Can prostatitis come and go?

Chronic bacterial prostatitis is an infection of the prostate that can last for a long time – at least three months. Chronic means that it is long-lasting. It tends to come and go, causing episodes or flare-ups.

prostatecanceruk.org - What is prostatitis? - Chronic pelvic pain syndrome (CPPS)

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Chronic pelvic pain syndrome (CPPS)

CPPS is the most common type of prostatitis – around 19 out of every 20 men (90 to 95 per cent) with prostatitis have it. You might also hear it called chronic non-bacterial prostatitis, chronic abacterial prostatitis or prostate pain syndrome. Chronic means long-lasting. Men with CPPS usually have symptoms for three months or longer. Even after treatment, you may still have prostatitis for a long time. It might come and go, causing occasional episodes of severe pain, sometimes known as flare-ups.

What causes it?

Nobody knows for certain what causes CPPS. Unlike other types of prostatitis it isn’t usually caused by a bacterial infection. There could be a number of causes, which makes it difficult to diagnose and treat.

There are also a number of things that might trigger it, including:

urine getting into the prostate

previous infections in or around the prostate

an infection that doesn’t show up in tests

problems with nerves pathway, so that they send pain signals to the brain even when there’s nothing physically wrong

stress, anxiety or depression

problems with the pelvic floor muscles (the muscles that support your bladder and bowel and help to control urination). Some research shows a link between stress, anxiety and depression and CPPS. But this doesn’t mean that CPPS is all in your head. If you’re feeling stressed or depressed, this may cause physical symptoms that trigger CPPS, or make symptoms worse. There’s some evidence that CPPS may be linked to other conditions such as chronic fatigue syndrome, which causes severe tiredness, and irritable bowel syndrome (IBS), which causes bowel problems. Some men with CPPS have symptoms of these conditions too. There’s also some evidence that in a small number of men, CPPS may be caused by a sexually transmitted infection. But we need more research to know for sure. You can read more about the symptoms of CPPS, the test used to diagnose it, and the treatments available.

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How does a urologist diagnose prostatitis?

You'll need to have a urine test so the doctor can check for bacteria and other signs of infection. You might also need a blood test. You might have a digital rectal examination to see if your prostate is inflamed and painful, and the doctor may examine your stomach area (abdomen) and penis.

prostatecanceruk.org - Prostatitis tests

Tests for chronic pelvic pain syndrome (CPPS)

There is no single test to diagnose CPPS. Your doctor will need to rule out other possible causes of your symptoms before they make a diagnosis. This can take some time. You might be diagnosed with CPPS if you’ve had some of the symptoms listed above for more than three of the last six months. But your doctor may diagnose CPPS sooner than this. They will ask you about your symptoms or give you a questionnaire to fill in. Your doctor may also ask about your medical history. This can help them work out what is causing your symptoms, and which treatments are most likely to help. You’ll need to have a urine test to make sure you don’t have a urine infection. You may also have a physical examination, including a digital rectal examination (DRE), and some other tests, such as a PSA test. Ask your doctor for more information about other tests you may have. For some tests, you might need to visit a doctor at the hospital who specialises in urinary problems (a urologist) or a specialist nurse.

Worried about having a DRE?

It’s natural to feel worried or embarrassed about having tests, but some men find the idea of having a DRE upsetting. For example, if you’ve ever been sexually abused, you might feel very upset about having this test. There’s no right or wrong way to feel, and it’s your choice whether or not to have a DRE. If you do decide to have a DRE, explain your situation to your doctor. They can talk you through the test and help to reassure you. It may also help to talk to a counsellor.

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