Prostatitis vs. BPH (Enlarged Prostate): How to Tell the Difference

  • Medical Author:
    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Prostatitis vs. BPH quick comparison of differences and similarities

  • Both BPH (benign prostatic hyperplasia) and prostatitis are problems with the prostate gland, a gland surrounding the neck of the bladder in males. The prostate gland is responsible for releasing prostatic fluid that helps make up part of the semen.
  • The normal prostate gland is about the size of a walnut. As it increases in size, for whatever reason, it can press on the urethra and cause urinary problems.
  • Both prostatitis and BPH can result in an enlarged prostate.
  • Most men over 50 years old have some prostate enlargement with no symptoms, while bacterial prostatitis usually occurs in men younger than 35 years old and non-infectious prostatitis occurs in older men.
  • You can have either BPH or prostatitis, and have no signs or symptoms. Nevertheless, both can cause pain (dysuria or pain with urination).
  • Prostatitis is caused by infections (usually bacterial) or other related health problems, while doctors don’t know exactly what causes an enlarged prostate, but they think it may be related to hormones.
  • BPH can be treated but not cured, but prostatitis is curable in many patients. The large majority of men with prostatitis have an infection of the prostate gland, while those with BPH do not have an infection.

What is prostatitis?

The definition of prostatitis is inflammation of the prostate tissue. Causes of the inflammation can be from infection or other health problems.

What is BPH (enlarged prostate)?

Most men over the age of 50 have some prostate enlargement due to the proliferation of the cells that comprise the prostate gland. Most of these men have BPH, or benign prostatic hyperplasia, even though do not have any symptoms. This gland enlargement is noncancerous and is termed benign prostatic hypertrophy or BPH. There is only one type of BPH, “benign,” meaning non-cancerous or not malignant in medical terms. 

Are prostatitis and BPH the same health problem?

The answer to this question is yes and no. Yes, BPH is by definition an enlarged prostate. However, not all enlarged prostates are due to BPH. An enlarged prostate may be caused by BPH, prostatitis, and prostate cancer.

Do prostatitis and BPH cause pain?

Both BPH and prostatitis may cause pain. However, if BPH causes pain, it usually occurs with urination (dysuria).

Prostatitis may cause painful urination, painful ejaculations, and generalized groin/abdominal pain. Prostatitis pain may be more constant and may be due to the inflammation of the prostatic tissue and/or adjacent tissues. Experts point out that often the source of pain from prostatitis is unclear.

How can I tell the difference between prostatitis and BPH (signs and symptoms)?

If you do not have any symptoms of BPH or any of the types of prostatitis, which can be the situation for some men, you may not be able to tell if you have either problem. However, a doctor or other health care professional can detect enlargement of the prostate with a digital rectal exam (digital examination of the rectal area and prostate), even if you don’t have any symptoms.

If you do have symptoms, they are related to the increase in size of your prostate gland. When the gland enlarges, it can constrict the urethra and produce one or more of these symptoms.

  • The need to urinate frequently during the day or night
  • The sudden urgent need to urinate
  • Difficulty initiating urinary stream
  • Feeling like you still need to urinate even though you recently urinated
  • Feeling like you need to push or strain to empty your bladder
  • A decrease in the force of the urine stream
  • Loss of small amounts of urine (dribbling urine)

The symptoms of prostatitis depend upon the type of prostatitis.

Acute bacterial prostatitis (type I) symptoms

  • Fever
  • Chills
  • Muscle soreness
  • Joint discomfort
  • Feeling tired
  • Prostatic discomfort and/or pain
  • Painful urination (dysuria)
  • Low back pain and/or abdominal pain
  • Possible urethral discharge
  • Urinary stream problems such as frequency, urgency, weak urine stream

Chronic bacterial prostatitis (type II)

  • Intermittent painful urination
  • Intermittent obstructive urinary tract symptoms
  • Recurrent urinary tract infections (with some symptoms for type I)

Chronic prostatitis and chronic pelvic pain syndrome (type III)

  • Pelvic pain and/or discomfort
  • Obstructive urinary tract symptoms such as frequency, painful urination, and incomplete urination
  • Pain with ejaculation
  • Erectile dysfunction (ED)

Asymptomatic inflammatory prostatitis (type IV)

  • By definition, type IV has no symptoms, but sometimes is diagnosed from a prostate biopsy or suspected when a prostate-specific antigen test (PSA blood test) is elevated.

Some men may have some of these symptoms with both BPH or prostatitis. If you are over age 50, it is more likely BPH than prostatitis, and if you are under age 35, acute bacterial prostatitis is more likely than BPH. In some patients, prostatitis may be recurrent (you may get the condition again).

