Prostatitis constitutes one of the most common reasons for visits to a urologist by men. The term prostatitis is used for a large group of patients whose symptoms include pelvic, lower back, and testicular discomfort. Men will often complain that when they sit, that it feels as if they are sitting on a golf ball. They may also complain of frequent, painful, and difficult urination, and/or painful ejaculation. Prostatitis is one of the most challenging urological conditions to manage in men. Treatments may take weeks to months to take effect.

There are different types of prostatitis:

1. Acute bacterial prostatitis: This typically presents with a sudden onset of fever with chills, lower back and perineal pain, and urinary frequency, burning and difficult urination sometimes leading to urinary retention. On physical examination, the prostate will be exquisitely tender and "boggy" to the touch. Urinalysis will reveal numerous inflammatory cells (white blood cells in the urine). For severe cases, treatment may require hospitalization with intravenous antibiotics. Otherwise, patients are treated as outpatients with oral antibiotics, and anti-inflammatory agents such as Motrin®, Naprosyn®, Advil®, or ibuprofen. Occationally, Tylenol® may be used to help bring the fever down.
2. Chronic bacterial prostatitis: Patients present with irritative urinary symptoms and vague pelvic or lower back discomfort. Patients may also complain of pain during or following ejaculation. Many report a a prior history of acute bacterial prostatitis or a history of recurrent urinary tract infections. The intensity of the symptoms is variable. On physical examination, there is no fever and the prostate feels normal. Urinalysis is normal but may show inflammatory cells after the prostate is massaged. Examination of the prostatic secretions under the microscope may also show inflammatory cells. Cultures of these secretions will often be positive for bacteria. Treatment may require several months of antibiotics along with anti-inflammatory agents and sitz baths. Prostatic massage may also be helpful.
3. Non-bacterial prostatitis: The signs and symptoms of non-bacterial prostatitis are similar to those of patients with chronic bacterial prostatitis except that documented urinary tract infections almost never occur in the former. Patients with non-bacterial prostatitis have abnormal numbers of inflammatory cells in their prostatic secretions, but no causative infectious agent can be found by culture or other means. A trial of antibiotics against "unconventional types of bacteria" may be tried. Unfortunately, non-bacterial prostatitis often does not respond to antibiotics and therapy must be directed toward control of symptoms. Patients need to understand that they have a non-infectious inflammatory disorder of the prostate. Treatment consists of anti-inflammatory agents and sitz baths. Prostate smooth muscle relaxants (otherwise known as alpha blockers) may be of benefit. Normal sexual activity is encouraged.
4. Prostatodynia (pelvic floor tension myalgia): The signs and symptoms of prostatodynia are similar to those of chronic bacterial prostatitis and non-bacterial prostatitis except that no inflammatory cells are seen in either the urinalysis or in the prostate secretions. Unlike the other prostatitis categories, the symptoms are thought to be secondary to a contraction of the muscles of the pelvis rather than to actual inflammation of the prostate. It may be thought of as the equivalent of a "headache" of the pelvis, often brought on from stress. In other men, it may be secondary to spasms in the neck of the bladder. Treatment recommendations may include anti-inflammatory medications and warm sitz baths. Prostate smooth muscle relaxants may also be of benefit. Occasionally Valium® may also be of help.

In summary, prostatitis is a challenging condition to treat that may take several months to resolve and may recur in the future.