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Men's Health
Prostatitis
Prostatitis is one of the most common urological conditions in men under 50 — accurate diagnosis and a tailored treatment plan can bring lasting relief.
Clinically Reviewed By
Honorary Associate Professor Jeremy Ockrim MD BSc(Hons) FRCS(Urol)
Consultant Urological Surgeon · Reviewed June 2026 · Review due June 2027
Understanding Prostatitis
Prostatitis refers to inflammation of the prostate gland. It is one of the most common urological diagnoses in men, estimated to affect up to 15% of men at some point in their lives. Despite this, it remains widely misunderstood and is often under-diagnosed or inadequately treated.
Unlike benign prostatic hyperplasia (BPH) or prostate cancer, prostatitis is not primarily a condition of older men. It most commonly presents in men aged 30 to 50, although it can occur at any age. The symptoms can be debilitating — involving pelvic pain, urinary difficulties, sexual dysfunction and significant psychological distress.
It is important to understand that prostatitis is a distinct condition from BPH (which causes the prostate to enlarge) and prostate cancer. Having prostatitis does not increase your risk of developing prostate cancer. However, prostatitis can cause a raised PSA level, which may lead to unnecessary anxiety if the context is not properly understood.
Prostatitis is treatable
Although chronic prostatitis can be frustrating, the majority of men experience significant improvement with the right combination of treatments. A specialist assessment is the essential first step towards understanding your symptoms and finding an effective management plan.
Types of Prostatitis
Prostatitis is classified into four types by the National Institutes of Health (NIH). Understanding which type you have is essential, as each requires a different treatment approach.
Acute Bacterial Prostatitis
A sudden, severe bacterial infection of the prostate. Presents with high fever, rigors, intense perineal or pelvic pain, and difficulty passing urine. This is a medical emergency requiring urgent antibiotic treatment and, in some cases, hospital admission and surgical drainage.
Chronic Bacterial Prostatitis
A recurring or persistent bacterial infection of the prostate. Symptoms are less dramatic than acute prostatitis but include recurrent cystitis symptoms, urinary tract infections, pelvic discomfort, and urinary symptoms that come and go over weeks or months. Prolonged antibiotic courses are typically required.
Chronic Pelvic Pain Syndrome (CPPS)
By far the most common type, accounting for approximately 90% of prostatitis cases. Characterised by chronic pelvic pain and urinary symptoms without evidence of bacterial infection. The cause is likely multifactorial, involving pelvic floor muscle dysfunction, nerve sensitisation, and psychological factors. A multimodal treatment approach is required.
Asymptomatic Inflammatory Prostatitis
Inflammation of the prostate detected incidentally — for example, on MRI imaging of the prostate, a prostate biopsy, or in semen analysis — without any symptoms. This type does not usually require treatment but may explain a raised PSA level in some men.
Usually no treatment is required.
Symptoms of Prostatitis
The symptoms of prostatitis vary depending on the type but commonly include a combination of pain, urinary difficulties and sexual symptoms. Chronic prostatitis in particular can have a significant impact on quality of life.
Pelvic and perineal pain
Pain or aching in the area between the scrotum and rectum (perineum), lower abdomen, lower back, groin, or tip of the penis. The pain may be constant or intermittent and can range from a dull ache to severe discomfort.
Pain during or after ejaculation
Ejaculatory pain is one of the most characteristic symptoms of prostatitis and can significantly affect sexual function and relationships. Some men also notice blood in the semen (haematospermia).
Urinary symptoms
Increased urinary frequency, urgency, difficulty starting or maintaining the urinary stream, a sensation of incomplete bladder emptying, and pain or burning during urination (dysuria). These symptoms can mimic those of a urinary tract infection or BPH.
Seek urgent medical attention
If you develop a sudden onset of severe pelvic pain, high fever, rigors (shaking chills), difficulty passing urine or feeling generally very unwell, you should seek urgent medical attention. Acute bacterial prostatitis can lead to sepsis if not treated promptly with intravenous antibiotics. Attend A&E or call 999 if you are severely unwell.
What Causes Prostatitis?
The cause depends on the type of prostatitis. In bacterial forms, a specific organism can be identified. In chronic pelvic pain syndrome, the cause is often multifactorial and not fully understood.
Bacterial infection
In acute and chronic bacterial prostatitis (Types I and II), bacteria — most commonly E. coli and other gram-negative organisms — infect the prostate tissue. The infection may ascend from the urethra, spread from a urinary tract infection, or occur following urological procedures such as catheterisation or prostate biopsy.
Pelvic floor muscle dysfunction
In CPPS (Type III), the pelvic floor muscles may become chronically tense or go into spasm, creating pain and urinary symptoms that mimic infection. This is increasingly recognised as a major contributor to chronic prostatitis symptoms and responds well to specialist pelvic floor physiotherapy.
Stress and psychological factors
Psychological stress, anxiety and depression are strongly associated with CPPS. Stress can trigger or worsen pelvic floor tension and pain sensitisation, creating a cycle of pain and distress. Addressing these factors is an important part of a comprehensive treatment plan.
