What is the difference between acute and chronic prostatitis?

Prostatitis is inflammation of the prostate gland. It usually affects younger men in their 20s up to those who are in their ‘middle age’. Patients typically describe severe pain deep in the pelvis, especially felt in the perineum (the part of the body between the scrotum and the anus). Leading urologist Mr Keng Jin Ng talks us through the difference between acute and chronic prostatitis, and how to spot their symptoms. 

What is the difference between acute and chronic prostatitis (male pelvic pain syndrome)?

Acute prostatitis occurs when there is bacterial infection affecting the prostate gland, causing inflammation. This is due to the tight ‘bladder neck’ muscle causing poor bladder emptying, so the stale pool of urine in the bladder harbours bacteria. When such contaminated stale urine shoots into the prostate gland due to turbulent flow, the patient can develop bacterial prostatitis which causes acute pain. In acute prostatitis, the patient will generally benefit from a course of antibiotics to clear the infection.

Chronic prostatitis describes the recurrent, intermittent flare-up of pain due to inflammation of the prostate not relieved by a course of antibiotics. This is due to chemical inflammation as a result of turbulent flow of stale urine shooting into the prostate. In chronic prostatitis, no bacteria are involved.

How is prostatitis treated?

Prostatitis can be easily and effectively treated. The main aim of treatment is to relax the bladder neck ring of muscle in the long-term. There are specific medications which can help with the relaxation of the bladder neck muscle. A new medication is available that improves the blood flow to the bladder neck and prostate. This improved blood flow not only helps to relax the muscles, but also washes away any chemicals that cause the inflammation.  A combination of medication may be prescribed.

In addition, patients who suffer the ‘short-circuiting’ effect of the pudendal nerve leading to a severe backache and groin pain, and also those with irritable bowel symptoms, can benefit from posterior tibial nerve stimulation (PTNS). American studies have shown a significant benefit of such nerve stimulation treatment in managing pudendal neuropathy.

Can prostatitis recur after treatment?

Once the patient is stabilised on treatment to relax the bladder neck muscle, he should no longer suffer a flare-up of the pelvic pain. The medications are safe to be taken in the long-term.

If you experience any symptoms which could point to prostatitis, book an appointment to see a urologist.