13 Common Prostatitis Questions

The prostate gland is located below the bladder and surrounds this structure of the urinary tract. 

That is why an enlarged prostate often triggers urinary symptoms. But what about prostatitis?

Prostatitis causes similar urinary problems, and it might be difficult to differentiate at first glance. But unlike benign prostatic hyperplasia, prostatitis causes significant pain symptoms in some patients. Others are entirely asymptomatic. 

We will address thirteen common prostatitis questions in this article.

What is prostatitis?

The prostate gland is connected to the lower urinary tract through a series of prostatic ducts. It increases semen volume by producing prostatic fluid. But such connection with the urinary tract makes this gland subject to bacterial infection. 

That is what we call bacterial prostatitis, and it is broken down into chronic prostatitis and acute prostatitis. They both feature inflammation of the prostate, usually caused by a bacterial infection.

Chronic prostatitis is a bit more complex, and sometimes there is no traceable cause. We can find a patient that does not have any bacteria in the prostate. Yet, they display the same signs and symptoms. This is known as chronic nonbacterial prostatitis. They all have in common an active inflammatory process in the gland.

Although prostatitis features swelling of the gland, not all patients have an enlarged prostate. Thus, distinguishing prostatitis from prostate cancer and benign prostatic hyperplasia (BPH) is essential. 

What does prostatitis pain feel like?

Different patients experience different symptoms. Some of them do not feel anything at all. Yet, they have an active inflammation of the prostate gland. Indeed, the disease manifests differently in each individual. 

However, we can describe the symptoms of prostatitis in two broad categories (1):

• Acute prostatitis, which features more severe pain and urinary tract symptoms. Pain can be felt between the rectum and the testicles (perineum). In some cases, it radiates to the testicles or the penis, and it may hurt when you ejaculate. Patients often describe a burning pain when urinating, too. It is usually a type of bacterial prostatitis, and the urinary symptoms can be confused with an enlarged prostate.
• Chronic prostatitis and chronic pelvic pain syndrome are a broader category with many subcategories. In these cases, pain is usually not as severe but lingers for a very long time. It affects the quality of life of the patient very profoundly. Pain is similar to the one described above, but the patient experiences constant flare-ups. The pain can be very severe during flare-ups and affect bowel movements, too.

What causes prostatitis to flare up?

As noted above, chronic prostatitis causes periodical flare-ups with severe symptoms. They are followed by periods of temporary remission in which patients may experience reduced or no symptoms. 

In acute prostatitis, the pain symptoms remain until antibiotic treatment is on course. Something similar happens with chronic prostatitis. But it is very difficult to predict when patients will experience a flare-up. Each patient will probably need to find out their own triggers. 

However, in general, most flare-up triggers include:

• Inflammatory foods, especially acidic and spicy meals (2).
• High levels of stress and anxiety (3).
• Not following or discontinuing the antibiotic therapy recommended by your doctor (4).
• Constipation, which prostatitis sometimes causes, also aggravates symptoms.
• Some studies also suggest that exposure to cold and other environmental changes may trigger the symptoms (5).

Interestingly, flare-up frequency and intensity can be reduced in patients with rheumatologic diseases. This is probably because they already use nonsteroidal anti-inflammatory drugs and other means to control inflammation.

Could your symptoms be caused by something other than prostatitis?

Before diagnosing bacterial prostatitis, other ailments should be considered. Some of them are directly associated with the prostate. Others have to do with adjacent organs such as the bladder. 

This is known as differential diagnosis, which includes (6):

• Benign prostatic hyperplasia, prostate cancer, and other forms of prostate enlargement.
• Inflammatory bowel disease and other chronic pain syndromes
• Testicular cancer
• Kidney stones
• A urinary tract infection and male urethritis

Chronic pelvic pain syndrome is a complex entity that includes chronic bacterial prostatitis. Sometimes even an immune problem can be the cause of these symptoms. These patients often need several tests and trying different therapies before finding significant relief.

How can you avoid getting prostatitis again?

The answer depends on the type of prostatitis you were diagnosed with. For instance, in acute prostatitis, the main reason why you would get a relapse is inadequate antibiotic treatment.

If you don’t follow your treatment, you are likely to experience a relapse. The same happens if you discontinue your therapy because you now feel better and don’t think you need it anymore (7).

In chronic prostatitis, noncompliance with antibiotic therapy is also one of the leading causes of relapse. Another possibility is that patients use other drugs that interact with antibiotic treatment. Studies suggest that prostate stones contribute to antimicrobial resistance and relapse.

In short, if you don’t want this prostate infection to keep giving symptoms, you should follow your treatment. Be sure to mention if you are currently taking medications to treat any chronic disease. Do not modify your therapy unless instructed by your urologist (4). 

What questions should I ask my doctor?

You can read a lot about prostatitis, but not everything you read applies to you. This would be a complex topic, especially if you were diagnosed with chronic prostatitis. 

So, the best source of personalized information about your condition should be your doctor. Here’s a list of questions you can ask in your next appointment:

• Is there anything, in particular, causing or worsening my symptoms?
• Do I have any overlapping health problems causing or worsening my symptoms?
• Do I need to run additional tests?
• What are my treatment options? Are there any alternatives we can try?
• For how long do I need to follow my prostatitis treatment? Should I make any changes after seeing an improvement in pain or urinary symptoms?
• Is there any printed material I can take to get informed?
• Do I have prostatitis and an enlarged prostate, or is it only prostatitis?