Urological procedures and catheterisation
Prostate biopsy, urinary catheterisation, and other urological instrumentation can introduce bacteria into the prostate and trigger acute or chronic bacterial prostatitis. The risk is minimised with appropriate antibiotic prophylaxis.
How is Prostatitis Diagnosed?
A thorough clinical assessment is essential to confirm the diagnosis, identify the type of prostatitis, and exclude other conditions. Your specialist will tailor the investigation pathway to your individual presentation.
Digital Rectal Examination (DRE)
A gentle examination of the prostate through the rectum to assess its size, shape and tenderness. In acute bacterial prostatitis, the prostate is typically very tender and swollen. In chronic prostatitis, findings may be more subtle. A DRE is avoided in acute cases if sepsis is suspected.
Urine Culture & Microscopy
Mid-stream urine samples are tested for bacteria and white blood cells. In bacterial prostatitis, cultures will identify the causative organism and guide antibiotic selection. A two-glass or four-glass test (Meares-Stamey), usually performed with cystoscopy under anaesthesia, may be used to localise the infection to the prostate specifically.
Cystoscopy & Biopsy
May be indicated to exclude other causes of pelvic pain, including inflammatory (interstitial) cystitis. Can be combined with the Meares-Stamey test.
PSA Interpretation
Prostatitis — particularly acute bacterial prostatitis — can cause a significantly raised PSA level. It is important that your specialist interprets PSA results in the context of your symptoms, as an elevated PSA in the setting of prostatitis does not indicate prostate cancer. PSA should be rechecked once the inflammation has settled.
MRI Prostate
MRI gives the most accurate structural evaluation of the prostate, but it is not in itself pathognomonic (diagnostic) of the condition. Prostatitis often shows up on MRI as diffuse or focal low signal intensity in the prostate's peripheral zone. Because these areas can look very similar to prostate cancer, they may cause false positives that require clinical context or a biopsy to confirm.
Flow Studies
In men with significant urinary symptoms, a flow rate test and post-void residual measurement can help assess bladder function.
Video-Urodynamic Studies
A specialist test measuring bladder pressure and flow rates during filling and voiding, combined with video fluoroscopy to give dynamic pressure and imaging together and exclude a functional cause of symptoms. May be recommended if there is suspicion of bladder outlet obstruction, detrusor overactivity, or if initial treatments have not been effective.
Treatment Options
Treatment depends on the type of prostatitis. Bacterial forms are treated with antibiotics, while chronic pelvic pain syndrome requires a multimodal approach addressing the physical, psychological and lifestyle factors involved.
Acute Bacterial Prostatitis
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Supportive care — adequate hydration, rest, anti-inflammatory medications and alpha-blockers to relieve urinary symptoms during the acute phase.
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Antibiotics — urgent intravenous or high-dose oral antibiotics (typically a fluoroquinolone or trimethoprim) for 2 to 4 weeks. The choice is guided by urine culture results. Treatment must be started promptly to prevent complications.
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Hospital admission — may be required in severe cases for intravenous antibiotics, fluids and monitoring. Urinary retention may necessitate a suprapubic catheter (a urethral catheter is avoided in acute prostatitis where possible). Surgical drainage is required if imaging suggests that the infection has formed a collection (abscess).
Chronic Bacterial Prostatitis
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Prolonged antibiotic course — typically 4 to 6 weeks of a fluoroquinolone (e.g. ciprofloxacin) or trimethoprim, which penetrate prostate tissue effectively. The duration is longer than for a simple UTI because antibiotic penetration into the prostate is limited. Fluoroquinolone prescribing follows MHRA safety guidance — your specialist will discuss the risks and benefits with you.
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Alpha-blockers — medications such as tamsulosin can be used alongside antibiotics to relax the bladder neck and prostate, improving urinary flow and reducing symptoms.
Chronic Pelvic Pain Syndrome (CPPS)
CPPS requires a multimodal treatment approach. No single treatment works for every patient, so your specialist will tailor a combination of the following strategies:
Alpha-blockers
Medications such as tamsulosin or alfuzosin can relax the smooth muscle of the prostate and bladder neck, reducing urinary symptoms and, in some men, pelvic pain. They are most effective in men with prominent urinary symptoms and are typically trialled for at least 6 weeks.
Pelvic Floor Physiotherapy
Specialist pelvic floor physiotherapy is one of the most effective treatments for CPPS. Unlike in incontinence, where the goal is to strengthen the pelvic floor, in CPPS the focus is on relaxing chronically tense muscles, releasing trigger points, and retraining muscle coordination. This requires a physiotherapist with specific expertise in male pelvic pain.
Overlap with Bladder Pain Syndrome
Management of Chronic Pelvic Pain Syndrome (CPPS) — Type III prostatitis — follows similar assessment and treatment options as Bladder Pain Syndrome / Interstitial Cystitis. Please see the page on Bladder Pain Syndrome / Interstitial Cystitis for further details.
