Prostatitis: symptoms, treatment and how long it lasts

The NHS lists pain when peeing, which may feel like stinging or burning, difficulty peeing or straining to pee, needing to pee more often than usual, pain in the penis, scrotum, testicles or bottom, pain when you ejaculate, and a high temperature. NICE Clinical Knowledge Summaries add that in acute infection there may be perineal or rectal pain, low back pain, urinary retention, and a tender, swollen, warm prostate on gentle examination, along with fever, rigors and muscle or joint aches that indicate infection in the bloodstream.

In chronic prostatitis, pain is the dominant feature. NICE describes at least 3 months of urogenital pain, which may be in the perineum, lower abdomen, penis, testicle, rectum or lower back, often with urinary symptoms such as frequency, hesitancy and urgency, and sexual symptoms such as painful ejaculation or erectile difficulty. Symptoms often fluctuate rather than following a steady course.

• Burning or stinging when passing urine.

• Straining, hesitancy or a weak stream.

• Pain between the scrotum and anus, or in the penis, testicles or lower back.

• Pain on ejaculation.

• Fever and feeling unwell, in the acute form.

The NHS says prostatitis is treated with antibiotics, and that you will usually feel better within 2 weeks of starting although it can take several weeks for every symptom to settle. NICE Clinical Knowledge Summaries describe assessment with a mid-stream urine sample, blood tests where appropriate, examination, and consideration of sexually transmitted infection screening. For a man who is not septic or in retention, a 14-day oral antibiotic course is prescribed, with follow-up after 48 hours to check the response and the urine culture result, and a review of the antibiotic after 14 days.

Simple measures help alongside: paracetamol or ibuprofen for pain, drinking enough fluid, and finishing the whole antibiotic course even if you feel better, as the NHS advises. After recovery NICE recommends investigation to exclude a structural problem in the urinary tract, such as an enlarged prostate, because that can make infection more likely to recur.

The NHS says that if symptoms have lasted 3 months or longer you may be referred to a urologist, and treatment may include antibiotics and other medicines to help symptoms, cognitive behavioural therapy or counselling, physiotherapy and alternative therapies such as acupuncture where available. NICE Clinical Knowledge Summaries estimate that about 10% of chronic prostatitis is chronic bacterial prostatitis and about 90% is chronic prostatitis or chronic pelvic pain syndrome with no proven bacterial infection.

For the latter group, the NICE summary lists paracetamol or an NSAID for pain, a stool softener if defecation is painful, a 4 to 6 week trial of an alpha-blocker when significant urinary symptoms are present, and a single course of antibiotics if symptoms have been present for less than 6 months. If symptoms persist, urology referral follows. NICE notes that in most cases symptoms trend to improve over months or years, though quality of life can be greatly reduced meanwhile.

The NHS says to see a GP if you have symptoms of prostatitis, and to try not to be embarrassed, since the doctor will be used to discussing them. It advises an urgent GP appointment or NHS 111 if you are unable to pee, or if you have taken antibiotics for prostatitis for 48 hours and your symptoms have not got better or have got worse.

It advises going to A&E or calling 999 if there are signs of serious infection or sepsis: sudden confusion, slurred speech or not making sense; blue, grey, pale or blotchy skin, lips or tongue; a rash that does not fade when a glass is rolled over it; or severe difficulty breathing. NICE Clinical Knowledge Summaries add that hospital admission is arranged if the person cannot take oral antibiotics, has severe symptoms or signs of sepsis, retention or abscess, or does not improve within 48 hours of starting antibiotics.

The prostate is a small gland found below the bladder in men, and in other people with a prostate. Prostatitis is inflammation of it. The NHS says symptoms can affect anyone with a prostate gland.

Prostate Cancer UK describes prostatitis as a set of symptoms thought to be caused by an inflammation of the prostate or problems with the nerves and muscles in the surrounding area. It says it may also be caused by an infection of the prostate, but this is rare, and that it is not cancer.

