple types of treatment, it also may require help from multiple medical specialists. A urologist can help manage most aspects of CPPS, including erectile dysfunction, a common problem among men with CPPS.

However, if you have tenderness or tightness in your pelvic floor muscles, you could benefit from pelvic floor physical therapy from a trained therapist. You might seek a consultation with a psychiatrist if CPPS is causing depression, anxiety, or stress. And, if your persistent pain hasn’t improved after a prolonged treatment, consider a referral to a chronic-pain-management program.

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Originally published in 2016, this post is regularly updated.

As a service to our readers, University Health News offers a vast archive of free digital content. Please note the date published or last update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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Jim Black

Jim Black has served as executive editor of Cleveland Clinic’s Men’s Health Advisor newsletter since 2005. He has written about prostate diseases, men’s health, cardiovascular disease, cancer, and a wide … Read More

View all posts by Jim Black

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  • Most of men confuse bph with prostatitis, I was confused about it as well but my brother thats urologist explained me the difference between those, I had strong prostate symptoms and they were getting worse and stronger, He prescribed me a treatment based on a supplement named alpharise.. I didn’t notice big changes at first but it was until the second month when I noticed the symptoms were disappearing and it’s been 5 months already and I am totally okay now.

  • My General Practitioners are not skilled or trained to deal with CPPS , I have seen many GP’s and made to feel like I’m wasting their time.
    This just exaggerates the condition and makes you feel twice as bad as before your visit to the doctors .

  • Hi Jim, just been kind of diagnosed with Prostatitis. What I mean is I’ve had stomach cramps and burning feelings in groin for 3 weeks now and this all occurred after a severe diet and a rare sexual experience with my wife. Naturally at first I’m thinking its either bruising from sex or the diet that followed the week after which involved a lot of fasting. I thought the lack of food was giving me going pain. Been to one female doc who said yes it probably was the diet, went back this week (week3) and male doc seems to think its Prostatitis and nothing to do with sex or diet. I had a 5 file blood test one of which was a spa test and am going for an ultrasound in a few weeks but Ive read so much in between time about misdiagnosis and generally crapping myself that I might have prostate cancer that I dont know what to think even if my all my results are clear. One post said you must get a culture smear from the prostate to be absolutely certain its not cancer or even Prostatitis .I was wondering how you’re symptoms have been going since your post. Have they completely gone and do you know what you had in the end? thanks Paul

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