Prostatitis

Chronic Nonbacterial Prostatitis (Chronic Pelvic Pain Syndrome)

The prostate gland might have an insignificant size but plays a critical role in male reproductive health.

Due to its position in the male body, problems with the gland can lead to discomfort and urinary complications. There are several conditions known to affect the prostate gland. 

Among the male population, benign prostatic hyperplasia, also known as an enlarged prostate, is often the most discussed prostate condition. While its prevalence remains high, other conditions need to be taken into account too.

Prostatitis is a condition that can lead to chronic pelvic pain syndrome. It can also affect the urinary system and lead to discomforting complications. 

There are both acute and chronic cases of prostatitis. When this condition becomes chronic, it leads to long-term effects on the male body. We look at what chronic nonbacterial prostatitis is.

We also consider symptoms and causes behind the condition. This post will also provide a comprehensive overview of current treatment procedures available for men with prostatitis. 

What Is Chronic Nonbacterial Prostatitis?

Prostatitis is a condition that affects the prostate gland. An infection from bacteria species often causes it. The bacteria invade the prostate, leading to inflammation. Several bacterium strains can lead to the development of bacterial prostatitis. 

There are different classifications of prostatitis, and we can highlight two of them. First, we have a classification according to the root cause. It can be divided into bacterial prostatitis and nonbacterial prostatitis. Then, we have a classification according to the progression of the disease. It is then divided into acute prostatitis and chronic prostatitis.

Joining both classifications, we have the following subtypes:

  • Acute bacterial prostatitis: This is an acute bacterial infection of the prostate. The symptoms have a sudden onset, and it is not the most common. An acute infection causes around 10% of prostatitis cases. It is more commonly seen after transrectal prostate biopsy or urethral catheterization (2).

  • Chronic bacterial prostatitis: This is a chronic bacterial infection of the prostate gland. In many cases, it is caused by a recurrent bacterial infection. In other cases, there’s no clear evidence of infection. The latter cases are often recognized as chronic pelvic pain syndrome. The symptoms are insidious, and the onset is very slow (3).

  • Acute nonbacterial prostatitis: This is very similar to acute bacterial prostatitis. The symptoms are basically the same, but the root cause is different. Instead of bacterial infections, we usually have a yeast infection. Chlamydia can be one of the causes. However, it is not as frequent and bacterial prostatitis (4).

  • Chronic nonbacterial prostatitis: It is also recognized as the pelvic pain syndrome. However, chronic nonbacterial prostatitis is perhaps the most common type. These patients have chronic pelvic pain for weeks, months, or years. It degrades their quality of life and can be challenging to treat because it does not always respond to antibiotic treatment (5).

  • Asymptomatic inflammatory prostatitis: It is an asymptomatic inflammation of the prostate. In other words, patients have infiltrated white blood cells and a swelling prostate. But they do not have any symptoms, which is often found after evaluating other problems, usually infertility. There’s usually no necessary treatment, and there’s no symptom whatsoever (6).

While commonly associated with bacteria, an infection is not the only reason a man may develop prostatitis. Nonbacterial prostatitis is possible too. In such a case, the prostate develops prostatitis symptoms without bacteria in the gland. 

In this case, the patient is diagnosed with nonbacterial prostatitis. There are several scenarios where prostatitis is an acute condition. The patient would receive treatment, and the infection clears up. Unfortunately, with nonbacterial prostatitis, the condition generally becomes chronic. 

When prostatitis becomes chronic and is not related to a bacterial infection, it is generally referred to as chronic pelvic pain syndrome. It is not only the prostate itself that will be affected by symptoms. Men often find that the symptoms affect the surrounding areas too. 

The symptoms associated with chronic nonbacterial prostatitis tend to come and go. Men may experience phases where there is no symptoms present. A flare-up can then occur at any time. In such a case, symptoms can vary from mild to severe. 

Some complications need to be taken into consideration when looking at chronic nonbacterial prostatitis. The inflammation of the prostate gland can cause problems with the urinary tract. 

Symptoms

Men should realize what symptoms may signal the presence of chronic nonbacterial prostatitis. This helps the patient identify the condition at an earlier stage.

