Diagnosis

Diagnosing prostatitis involves ruling out other conditions as the cause of your symptoms and determining what kind of prostatitis you have. Your doctor will ask about your medical history and your symptoms. He or she will also do a physical exam, which will likely include a digital rectal examination.

Initial diagnostic tests might include:

  • Urine tests. Your doctor might have a sample of your urine analyzed to look for signs of infection in your urine (urinalysis). Your doctor might also send a sample of your urine to a lab to determine if you have an infection.
  • Blood tests. Your doctor might examine samples of your blood for signs of infection and other prostate problems.
  • Post-prostatic massage. In rare cases, your doctor might massage your prostate and test the secretions.
  • Imaging tests. In some cases, your doctor might order a CT scan of your urinary tract and prostate or a sonogram of your prostate. CT scan images provide more detailed information than plain X-rays do. A sonogram is the visual image produced by an ultrasound.

Based on your symptoms and test results, your doctor might conclude that you have one of the following types of prostatitis:

  • Acute bacterial prostatitis. Often caused by common strains of bacteria, this type of prostatitis generally starts suddenly and causes flu-like signs and symptoms, such as fever, chills, nausea and vomiting.
  • Chronic bacterial prostatitis. When antibiotics don't eliminate the bacteria causing prostatitis, you can develop recurring or difficult-to-treat infections. Between bouts of chronic bacterial prostatitis, you might have no symptoms or only minor ones.
  • Chronic prostatitis/chronic pelvic pain syndrome. This type of prostatitis — the most common —isn’t caused by bacteria. Often an exact cause can't be identified. For some men, symptoms stay about the same over time. For others, the symptoms go through cycles of being more and less severe.
  • Asymptomatic inflammatory prostatitis. This type of prostatitis doesn't cause symptoms and is usually found only by chance when you're undergoing tests for other conditions. It doesn't require treatment.

Treatment

Prostatitis treatments depend on the underlying cause. They can include:

  • Antibiotics. This is the most commonly prescribed treatment for prostatitis. Your doctor will choose your medication based on the type of bacteria that might be causing your infection.

  • If you have severe symptoms, you might need intravenous (IV) antibiotics. You'll likely need to take oral antibiotics for four to six weeks but might need longer treatment for chronic or recurring prostatitis.

  • Alpha blockers. These medications help relax the bladder neck and the muscle fibers where your prostate joins your bladder. This treatment might ease symptoms, such as painful urination.
  • Anti-inflammatory agents. Nonsteroidal anti-inflammatory drugs (NSAIDs) might make you more comfortable.

Lifestyle and home remedies

The following might ease some symptoms of prostatitis:

  • Soak in a warm bath (sitz bath) or use a heating pad.
  • Limit or avoid alcohol, caffeine, and spicy or acidic foods, which can irritate your bladder.
  • Avoid activities that can irritate your prostate, such as prolonged sitting or bicycling.
  • Drink plenty of caffeine-free beverages. This will cause you to urinate more and help flush bacteria from your bladder.

Alternative medicine

Alternative therapies that show some promise for reducing symptoms of prostatitis include:

  • Biofeedback. A biofeedback specialist uses signals from monitoring equipment to teach you to control certain body functions and responses, including relaxing your muscles.
  • Acupuncture. This involves inserting very thin needles through your skin to various depths at certain points on your body.
  • Herbal remedies and supplements. There's no evidence that herbs and supplements improve prostatitis, although many men take them. Some herbal treatments for prostatitis include rye grass (cernilton), a chemical found in green tea, onions and other plants (quercetin) and extract of the saw palmetto plant.

Discuss your use of alternative medicine practices and supplements with your doctor.

Preparing for your appointment

You might start by seeing your primary care provider. Or you might be referred immediately to a specialist in urinary tract and sexual disorders (urologist).

Here's some information to help you get ready for your appointment.

What you can do

Make a list of:

  • Your symptoms, including any that might seem unrelated to the reason for your appointment, and when they began
  • Key personal information, including major stresses or recent illnesses
  • All medications, vitamins or other supplements you take, including doses
  • Questions to ask your doctor

Take a family member or friend along, if possible, to help you remember the information you're given.

For prostatitis, questions to ask your doctor include:

  • What is likely causing my symptoms?
  • What other conditions could be causing my pain?
  • What kinds of tests will I need?
  • What treatment do you recommend?
  • Are there other treatment options?
  • Are there brochures or other printed materials I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

  • When did you begin having symptoms?
  • How severe are your symptoms?
  • Have your symptoms been continuous, or do they come and go?
  • Were you recently diagnosed with a urinary tract infection?
  • Have you had frequent urinary tract infections in the past?
  • Have you had a recent injury to your groin?
  • What, if anything, seems to improve your symptoms?
Nov. 23, 2016
References
  1. Meyrier A, et al. Acute bacterial prostatitis. http://www.uptodate.com/home. Accessed Oct. 11, 2016.
  2. Meyrier A, et al. Chronic bacterial prostatitis. http://www.uptodate.com/home. Accessed Oct. 11, 2016.
  3. Prostatitis. Prostate Cancer Foundation. http://www.pcf.org/site/c.leJRIROrEpH/b.5813305/k.A27E/Prostatitis.htm. Accessed Oct. 14, 2016.
  4. Prostatitis: Inflammation of the prostate. National Kidney and Urological Diseases Information Clearinghouse. https://www.niddk.nih.gov/health-information/health-topics/urologic-disease/prostate-problems/Pages/facts.aspx/. Accessed Oct. 14, 2016.
  5. Pontari M. Chronic prostatitis/chronic pelvic pain syndrome. http://www.uptodate.com/home. Accessed Oct. 14, 2016.
  6. Sharp VJ, et al. Prostatitis: Diagnosis and treatment. American Family Physician. 2010;82:397.
  7. Castle EP (expert opinion). Mayo Clinic, Scottsdale/Phoenix, Ariz. Oct. 26, 2016.