Prostatitis and Pelvic Pain in Men

What prostatitis is

Prostatitis is a frequently painful condition involving inflammation of the prostate and sometimes the areas around it. [1] NIDDK describes four types: chronic prostatitis/chronic pelvic pain syndrome, acute bacterial prostatitis, chronic bacterial prostatitis, and asymptomatic inflammatory prostatitis, which causes no symptoms and needs no treatment. [1]

It is common. NIDDK says prostatitis is the most common urinary tract problem for men younger than 50 and the third most common for men older than 50. It reports that chronic prostatitis/chronic pelvic pain syndrome, the most common and least understood form, affects 10 to 15 percent of the US male population. [1]

Symptoms by type

• Acute bacterial prostatitis: symptoms come on suddenly and are severe, such as fever, chills, burning or pain on urination, frequent or urgent urination, nocturia, pain in the genital area, groin, lower abdomen or lower back, nausea and body aches. This needs immediate medical care. [1]
• Chronic prostatitis/chronic pelvic pain syndrome: pain or discomfort lasting 3 months or more in the area between the scrotum and anus, lower abdomen, penis, scrotum or lower back, sometimes with pain during or after ejaculation or urinary symptoms. The pain may come and go. [1]
• Chronic bacterial prostatitis: develops slowly and can last years. [1]

Many of these symptoms look like other conditions, such as a UTI, BPH or, rarely, prostate cancer, so a health professional needs to rule them out. [1]

Causes

Acute and chronic bacterial prostatitis come from bacterial infection, often when bacteria travel from the urethra into the prostate. The exact cause of chronic prostatitis/chronic pelvic pain syndrome is unknown; NIDDK mentions chemicals in the urine, an immune response to an earlier UTI and nerve damage in the pelvic area as possibilities, and says psychological stress may increase the chance of it. [1] The NHS says prostatitis is usually caused by an infection such as a UTI. [2]

Established care

• Bacterial prostatitis is treated with antibiotics; the NHS says you usually feel better within 2 weeks, but it can take several weeks for all symptoms to ease. [2]
• Chronic prostatitis/chronic pelvic pain syndrome has no single treatment that works for every man. NIDDK lists alpha blockers, anti-inflammatory medicines, muscle relaxants and nerve-calming medicines, and notes that antibiotics do not help the nonbacterial form. [1] The NHS says treatment may also include cognitive behavioral therapy (CBT) or counseling, physiotherapy and sometimes alternative therapies such as acupuncture. [2]
• Self-care: the NHS suggests drinking plenty of fluids, taking paracetamol (acetaminophen) or ibuprofen for pain, and finishing any antibiotic course. [2]

Complementary approaches

NIDDK lists sitz baths (warm baths), local heat, physical therapy such as Kegel exercises, myofascial release, relaxation exercises and biofeedback, plant extracts such as quercetin, bee pollen and saw palmetto, and acupuncture as alternative options, and advises telling your provider about all of them. [1] It also says that for men whose symptoms are affected by psychological stress, stress reduction may reduce recurrence. [1] See Stress and relaxation.

For saw palmetto specifically, a 2022 review of five studies did not find a significant benefit in this condition. [3] Insufficient evidence or no benefit for herbal products; limited for non-drug approaches such as heat and physical therapy, where I did not find trial data in the sources read. See Saw palmetto and prostate supplements and Medication interactions.

Prevention

NIDDK says men cannot currently prevent prostatitis. [1]

Related: Urinary symptoms and enlarged prostate and Men's health safety.