The NHS says prostatitis is usually caused by an infection, such as a urinary tract infection (UTI), and that it is not always known what causes long-term (chronic) prostatitis. It is thought that an infection or inflammation, or a combination, may be responsible.

NICE Clinical Knowledge Summaries says acute bacterial prostatitis may follow urethral instrumentation, trauma, bladder outflow obstruction, or spread of infection from outside the urinary tract. Prostate Cancer UK adds that it can happen if you have a urine infection, have had difficulty emptying your bladder, have had a prostate biopsy, or regularly use a catheter.

For chronic pelvic pain syndrome, Prostate Cancer UK says nobody knows for certain what causes it, and lists possible triggers including urine getting into the prostate, previous infections, nerve problems, stress, anxiety or depression, and problems with the pelvic floor muscles. It says some research shows a link between stress, anxiety and depression and CPPS, but that this does not mean it is all in your head.

For the acute infection, the NHS says you will usually feel better within 2 weeks after starting antibiotics, but it may take several weeks for all your symptoms to get better. NICE Clinical Knowledge Summaries says most people treated appropriately for acute prostatitis recover completely within 2 weeks, and that in some the infection may last for up to 6 weeks.

Chronic prostatitis is defined as at least 3 months of symptoms. NICE says people with it can have a greatly reduced quality of life, but that in most cases the trend is for symptoms to improve over months or years. Prostate Cancer UK says that with CPPS even after treatment you may still have prostatitis for a long time, and it might come and go, causing occasional episodes of severe pain known as flare-ups.

NICE Clinical Knowledge Summaries describes the assessment for suspected acute bacterial prostatitis as a mid-stream urine sample to confirm infection by dipstick, culture and sensitivity, blood cultures and a full blood count, a physical examination including the abdomen and genitals, and a digital rectal examination. Screening for sexually transmitted infections is considered, particularly in people at risk.

Chronic prostatitis should be diagnosed from the person's history and by excluding other conditions that could be causing symptoms, NICE says, including a urinary tract infection, urethritis, epididymo-orchitis, benign prostatic enlargement, cancer of the prostate, bladder or colon, urethral stricture, and stones or a foreign body in the urinary tract.

Usually not. NICE Clinical Knowledge Summaries describes acute bacterial prostatitis as a non-sexually transmitted bacterial infection of the prostate. Even so, it advises considering screening for sexually transmitted infections, particularly in people considered to be at risk, and urgent referral to a genito-urinary medicine clinic if one is identified.

Prostate Cancer UK says there is some evidence that in a small number of men CPPS may be caused by a sexually transmitted infection, but that more research is needed to know for sure.

The NHS lists things you can do to help with prostatitis symptoms while being treated.

• Drink plenty of fluids to avoid dehydration.

• Take paracetamol or ibuprofen to help with pain.

• If you have been given antibiotics, finish the whole course, even if you feel better.

• Seek medical help if symptoms worsen, or if they do not start to improve within 48 hours of starting the antibiotic, as NICE advises.

Several conditions cause similar symptoms. NICE Clinical Knowledge Summaries lists urinary tract infection, urethritis, epididymo-orchitis, benign prostatic hypertrophy, cancer of the prostate, bladder or colon, urethral stricture and stones or foreign bodies as possibilities to exclude. Recurrent or relapsing urinary infections usually suggest chronic bacterial prostatitis.

The NHS PSA testing page says a urine infection can affect PSA test results, and that if you have a urine infection you need to wait 4 to 6 weeks after it has cleared before having a PSA test.

On the NHS, a GP is the first step for suspected prostatitis, with NHS 111 or A&E for the urgent signs listed above. The GP may arrange urine tests and antibiotics, and refer to a urologist if symptoms last 3 months or longer or if the diagnosis is uncertain.

Some people choose to see a private urologist, particularly for long-standing pelvic pain. If you do, bring details of previous antibiotic courses and test results, and share the findings with your NHS GP. The urgent advice above applies whichever route you use.