The sooner chronic prostatitis is diagnosed, the more successful treatment may be. This may also help to improve the quality of life in the patient. Early treatment may assist in reducing the risk of the more severe complications associated with the condition too. 

There are a few common symptoms that men should look out for. These include:

  • Urinary problems are prevalent in men with chronic prostatitis. These symptoms are present with both bacterial and nonbacterial prostatitis. The man may find that they strain during urination. Other lower urinary tract symptoms may also be present. 

  • There may be a more consistent and frequent urge to urinate. Some men find that they experience unexpected urges to urinate – often at the most unpleasant times. 

  • There may be a burning sensation when the man urinates. Some men also complain about painful urination. 

  • When the man ejaculates, pain may be experienced. In some men, blood appears to be present in the semen. When there is blood in the semen, it may have a pinkish color. 

  • During a bowel movement, some men experience pelvic pain when they have chronic prostatitis. 

Pain may also develop in surrounding regions of the pelvis. Lower back pain is another potential symptom that is often noted among men with this condition.

Additionally, there have been reports of pain at the penis’ tip. These pain symptoms may affect the urethra, too, as well as the region located between the anus and the genitals. 

Another sign to look out for is sexual dysfunction. Several studies have shown a high prevalence of sexual dysfunction among men with chronic prostatitis. One study explains that prostatitis’ painful symptoms might be behind the potential loss of interest in sex. The patient may have pain when they ejaculate, for example.

Patients experiencing these symptoms are advised to consult with a doctor. The symptoms may signal the presence of chronic nonbacterial prostatitis. Other conditions can also cause these symptoms. A urinary tract infection is one example. A doctor can do tests to provide an accurate diagnosis.  

What Causes Chronic Nonbacterial Prostatitis?

Research has shown that chronic nonbacterial prostatitis is the most prevalent type of this disease. Other types of prostatitis can also develop, but these are not as prevalent. 

At the moment, medical experts have not found a specific cause behind chronic nonbacterial prostatitis. While ongoing research is conducted, many men never identify the reason for the condition to develop. 

What Are The Risk Factors For Chronic Nonbacterial Prostatitis?

While no specific cause is linked to the condition, it should be noted that some possible risk factors have been identified that may contribute to the development of the condition.

By considering these causes, it is possible for men to at least have a basic understanding of why the disease could have developed. These causes can also be used as a way of determining the patient’s risk.

Below, we will outline some of the possible causes that have been linked to chronic nonbacterial prostatitis. 

  • A patient who had experienced an infection in their prostate previously tend to be at a greater risk for developing nonbacterial chronic prostatitis. This seems to be an even greater risk among men who had prostatitis caused by less common bacterium strains. 

  • Men who have been exposed to parasites may be at risk of developing this condition. The risk becomes significant if the parasites make their way toward the urethra and prostate gland

  • Exposure to certain chemicals can irritate the prostate gland. This has also been linked to a more significant risk of developing chronic nonbacterial prostatitis. 

  • Among men with nerve-related problems affecting the urinary tract, there also seems to be a higher risk of this condition. Several factors can cause such nerve problems, with type 2 diabetes being only one example. 

  • Men who had experienced sexual abuse in the past could also have a possible higher risk of experiencing this condition. 

  • Among men who experience a backup of their urine, there is also an increased likeliness of developing chronic nonbacterial prostatitis. This is generally because urine backs up into the prostate gland. In turn, it irritates. The irritation leads to the development of inflammation. 

  • An issue affecting the pelvic floor muscle has also been shown to be a risk factor for the condition. 

Apart from these factors, it should be noted that not only bacteria can cause infection in the prostate gland. It is possible for viruses to invade the prostate gland as well. These scenarios can lead to a chronic display of symptoms related to prostatitis. 

Another risk factor that has been identified is bicycle riding. Among men who frequently ride on a bicycle, it has been found that the prevalence of chronic nonbacterial prostatitis is higher. This could be due to friction that occurs in the pelvis region during riding sessions. In turn, the prostate gland may be irritated. 

How Is This Condition Diagnosed?

Diagnosis of chronic nonbacterial prostatitis plays a critical role in developing an efficient treatment plan for the patient. When the patient complains about symptoms related to the condition, a doctor will order specific tests.