Also, if the fear of prostate cancer is in your mind, don’t be afraid to talk it over. You could ask if you will need prostate cancer screening in the future.

Who is more likely to develop prostatitis?

Unlike prostate cancer, bacterial prostatitis is more common in young people than seniors. You can be at a higher risk of acute prostatitis if you have:

• Diagnosed intraprostatic ductal reflux
• If you regularly practice unprotected anal sex
• Redundant foreskin and phimosis
• If you have repeated urinary tract infections
• If you recently had a urinary catheter placed, especially if it was there for a long time

Chronic prostatitis is a more complex entity, and the risk factors vary. However, you are still more likely to suffer this problem in these cases (8):

• If you’re a young man
• If you consume higher levels of alcohol, caffeine, and spicy foods
• Depression is predictive of more severe chronic prostatitis symptoms
• You’re also expected to experience more severe symptoms the more treatments courses you needed

Interestingly, prostatitis is much more common than we think. According to a study, there is something known as asymptomatic inflammatory prostatitis, which can be found in up to 19% of males. Thus, males are likely to have prostatitis at any point in their lives, even if not all of them display symptoms (9).

How is prostatitis diagnosed?

Acute prostatitis and chronic bacterial prostatitis are suspected based on prostatitis symptoms such as pelvic pain, painful urination, a weak urine flow, painful ejaculations, and more. 

When these symptoms are detected, prostatitis is the first guess in a young patient, while an enlarged prostate should be ruled out in seniors.

This is a bacterial infection. Thus, the first step for the diagnosis is usually performing a urinalysis and urine culture. 

They would help doctors identify the bacteria that is causing problems. They could order more specific tests to help them differentiate between urethritis and prostatitis (4).

Can prostatitis go away on its own?

Once you have an infected prostate, doctors will recommend antibiotic treatment. Otherwise, the disease may not be resolved entirely.

Moreover, if you leave prostatitis untreated, hoping that it goes away on its own, you could end up with chronic prostatitis. When acute prostatitis goes chronic, the disease is much more difficult to treat.

What is sex with prostatitis like?

Bacterial prostatitis can also trigger sexual dysfunction. Among the usual symptoms of this ailment, we have ejaculatory pain, and some patients may even report erectile dysfunction. The experience can be different depending on the type of prostatitis you were diagnosed with.

Acute prostatitis features a more intense pain that will likely help you achieve full erections. It might be particularly painful when you ejaculate. 

This uncomfortable sensation will probably refrain you from reaching orgasm in the future. Thus, it could trigger further sexual-related problems.

Studies about chronic prostatitis suggest that these patients experience various sexual dysfunction symptoms. 

Besides pain during ejaculation, they could experience pain during intercourse. Many of them also report a significant reduction in sexual desire (libido). Premature ejaculation is also a problem in these patients. All of this could make their sexual experience difficult and quite troublesome (10).

What happens if prostatitis is left untreated?

As noted above, bacterial prostatitis does not go away or resolve on its own. Some types of chronic prostatitis may respond better to lifestyle changes than medications. However, you will know that after trying different approaches until you find the one that works best for you.

In any case, if you leave prostatitis untreated, there are more consequences than the possibility of a relapse. You could also develop a prostatic abscess as a complication of the disease. 

This is basically an encapsulated collection of pus that grows larger if the infection is not resolved. Ultimately, a prostatic abscess might rupture and cause a life-threatening event (11).

Does ejaculating help prostatitis?

There are different opinions and evidence to guide each one. For example, a trial with 34 male patients with bacterial prostatitis described the effects after abstinence versus masturbating at least twice a week. 

The authors reported that 11% of patients with more frequent ejaculations had a complete resolution of the symptoms. 33% reported marked improvements, and the other 33% had a moderate improvement. Only 22% of them did not benefit. 

These results seem to recommend ejaculating and regular sexual activity as an activity worth encouraging to improve prostatitis symptoms (12).

Another study correlated ejaculation frequency and urinary symptoms such as those found in prostatitis and an enlarged prostate. The authors reported no association between the variables. 

In other words, according to their study, it doesn’t matter how frequently you ejaculate; the risk of prostatitis symptoms remains the same (13).

There is no consensus about this topic, and the evidence is so far not conclusive. However, there is no reason to stop having sex if you have prostatitis. It might be uncomfortable for some patients, but it is not contraindicated.

RELATED: 9 Tips for Having Sex if You Have Prostatitis.

Can prostatitis affect bowel movements?

Yes, chronic prostatitis, in particular, can lead to slow bowel movements (constipation). By itself, constipation could also increase prostate pain after straining. Thus, if you were diagnosed with this disease, it is a good idea to stimulate intestinal transit. This can be done naturally with high-fiber foods, probiotics, and fiber supplements.

Conclusion

Prostatitis causes urinary tract symptoms similar to a bacterial bladder infection. It is broken down into acute and chronic bacterial prostatitis. 

Each type of prostatitis has different features, symptoms, causes, risk factors, and treatment. There’s also an entity known as chronic pelvic pain syndrome, which features lingering pain with flare-ups that affect the patients’ quality of life. These infections of the prostate gland should be promptly treated. 

We still need to know more about this ailment, especially the chronic variant of prostatitis. However, our current medical knowledge allows us to treat the condition and achieve significant improvements in the patient’s quality of life.

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