Prostatitis vs BPH: How to Tell the Difference

What is the difference between prostatitis and BPH?

The short version, using the NIDDK and the Cleveland Clinic pages: prostatitis is inflammation or infection of the prostate, and BPH (benign prostatic hyperplasia) is an enlarged prostate that is not caused by cancer. One is about irritation, the other about size.

The prostate is the walnut-sized gland just below the bladder, and it wraps around the urethra, the tube that carries urine out. That placement explains the overlap. When the gland is swollen from inflammation or from growth, it squeezes the urethra, and in both cases you may feel it as a weak stream, trips to the bathroom and sometimes pain. The cause is different, and so is what usually happens next.

If you are already reading about night trips, our guides on enlarged prostate symptoms and waking up to pee at night cover the BPH side in more detail. This article is about where the two conditions part ways.

How do prostatitis and BPH compare side by side?

This is the table to hand a friend who asks which one he has. It is built from the four pages in the sources list, and where a row says "can happen," the page lists it as possible, not guaranteed.

Look at the overlap first. A weak or stop-and-start stream, urgency, frequent trips and getting up at night appear on both sides. That is why a man cannot reliably sort himself into one box. That overlap is the real lesson of this page: if the same night trips can come from two different causes, it is not something to settle at the kitchen table.

Then look at what is different. Pain in the pelvis, perineum, genitals or lower back, pain with ejaculation and fever are the clues the sources tie to prostatitis. A gradual build-up with age, with the stream and the night trips as the main complaints, is the usual BPH picture. The NIDDK adds a detail worth remembering for BPH: how bad the symptoms are does not always match how big the prostate is.

What are the four types of prostatitis?

This is the part that surprises many men. "Prostatitis" is not one thing. The Cleveland Clinic and the NIDDK both describe four types, and only two involve bacteria.

The Cleveland Clinic says chronic pelvic pain syndrome affects about 1 in 3 men and "isn't an infection." The NIDDK adds that it is the most common and least understood form, with causes that are still unclear. The bacterial types often start when bacteria move from the urethra into the prostate, and the NIDDK lists repeated or hard-to-treat urinary infections as a risk factor.

How common is all this? The Cleveland Clinic says more than 2 million men see a provider each year for prostatitis, and the NIDDK calls it the most common urinary tract problem in men under 50 and the third most common in men over 50. So if you are 50 or older, both conditions are on the table.

How common is BPH after 50?

Very common, and it grows with age. The Cleveland Clinic says about half of men show signs of BPH by age 60 and about 90% by age 85, and that about half of men with BPH develop symptoms that need treatment. The NIDDK counts it differently: roughly 5 to 6 percent of men ages 40 to 64 and 29 to 33 percent of men 65 and older. The numbers differ because one counts signs and the other counts men affected, and the message is the same: an enlarged prostate is normal company for a man in his 50s and 60s.

The NIDDK also lists what raises the odds besides age: a family history of BPH, heart and blood vessel disease, type 2 diabetes, obesity, kidney disease, erectile dysfunction and not being physically active. And it notes that some everyday medicines can make symptoms worse, such as cold and cough products with decongestants or antihistamines, so tell your doctor everything you take. Erectile dysfunction is on that list too, and our article on erectile dysfunction after 50 covers its causes and when to see your doctor.

Can you have prostatitis and BPH at the same time?

Yes. The Cleveland Clinic lists an enlarged prostate as a risk factor for prostatitis, and says being over 50 raises the risk for all four types. In plain words, a man who already has BPH can also pick up prostatitis, and a sudden change on top of your usual BPH symptoms, like new pain or a fever, is the cue to call the doctor, not to wait it out.

The good news is that neither one raises your risk of prostate cancer, according to the Cleveland Clinic. Both can push your PSA number up, though, and symptoms overlap with cancer, so your doctor may want more tests to find out why. Our PSA test guide explains what that number means.

Which symptoms need medical care right away?

This is the one list to take seriously. The NIDDK lists these for both conditions, and the Cleveland Clinic gives similar warnings.

For anything milder, like a new pain, a change in your stream or more trips than usual, the sources still say the same thing: see your provider. These symptoms can also point to other conditions, including prostate cancer, so a name you pick for yourself is not a diagnosis.