These tests can assist in identifying problems with the prostate gland. The doctor can use the test results to provide a diagnosis for chronic nonbacterial prostatitis. The healthcare provider can also help rule out other potential causes with the results provided by these tests. 

The first step is for the doctor to analyze the patient’s medical history. This information helps the doctor identify potential risk factors for prostate conditions. A comprehensive overview of symptoms experienced will be requested. The patient should provide the doctor with as many details as possible. 

The next step of the diagnosis process usually involves a prostate exam. This procedure is sometimes also referred to as a digital prostate exam. It can be a little uncomfortable for men but plays an essential role in helping the doctor identify prostate problems.

During this test, the doctor puts on a glove. A lubrication agent is used on one finger. The lubricated finger is placed into the patient’s rectum. The doctor then presses against the prostate gland. 

Abnormalities with the prostate, such as inflammation, can usually be identified through this particular test. 

If problems are identified, the doctor is likely to order additional tests. A urine sample will be collected from the patient. This sample is sent toward a laboratory. The lab will investigate the urine sample to see if any infections are present. 

Following these two procedures, additional tests are usually ordered too. The doctor will determine the most likely diagnosis. Based on the findings, they may order one or more of the following tests:

  • An ultrasound on the prostate gland. This provides a visual view of the prostate gland. It helps detect inflammation, growths, and an enlargement of the prostate gland. 

  • The doctor may advise the patient to get tested for certain sexually transmitted infections. There are a few STIs known to affect the prostate gland. Ruling these out helps with the process of providing the patient with an accurate diagnosis. 

  • The flow of the man’s urine may be analyzed. There are a few studies that can be used for this purpose. The doctor will consider the study that is most suitable for the scenario. 

  • The urinary tract may be analyzed too. This can help identify anomalies with the urinary system and rule out factors like a urinary tract infection. 

What Treatment Options Are Available?

Men need to ensure they take care of their prostate. Serious conditions affecting the prostate gland can lead to long-lasting damage.

These long-term effects can interfere with reproductive health. It can also lead to problems with the urinary tract and even contribute to the development of sexual dysfunction. 

Among male patients with chronic nonbacterial prostatitis, treatment options are available. The condition is considered chronic, however. This means the condition is likely not curable.

Instead, a doctor will devise a treatment plan that focuses on reducing symptoms experienced. This can help the patients experience less interference with their daily life. For example, medications used to reduce urinary symptoms may improve sleep. This is due to fewer sessions of nighttime urination

Antibiotics are sometimes used for the treatment of prostatitis. This, however, is a topic with controversial opinions. Many medical experts believe antibiotics should not be used as a first-line treatment.

With chronic nonbacterial prostatitis, the use of antibiotics will not do any good. This is because antibiotics will only help to treat a bacterial infection. In the case of this particular condition, it is not a bacterium that causes inflammation and accompanying symptoms. 

A couple of conventional treatment options are available for men with chronic prostatitis. The doctor will determine what is needed to help improve the man’s quality of life. 

A few examples of medications that may be prescribed to the patient include:

  • Alpha-adrenergic blockers are sometimes used. These drugs are most often provided to men with benign prostatic hyperplasia. Some studies show that medicine may also have therapeutic potential in men with prostatitis. The drugs work by relaxing the muscles located within the prostate gland. The medication may assist in reducing the pressure applied to the urethra and bladder by the prostate. It could potentially improve urinary symptoms. However, it should be noted that these medication can have severe side effects. Before taking them discuss the potential side effects with your doctor.

  • Muscle relaxants may be used in some cases. The goal here is also to help reduce tension in the prostate gland’s muscles. 

  • Some men find that tricyclic antidepressants are helpful. These antidepressants are indicated for the management of pain in men with this condition. 

  • Nonsteroidal anti-inflammatory drugs can be a potential treatment option too. These drugs may assist in reducing the inflammation in the prostate gland. Additionally, NSAIDs might assist in alleviating the pain symptoms experienced. 

  • A prescription painkiller can be used too. These are particularly useful in men with more severe levels of pain. 

A lot of men with chronic prostatitis opt for the use of more natural treatments too. These treatments are often considered safer compared to the long-term use of pharmaceuticals. Several natural treatments have been researched. Studies show that a few options may provide an effective improvement in symptoms. 

