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Prostatitis - nonbacterial

  • Definition
    • Chronic nonbacterial prostatitis causes long-term pain and urinary symptoms. It involves the prostate gland or other parts of a man's lower urinary tract or genital area. This condition is not caused by an infection with bacteria.

  • Alternative Names
    • NBP; Prostatodynia; Pelvic pain syndrome; CPPS; Chronic nonbacterial prostatitis; Chronic genitourinary pain

  • Causes
    • Possible causes of nonbacterial prostatitis include:

      • A past bacterial prostatitis infection
      • Bicycle riding
      • Less common types of bacteria
      • Irritation caused by a backup of urine flowing into the prostate
      • Irritation from chemicals
      • Nerve problem involving the lower urinary tract
      • Parasites
      • Pelvic floor muscle problem
      • Sexual abuse
      • Viruses

      Life stresses and emotional factors may play a part in the problem.

      Most men with chronic prostatitis have the nonbacterial form.

  • Symptoms
    • Symptoms may include:

      • Blood in the semen
      • Blood in the urine
      • Pain in the genital area and lower back
      • Pain with bowel movements
      • Pain with ejaculation
      • Problems with urinating
  • Exams and Tests
    • Most of the time a physical exam is normal. However, the prostate may be swollen or tender.

      Urine tests may show white or red blood cells in the urine. A semen culture may show a higher number of white blood cells and low sperm count with poor movement.

      Urine culture or culture from the prostate does not show bacteria.

  • Treatment
    • Treatment for nonbacterial prostatitis is difficult. The problem is hard to cure, so the goal is to control symptoms.

      Several types of medicines may be used to treat the condition. These include:

      • Long-term antibiotics to make sure that the prostatitis is not caused by bacteria. However, people who are not helped by antibiotics should stop taking these medicines.
      • Drugs called alpha-adrenergic blockers help relax the muscles of the prostate gland. It often takes about 6 weeks before these medicines start working. Many people do not get relief from these medicines.
      • Aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs), which may relieve symptoms for some men.
      • Muscle relaxers like diazepam or cyclobenzaprine can help to reduce spasms in the pelvic floor.

      Some people have found some relief from pollen extract (Cernitin) and allopurinol, although research does not confirm their benefit. Stool softeners may help reduce discomfort with bowel movements.

      Surgery, called transurethral resection of the prostate, may be done in rare cases if medicine does not help. This surgery is not done on younger men in most cases. It may cause retrograde ejaculation. This can lead to sterility, impotence, and incontinence.

      Other treatments that may be tried include:

      • Warm baths to ease some of the pain.
      • Prostate massage, acupuncture, and relaxation exercises. However, none of these therapies have been proven to be effective.
      • Dietary changes to avoid bladder and urinary tract irritants.
  • Outlook (Prognosis)
    • Many people respond to treatment. However, others do not get relief, even after trying many things. Symptoms often come back and may not be treatable.

  • Possible Complications
    • Untreated symptoms of nonbacterial prostatitis may lead to sexual and urinary problems. These problems can affect your lifestyle and emotional well-being.

  • When to Contact a Medical Professional
    • Call your health care provider if you have symptoms of prostatitis.

  • References
    • Kaplan SA. Benign prostatic hyperplasia and prostatitis. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 129.

      Nickel JC. In: Wein AJ, ed. Prostatitis and related conditions, orchitis, and epididymitis. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 11.