How do doctors tell prostatitis from BPH?

Not by one test. Both the NIDDK and the Cleveland Clinic describe a stack of steps, and which ones you get depends on your story.

• Your history and an exam. Your symptoms, how they started, your medicines, and a digital rectal exam, where the doctor feels the prostate. For prostatitis the exam can include collecting prostate fluid.
• A urine test. Urinalysis and a urine culture look for infection. It shows whether an infection is part of the picture.
• A PSA blood test. Useful, but it cannot separate the causes by itself, since inflammation, an enlarged prostate and cancer can all raise it.
• Flow and bladder checks. For BPH, the Cleveland Clinic lists a symptom survey, a urine flow test and a test for the urine left in the bladder after you go.
• Further tests when needed. The sources list cystoscopy (a look inside the bladder) and a transrectal ultrasound in some cases.

Why does it matter to get the name right? Because the paths are different. The Cleveland Clinic says bacterial prostatitis does not go away without medication, while the non-bacterial forms may settle on their own, and the NIDDK says mild BPH can be handled with regular check-ins. Guessing wrong can cost you months, and one afternoon in an exam room beats a season of wondering. If a doctor starts talking about BPH medicines, our BPH medicines guide explains how they work.

What should I bring to the appointment?

A few lines on paper beat a vague memory. Write down:

• Where the pain is, if any, and whether it spreads to the lower back or hurts with ejaculation.
• When it started and whether it came on in days or built up over months.
• Any fever, chills or burning when you pee, and any recent urinary infection or catheter.
• Your stream and your nights: how many trips at night, whether the stream is weak or stops and starts. The bladder diary in our night-time article is built for exactly this.
• Every medicine and supplement you take.

The NIDDK says that cutting back on alcohol and caffeine, may reduce how often you need to go. It is a free thing to try while you wait for your appointment, and we go through it step by step in what to cut first. If you are also curious about supplements for the prostate, our prostate guide is the place to start once you have talked to your doctor.

Frequently asked questions

Is prostatitis the same as an enlarged prostate?

No. Prostatitis is inflammation or infection of the prostate, while BPH (benign prostatic hyperplasia) is a non-cancerous growth of the gland. They can look alike because both can cause frequent urination and a weak stream, but they are different conditions. The Cleveland Clinic also lists an enlarged prostate as a risk factor for prostatitis, so a man can have both.

Can BPH turn into prostatitis, or the other way around?

One does not turn into the other, but they can overlap. The Cleveland Clinic says age over 50 and BPH increase the risk of every type of prostatitis. That is one more reason to get a proper exam when symptoms change instead of guessing which one you have.

Does prostatitis or BPH raise my risk of prostate cancer?

The Cleveland Clinic says prostatitis is benign and does not increase prostate cancer risk, and that research shows BPH does not increase it either. Both can raise your PSA number, though, and symptoms overlap with cancer, which is why your doctor may order more tests to find the cause of a high PSA.

Does prostatitis go away on its own?

It depends on the type. The Cleveland Clinic says bacterial prostatitis does not resolve without medication, while the non-bacterial forms and chronic pelvic pain syndrome may calm down on their own. You cannot tell which one you have from the couch, so a urine test and an exam come first.

How common is BPH after 50?

Very. The Cleveland Clinic says about half of men show signs of BPH by age 60 and about 90% by age 85. The NIDDK counts men with BPH at roughly 5 to 6 percent of men ages 40 to 64 and 29 to 33 percent of men 65 and older. Having it does not always mean having symptoms.

Which symptoms mean I should go to the doctor right away?

The NIDDK lists these for both conditions, and the Cleveland Clinic gives similar warnings: not being able to urinate at all, painful and urgent urination with fever and chills, blood in the urine, and severe pain in the lower belly or urinary tract. The Cleveland Clinic calls acute prostatitis a medical emergency.

Sources we checked for this article

• NIDDK: Prostatitis: Inflammation of the Prostate (page last reviewed July 2014)
• NIDDK: Prostate Enlargement (Benign Prostatic Hyperplasia) (page last reviewed June 2024)
• Cleveland Clinic: Prostatitis (last updated November 2023)
• Cleveland Clinic: Benign Prostatic Hyperplasia (BPH) (last updated January 2024)