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Prostatitis - nonbacterial

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

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.

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Causes

Possible causes of nonbacterial prostatitis include:

• A past bacterial prostatitis infection
• Bicycle riding
• Less common types of bacteria that are not detected by common tests for 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 main 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.
• Medicines 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 medicines (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. But 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. In most cases, this surgery is not done on younger men. It may cause retrograde ejaculation. The surgery 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
• Dietary changes to avoid bladder and urinary tract irritants
• Pelvic floor physical therapy

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

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

References

Carter C. Urinary tract disorders. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 40.

Kaplan SA. Benign prostatic hyperplasia and prostatitis. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 114.

McGowan CC. Prostatitis, epididymitis, and orchitis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 110.

Pontari M. Inflammatory and pain conditions of the male genitourinary tract: prostatitis and related pain conditions, orchitis, and epididymitis. In: Partin AW, Domochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 56.

Review Date: 7/1/2023  

Reviewed By: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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