Prostatitis means the prostate is swollen or irritated. It is more common than many people think. Each year, about two million doctor visits are for prostatitis. The main signs are:

• Burning or pain when peeing
• Very strong urge to pee, especially at night
• Pain during or after ejaculation
• Pain in the lower back or in the area between the scrotum and anus

Four Types of Prostatitis

• Acute bacterial prostatitis comes on quickly and is usually caused by common gut bacteria. You may have fever, muscle aches, and blood in your urine or semen. The prostate can swell so much that urine cannot pass. Complete blockage is an emergency.
• Chronic bacterial prostatitis is a milder infection that can last for months. Symptoms may come and go, and it is more common in older men.
• Chronic nonbacterial prostatitis (also called chronic pelvic pain syndrome) is the most common form. It is not caused by bacteria. It may start after stress, a past infection, or an injury. Sometimes no clear cause is found. It affects the muscles, nerves, and tissues in the pelvic area.
• Asymptomatic inflammatory prostatitis has no noticeable symptoms. It is found by accident when doctors test for other problems. It usually does not need treatment.

Both acute and chronic bacterial prostatitis can raise prostate-specific antigen (PSA) levels in the blood. High PSA can also occur in prostate cancer. If prostatitis is treated, PSA levels usually go back to normal.

How Prostatitis Is Treated

Bacterial types: Doctors give antibiotics for four to six weeks. Most men get better. If the usual medicine stops working, another antibiotic may be tried. PSA levels fall over the next three to six months.

Chronic nonbacterial prostatitis (CPPS): Since this is not a bacterial infection, antibiotics do not help. Treatment options include:

• Pain relievers like ibuprofen
• Alpha blockers (for example, tamsulosin) to relax muscles in the prostate and bladder
• PDE-5 inhibitors (for example, tadalafil) to improve blood flow to the prostate

Physical therapy can also ease pain. Therapists focus on releasing tight spots and reducing muscle spasms in the pelvic area. Men with CPPS should avoid Kegel exercises, which can make the pelvic floor too tight.

Some studies show that acupuncture can help men with CPPS for months after treatment. Mental health is an important part of recovery. Stress, anxiety, or depression can make pain feel worse. Practices such as mindfulness or cognitive behavioral therapy can teach helpful ways to cope with symptoms.