What are the symptoms of prostatitis?

Symptoms of Prostatitis

The hallmark symptoms of prostatitis include pelvic pain (particularly in the perineum, suprapubic region, testicles, or tip of the penis), urinary frequency, urgency, and painful ejaculation. 1, 2

Types of Prostatitis and Their Symptoms

Prostatitis is classified into four categories according to the National Institutes of Health (NIH), each with distinct symptom presentations:

1. Acute Bacterial Prostatitis (Category I)

• Sudden onset of severe symptoms
• High fever, chills, and possible hypotension
• Intense pelvic and genital pain
• Urinary urgency and frequency
• Dysuria (painful urination)
• Urinary retention may occur due to prostatic swelling
• Tender, swollen, and warm prostate on examination 3, 4

2. Chronic Bacterial Prostatitis (Category II)

• Recurrent urinary tract infections with the same organism
• Persistent or intermittent pelvic pain
• Ejaculatory pain
• Urinary symptoms (frequency, urgency, nocturia)
• Sense of incomplete bladder emptying 3, 5

3. Chronic Prostatitis/Chronic Pelvic Pain Syndrome (Category III)

• Accounts for 90-95% of prostatitis cases
• Pelvic pain lasting at least 3 months
• Pain may be felt in the perineum, suprapubic region, testicles, or penis
• Pain often exacerbated by urination or ejaculation
• Urinary frequency and urgency
• Painful ejaculation
• Symptoms may wax and wane in intensity 2, 5

4. Asymptomatic Inflammatory Prostatitis (Category IV)

• No symptoms by definition
• Inflammatory cells found in prostate tissue, semen, or prostatic fluid
• Usually discovered incidentally during evaluation for other conditions 3, 4

Key Symptom Patterns

Pain Characteristics

• Location: perineum, suprapubic region, testicles, tip of penis, lower back, and rectum
• Quality: may be described as pressure, discomfort, or frank pain
• Timing: often worsens with bladder filling and improves with urination
• Exacerbating factors: may worsen with specific foods/drinks, ejaculation, or prolonged sitting 1

Urinary Symptoms

• Frequency (voiding often)
• Urgency (compelling need to urinate)
• Nocturia (waking at night to urinate)
• Dysuria (painful urination)
• Sense of incomplete emptying
• Urinary hesitancy or weak stream 5, 4

Sexual Symptoms

• Painful ejaculation
• Erectile dysfunction
• Decreased libido
• Post-ejaculatory pain 3, 6

Diagnostic Considerations

It's important to note that chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) shares many symptoms with interstitial cystitis/bladder pain syndrome (IC/BPS), particularly in men. The clinical characteristics that define CP/CPPS are very similar to those previously described for IC/BPS, and some men may meet criteria for both conditions 1.

Clinical Pitfalls

1. Misdiagnosis is common: Symptoms of prostatitis overlap with other conditions like benign prostatic hyperplasia, urinary tract infections, and bladder cancer 4.

2. Pain descriptors vary: Patients may use different terms to describe their symptoms, especially "pressure" rather than "pain" 1.

3. Delayed diagnosis: The complex and variable presentation often leads to delayed diagnosis and treatment 1.

4. Psychological impact: Chronic prostatitis can have significant effects on quality of life and psychological well-being, which may not be immediately apparent 5.

5. Symptom fluctuation: Symptoms may wax and wane, making consistent evaluation challenging 3.

By recognizing these symptom patterns, clinicians can more effectively diagnose and manage prostatitis, improving outcomes for patients with this common but often challenging condition.