Living with Chronic Prostatitis
Chronic prostatitis, particularly CPPS, can be a long-term condition with periods of improvement and flare-ups. Understanding how to manage the condition day to day is an important part of taking control of your symptoms.
Stay active — regular, moderate exercise such as walking, swimming or yoga can help reduce pelvic tension and improve mood
Manage stress — mindfulness, breathing exercises or cognitive behavioural therapy (CBT) can help break the pain-stress cycle
Know your triggers — keeping a symptom diary can help identify activities, foods or situations that worsen your symptoms so you can adjust accordingly
Have a flare plan — discuss a flare management plan with your specialist so you know what to do when symptoms worsen, including when to use heat therapy, adjust medications, or seek review
Avoid prolonged sitting — use a cushion or donut seat if needed, and take regular breaks to stand and move
Talk about it — chronic pelvic pain can be isolating. Discussing your symptoms with your partner, a counsellor, or a support group can help reduce the emotional burden
Meet your Specialists
Assessment and treatment of prostatitis is led by our experienced consultant urologists. Your care will be personally overseen by one of our senior specialists.
Key Takeaways
Prostatitis is a common and often misunderstood condition that can significantly affect quality of life. Whether caused by bacterial infection or the more common chronic pelvic pain syndrome, prostatitis is treatable — but effective management requires accurate diagnosis and a tailored treatment plan.
Our specialist team takes a thorough, evidence-based approach, combining urological expertise with access to pelvic floor physiotherapy, pain management and psychological support when needed. You do not need to suffer in silence.
Prostatitis affects up to 15% of men and is the most common urological diagnosis in men under 50. With accurate classification and a multimodal treatment approach, the majority of men achieve meaningful, lasting improvement.
Further Reading — BAUS Patient Information
Frequently Asked Questions About Prostatitis
Prostatitis is inflammation of the prostate gland. It can present acutely with fever and severe pelvic pain, or as a chronic condition with milder but persistent urinary and pelvic symptoms. It affects up to 15% of men and is the most common urological diagnosis in men under 50. Prostatitis is very treatable, but effective management depends on identifying the correct type.
The NIH classifies prostatitis into four types: Type I (Acute Bacterial Prostatitis) — a medical emergency; Type II (Chronic Bacterial Prostatitis) — recurrent bacterial infection; Type III (Chronic Pelvic Pain Syndrome, CPPS) — the most common form, accounting for around 90% of cases, with no evidence of bacterial infection; and Type IV (Asymptomatic Inflammatory Prostatitis) — found incidentally with no symptoms and usually no treatment required. Accurate classification is essential because the treatment differs significantly for each type.
No — prostatitis itself is not sexually transmitted. The bacterial forms are usually caused by the same organisms that cause urinary tract infections (most commonly E. coli). In younger men, occasionally a sexually transmitted infection such as chlamydia or gonorrhoea can contribute, but this is not the typical cause. Chronic pelvic pain syndrome (CPPS) — the most common type — is not caused by infection at all.
No — prostatitis does not cause prostate cancer, and having prostatitis does not increase your future risk of prostate cancer. However, prostatitis can raise your PSA level, which sometimes prompts further investigation. If your PSA is elevated during or after an episode of prostatitis, it should be rechecked after treatment and, if it remains raised, appropriate imaging or biopsy considered to exclude cancer.
Because the most common form of prostatitis — Chronic Pelvic Pain Syndrome (CPPS) — is not caused by bacterial infection. Antibiotics can help the bacterial forms (Types I and II), but for CPPS they typically have little to no effect. If your symptoms haven't improved after a course of antibiotics, it is likely that CPPS is the correct diagnosis and a different treatment approach is needed — often a combination of pelvic floor physiotherapy, alpha-blockers, pain management and, where appropriate, psychological support.
Assessment begins with a full symptom history — often using the NIH Chronic Prostatitis Symptom Index (NIH-CPSI) — and a physical examination. Investigations may include urine tests, a PSA blood test, uroflowmetry, and where appropriate imaging such as ultrasound or MRI. In some cases, a Meares-Stamey test is used to differentiate between the bacterial and non-bacterial types. Accurate diagnosis is the single most important step in effective treatment.
Acute and chronic bacterial prostatitis can usually be fully cleared with the right antibiotic treatment. Chronic pelvic pain syndrome (CPPS) is more complex — for many men it can be greatly improved and managed, but symptoms may fluctuate over time. The goal is not always to eliminate all symptoms permanently, but to significantly reduce their impact on your quality of life. With the right multimodal approach, the majority of men achieve meaningful, lasting improvement.
We offer rapid-access appointments, with most patients seen within 24 to 48 hours of contacting us. You do not need a GP referral to book a private consultation, though some insurers may require one — we recommend checking your policy before your appointment. If you have symptoms suggesting acute bacterial prostatitis (high fever, severe pelvic pain, difficulty passing urine), you should seek urgent medical attention immediately — go to A&E or call 999.
Experiencing Symptoms of Prostatitis?
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