Prostatitis

Also called Chronic pelvic pain syndrome, Prostate inflammation

Pelvic pain in men, usually not an infection despite the name, and usually treated with repeated antibiotics that do not work.

What it is

Pain and urinary symptoms arising from or around the prostate. The name is misleading, because the great majority of cases are not bacterial infection.

Acute bacterial prostatitis is a genuine infection, is uncommon, and is a serious illness with fever and severe symptoms needing prompt antibiotics.

Chronic prostatitis, more accurately called chronic pelvic pain syndrome, accounts for around 90 per cent of cases. There is usually no bacterium to find, and the mechanism involves pelvic floor muscle tension, nerve sensitisation and inflammation. Repeated courses of antibiotics are the standard experience and they do not help.

What does help is a combination approach: pelvic floor physiotherapy, alpha blockers, neuropathic pain treatment, and addressing stress and sleep. Pelvic health physiotherapy for men is barely known and is one of the most under-used referrals in this library.

It is not prostate cancer and it does not lead to it, which is the reassurance most men are looking for and often do not get clearly.

Signs you might notice

Pain in the perineum, the area between the scrotum and anus, and in the lower abdomen, groin, penis, testicles or lower back.

Pain or burning on passing urine, needing to go frequently or urgently, a weak or interrupted stream, and getting up at night.

Pain on or after ejaculation, and erectile difficulty.

Pain worse on sitting, particularly on hard surfaces or when cycling.

Acute bacterial prostatitis, needing same-day assessment: fever, chills, feeling very unwell, severe pain, and difficulty or inability to pass urine.

999 or urgent care: unable to pass urine at all. See urinary retention.

How it can affect day-to-day life

The typical story is years of it: multiple GP visits, several antibiotic courses, normal tests, and a growing suspicion that nobody believes them or that something has been missed.

The effect on mood, relationships and sexual function is substantial and rarely asked about. Pain on ejaculation is particularly hard to raise.

Sitting is the main practical problem: work, driving and cycling all become difficult, and a properly shaped cushion genuinely helps.

Being told the tests are normal is heard as being told nothing is wrong. Explaining that pelvic pain is a real, recognised, treatable condition without an infection is the single most useful conversation available.

Supporting someone well

Take fever, severe pain and inability to pass urine seriously; that is the acute bacterial form and needs same-day care.

For chronic symptoms, stop expecting antibiotics to be the answer after the first course or two.

Ask for pelvic floor physiotherapy specifically. Men's pelvic health physiotherapy exists and is rarely offered.

Ask about alpha blockers and about neuropathic pain medication.

Use a cushion with a cut-out for sitting, and reduce cycling during flares.

Warm baths, and pelvic floor relaxation rather than pelvic floor strengthening; tightening the muscles usually makes this worse.

Address sleep, stress and mood as part of the treatment rather than as an implication that it is psychological.

Ask for referral to a urologist or a specialist pelvic pain service if it is not improving.

Where to get help

A GP practice, and same-day for fever or inability to pass urine.

Urology, or a specialist pelvic pain service.

Prostate Cancer UK specialist nurses answer questions about prostatitis too, and are a good source of clear information.

Pelvic Obstetric and Gynaecological Physiotherapy publish male pelvic health leaflets and list specialists.