One research paper describes current interventions for prostatitis among male patients. The study includes suggestions related to natural treatments as well. Among the phytotherapy suggestions, researchers believe that quercetin may be an effective option. 

Numerous studies have been conducted on the effect of quercetin on the prostate gland. It has been found that quercetin may have a beneficial effect on the prostate gland.

In one study, it was shown that this natural plant extract might even assist in reducing the risk of prostate cancer. In particular, prostate cancer cells were effectively down-regulated by the use of quercetin supplementation.

Coping With Chronic Conditions

Men need to realize that this condition is chronic. This means the condition is likely to cause episodes of symptoms. With this in mind, men should realize what they can do to cope with the situation. 

The first step to coping is to ensure appropriate treatment is provided. A doctor should diagnose the condition and provide appropriate medications. The man also needs to ensure they follow the instructions provided by the doctor. This can help to ease symptoms and reduce discomfort experienced. 

A regular check-up with the doctor is also advisable. This ensures a doctor can identify a worsening of the condition. In such a case, the treatment plan can be adjusted accordingly. 

Some men experience depression and anxiety as a result of the condition. There are ways that these issues can be addressed. The man should consider talking to their doctor about mental symptoms. An antidepressant may be provided. This could assist in reducing depressive symptoms.

Additionally, some antidepressants have been shown to offer an effective reduction in pain symptoms. Anti-anxiety drugs are also available. 

A few alternative therapies and treatment methods can be used by the patient too. These may assist in improving symptoms. There are a couple of alternative treatments and remedies that can be utilized. 

One example is to take warm baths. This helps to improve blood circulation. The warm bath could assist in reducing inflammation.

Relaxation techniques, such as meditation, can be helpful too. These can help the man experience reduced tension in his muscles. Meditation is also known to assist in improving depression and anxiety symptoms. 

Other options that men can consider include:

  • Biofeedback techniques. These techniques help the man equip himself with skills to reduce tension in his body. 

  • Opting for massage therapy can further assist in promoting relaxation throughout the body. This ensures tense muscles become loose. 

  • Acupuncture has been shown to provide an effective alleviation of both pain and inflammation. The use of acupuncture might assist in reducing the severity of symptoms related to this condition. It could also promote enhanced relaxation. 

  • A pillow can be used if the man sits down for a prolonged period. This can add additional support to the buttocks and pelvic region. 

Some men also find that avoiding certain foods in their daily diet helps. Foods to avoid with prostatitis include alcohol and caffeine, which can cause irritation to the bladder.

Both of these irritate the patient’s bladder. Additionally, it is vital to limit the intake of spicy foods. Similar to caffeine, spicy foods may also pose an irritation to the bladder

Conclusion

Prostatitis is often associated with a bacterial infection in the prostate gland. Men should realize, however, that the condition can be caused by nonbacterial elements too. Nonbacterial prostatitis is often chronic. This means the disease leads to long-term effects in the body.

Men may experience pain and discomfort. The condition often causes urinary symptoms, as well. Some treatments focus on reducing symptoms experienced. Specific prescribed medicines depend on the patient’s condition.

Sources

  1. MedlinePlus. Prostatitis – nonbacterial. [online] Available at: https://medlineplus.gov/ency/article/000524.htm#:~:text=Chronic%20nonbacterial%20prostatitis%20causes%20long,by%20an%20infection%20with%20bacteria.
  2. Journal of Urology. (2004) Mechanisms In Prostatitis / Chronic Pelvic Pain Syndrome. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3591463/
  3. Canadian Urological Association Journal. (2011) Prostatitis. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202001/
  4. BJBMS. (2007) Management of Chronic Nonbacterial Prostatitis/Chronic Pelvic Pain Syndrome. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5736117/
  5. Korean Journal of Urology. (2011) Prostatic Disease and Sexual Dysfunction. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3123811/#:~:text=Pain%20caused%20by%20prostatitis%2C%20which,BPH%2C%20may%20affect%20sexual%20function.
  6. Prostate Journal. (2010) The Dietary Bioflavonoid, Quercetin, Selectively Induces Apoptosis of Prostate Cancer Cells by Down-Regulating the Expression of Heat Shock Protein 90. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826114/

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