Quick GuideEnlarged Prostate (BPH) Symptoms, Diagnosis, Treatment

Enlarged Prostate (BPH) Symptoms, Diagnosis, Treatment

Prostate Problems Symptoms and Warning Signs

It's common for men over the age of 50 to have prostate problems. The prostate gland produces semen. Common conditions that affect the gland are enlarged prostate (BPH, benign prostatic hyperplasia), acute and chronic bacterial prostatitis, chronic non-bacterial prostatitis, and prostate cancer. Talk to your doctor if you think you may have problems urinating or pain with urination.

What causes prostatitis vs. BPH?

The cause of BPH or enlarged prostate is by benign growth that enlarges the prostate gland. Researchers do not know exactly what causes the gland to enlarge, but they have speculated that it might be related to hormonal changes as men age.

In men under the age of 35, the most common type of prostatitis is acute bacterial prostatitis, while in older patients non-bacterial prostatitis is the most common type. There are four types or syndromes of prostatitis.

  • Type I - Acute bacterial prostatitis
  • Type II - Chronic bacterial prostatitis
  • Type III Chronic prostatitis and chronic pelvic pain syndrome
  • Type IV is asymptomatic inflammatory prostatitis.

The cause of acute bacterial prostatitis is by bacteria that may be present in the urethra and then infect the prostate gland. Chronic bacterial prostatitis (about 75% of infections are due to E. coli) occurs because of inadequate treatment or because of a structural/functional problem in the urinary tract. Researchers and doctors do not completely understand the cause of chronic prostatitis, but it is speculated that the cause may be initiated by neurological injury and/or related to infection.

Where is the prostate gland located, and what does it look like?

Picture and Location of the Prostate Gland
Picture and Location of the Prostate Gland

What should I do if I think I may have one of these prostate problems?

Regardless of which problem you may think you have, you should see your primary care doctor. To make the diagnosis your doctor will take a complete history, physical exam that includes a digital rectal exam, and other appropriate diagnostic tests, for example, a urinalysis, urine culture, blood tests such as the PSA test, electrolytes, creatinine, and occasionally blood urea nitrogen levels. Your doctor may order other tests, for example, ultrasound, endoscopy, urine flow rate studies, and biopsy of the prostate gland. Your doctor also may refer you to a specialist called a urologist, especially if you require surgery as part of your treatment.

Are the treatments for prostatitis and BPH different?

The treatment for an enlarged prostate and prostatitis are very different.

BPH treatment may include an interactive questionnaire to determine the extent of your symptoms. The results of the questionnaire may influence what medications or other treatments you may need. Drugs used to treat BPH include:

  • Alpha receptor blockers (alpha-1, alpha- adrenergic, 5-alpha reductase)
  • Phosphodiesterase inhibitors
  • Anticholinergic agents

Some patients with more severe prostatic enlargement may need surgery. A transurethral resection of the prostate (TURP) is the usual procedure to reduce pressure on the urethra by reducing the size of the prostate.

Treatment for prostatitis depends on the type.

  • Bacteria acute and chronic prostatitis (type I and type II) are typically treated and cured with antibiotics like fluoroquinolones or trimethoprim. These infections typically take longer to cure so you may have to take antibiotics for as long as 4-8 weeks. Some infections of the prostate gland are resistant or unresponsive to treatment so antibiotics like gentamicin or doxycycline may need to be injected directly into the gland.
  • Type III, chronic bacterial prostatitis and pelvic pain syndrome, is treated similarly with antibiotics, however, alpha-blockers and NSAIDs (nonsteroidal anti-inflammatory drugs), for example, aspirin, ibuprofen (Motrin, Aleve, Advil), naproxen (Naproxen) also are used.
  • Type IV, asymptomatic inflammatory prostatitis, in most patients requires no treatment. However, some doctors prescribe antibiotics and NSAIDs for this condition.

Can prostatitis and BPH be cured (prognosis)?

The prognosis for BPH for most patients that undergo treatment is good to fair, depending upon how well patients respond. BPH that requires surgery may result in complications such as erectile dysfunction. The prognosis for patients with more severe BPH symptoms that require surgery and medication for symptom relief is fair. There is no cure for BPH.

Most men with prostatitis (all types) may have significant symptom relief, and most men can be cured with long-term appropriate antibiotic treatments. The prognosis for prostatitis ranges from good to fair because some patients have a tendency to have recurrent bouts of the condition.

REFERENCES:

Deters, LA, MD."Benign Prostatic Hypertrophy." Medsape. Updated: Nov 06, 2016.
<http://emedicine.medscape.com/article/437359-overview>

Turek, PJ., MD. "Prostatitis Clinical Presentation." Medsape. Updated: Mar 20, 2017.
<http://emedicine.medscape.com/article/785418-clinical >

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Reviewed on 5/31/2017
References
REFERENCES:

Deters, LA, MD."Benign Prostatic Hypertrophy." Medsape. Updated: Nov 06, 2016.
<http://emedicine.medscape.com/article/437359-overview>

Turek, PJ., MD. "Prostatitis Clinical Presentation." Medsape. Updated: Mar 20, 2017.
<http://emedicine.medscape.com/article/785418-clinical >

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