Prostatitis - nonbacterial - chronic

Answer 1

Definition

Chronic nonbacterial prostatitis is long-term pain and urinary symptoms that involve the prostate gland or other parts of a man's lower urinary tract or genital area. This condition is not caused by bacterial infection.

See also: Chronic bacterial prostatitis

Alternative Names

NBP; Prostatodynia; Pelvic pain syndrome; CPPS; Chronic nonbacterial prostatitis; Chronic genitourinary pain

Causes, incidence, and risk factors

Possible risk factors for nonbacterial prostatitis include:

• Bacteria
• Fungi
• Irritation caused by a backup of urine flowing into the prostate
• Parasites (trichomonads)
• Viruses
• Chemicals
• Nerve disorder involving the lower urinary tract
• Problems with toilet training
• Sexual abuse

Life stresses and some psychological factors may also contribute.

Most patients with chronic prostatitis have the nonbacterial form.

Symptoms

• Blood in the semen
• Blood in the urine
• Pain that is located:
  • Above the pubic bone (suprapubic)
  • Between the genitals and anus (perineal)
  • Low back
  • Scrotum
  • Tip of penis
  • Urethra
• Problems with urinating
  • Decreased urinary stream
  • Frequent urination
  • Pain or burning with urination
  • Incomplete emptying of your bladder
  • Weak urine stream
• Pain with bowel movements
• Pain with ejaculation

Signs and tests

A physical examination usually will not show anything unusual. However, the prostate may be swollen, soft or firm, warm, and tender.

Urine tests may show white or red blood cells in the urine. A semen culture may show increased white blood cells and low sperm count with poor movement (motility).

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

Treatment

Treatment for nonbacterial prostatitis is difficult. The goal is to control symptoms, because a cure is difficult to achieve.

MEDICATIONS:

Many patients are treated with long-term antibiotics to make sure that bacteria are not causing their prostatitis. However, patients who have had symptoms for a long period of time and do not seem to benefit from antibiotics should stop taking them.

See: Chronic bacterial prostatitis

Medications called alpha-adrenergic blockers help relax the muscles of the prostate gland. They include:

• Doxazosin (Cardura)
• Tamsulosin (Flomax)
• Terazosin (Hytrin)

It usually takes about 6 weeks before these medicines start working.

Aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs) may relieve symptoms in some patients.

Some people have had limited success with pollen extract (Cernitin) and allopurinol. Stool softeners may be recommended to reduce discomfort with bowel movements.

SURGERY:

Transurethral resection of the prostate may be done in rare cases if medical therapy is not successful. This surgery is usually not performed on younger men, because it may cause retrograde ejaculation, which can lead to sterility, impotence, and incontinence.

OTHER THERAPY:

Warm baths may help relieve some of the perineal and lower Back pain. A number of other therapies have been used, such as prostatic massage, acupuncture, and relaxation exercises. However, none of these therapies have been proven beneficial.

Expectations (prognosis)

Many patients respond to treatment. However, others do not get relief even after many attempts at treatment. Symptoms often come back after treatment, and may eventually not be treatable.

Complications

Untreated symptoms of nonbacterial prostatitis may lead to sexual and urinary problems, which can affect your lifestyle and emotional well-being.

Calling your health care provider

Call your health care provider if you have symptoms of prostatitis.

References

Nickel JC. Inflammatory conditions of the male genitourinary tract: Prostatitis and related conditions, orchitis, and epididymitis. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 9.

Barry MJ, McNaughton-Collins M. Benign prostate disease and prostatitis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 130.

Answer 2

Definition

Chronic nonbacterial prostatitis is a condition that 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.

See also: Prostatitis - bacterial

Alternative Names

NBP; Prostatodynia; Pelvic pain syndrome; CPPS; Chronic nonbacterial prostatitis; Chronic genitourinary pain

Causes, incidence, and risk factors

Possible causes of nonbacterial prostatitis include:

• A past bacterial prostatitis infection
• Bacteria that are not typical (atypical), such as mycoplasma or ureaplasma
• Irritation caused by a backup of urine flowing into the prostate
• Irritation from chemicals
• Nerve problem involving the lower urinary tract
• Parasites (trichomonads)
• Pelvic floor muscle problem
• Sexual abuse
• Viruses

Life stresses and some psychological factors may also contribute.

Most patients with chronic prostatitis have the nonbacterial form.

Symptoms

• Blood in the semen
• Blood in the urine
• Pain that is located:
  • Above the pubic bone (suprapubic)
  • Between the genitals and anus (perineal)
  • Low back
  • Scrotum
  • Tip of penis
  • Urethra
• Pain with bowel movements
• Pain with ejaculation
• Problems with urinating
  • Decreased urinary stream
  • Frequent urination
  • Pain or burning with urination
  • Incomplete emptying of your bladder
  • Weak urine stream

Signs and tests

A physical examination usually will not show anything abnormal. 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 increased white blood cells and low sperm count with poor movement (motility).

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

Treatment

Treatment for nonbacterial prostatitis is difficult. The goal is to control symptoms, because it is hard to cure this condition.

MEDICATIONS:

Many patients are treated with long-term antibiotics to make sure that bacteria are not causing their prostatitis. However, patients who have had symptoms for a long period of time and do not seem to benefit from antibiotics should stop taking them.

See also: Prostatitis - bacterial

Medications called alpha-adrenergic blockers help relax the muscles of the prostate gland. They include:

• Alfuzosin (Uroxatral)
• Doxazosin (Cardura)
• Silodosin (Rapaflo)
• Tamsulosin (Flomax)
• Terazosin (Hytrin)

It usually 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) may relieve symptoms in some patients.

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

SURGERY:

Transurethral resection of the prostate may be done in rare cases if medicine does not help. This surgery is not usually done on younger men, because it may cause retrograde ejaculation. This can lead to sterility, impotence, and incontinence.

OTHER THERAPY:

Warm baths may help relieve some of the pain. A number of other treatments have been used, such as prostate massage, acupuncture, and relaxation exercises. However, none of these therapies have been proven to help.

Expectations (prognosis)

Many patients respond to treatment. However, others do not get relief, even after trying many treatments. Symptoms often come back after treatment, and may eventually not be treatable.

Complications

Untreated symptoms of nonbacterial prostatitis may lead to sexual and urinary problems, which can affect your lifestyle and emotional well-being.

Calling your health care provider

Call your health care provider if you have symptoms of prostatitis.

References

Barry MJ, Collins M. Benign prostate disease and prostatitis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 131.

Nickel JC. Inflammatory conditions of the male genitourinary tract: Prostatitis and related conditions, orchitis, and epididymitis. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 9.

Reviewed By

Review Date: 09/16/2011

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Scott Miller, MD, Urologist in private practice in Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.