Causes of Prostatitis

The cause of bacterial prostatitis is obvious and easy to detect—infection with some type of bacteria. But researchers are not sure why some men develop the more common, nonbacterial form. For some men stress, emotional problems, or even coffee can trigger flare-ups.

Other possible culprits include urinary tract abnormalities, infrequent ejaculation, dysfunctional urination, lower urinary tract infection, trauma to the perineal area (for example, from riding a bicycle) and inflammation. None of these potential causes of nonbacterial prostatitis has been confirmed with solid research.

Some researchers suggest that chronic prostatitis is not a prostate problem at all. They attribute flare-ups to a pelvic muscle spasm or some other factor that mimics symptoms originating in the prostate. Another theory is that prostatitis is an autoimmune disorder, in which the immune system mistakenly attacks healthy prostate tissue and promotes inflammation.

Some researchers believe that the initial trigger of chronic nonbacterial prostatitis promotes inflammation and then sets off a cascade of neurological events that lead to pain sensitization and, ultimately, chronic pain. Recent evidence suggests that any of these problems or a combination of them can trigger chronic prostatitis.

Diagnosis of Prostatitis

As part of the initial evaluation for prostatitis, a urine sample is evaluated to determine whether the disease stems from a bacterial infection. If chronic prostatitis is suspected, a urine sample may be taken from a man's normal urine flow and then from urine voided after a prostate massage (in which the doctor strokes the prostate until fluid is pushed into the urethra). However, the value of these pre- and post-massage urine cultures has been questioned. When the diagnosis is not clear-cut—which is often the case—other diagnostic tests will need to be performed.

Publication Review By: H. Ballentine Carter, M.D.

Published: 14 Jun 2011

Last Modified: 19 Feb 2015