What is chronic nonbacterial prostatitis?

Chronic nonbacterial prostatitis, also known as chronic pelvic pain syndrome, is a common condition that affects men. It causes pain and inflammation in the prostate, pelvis, and the lower urinary tract. The prostate gland is located right below the bladder in men. It produces fluid that helps transport sperm. In the United States, chronic nonbacterial prostatitis affects around 10 to 15 percent of men.

Symptoms can cause ongoing pain, discomfort, and urinary issues, such as:

Don’t ignore any of the symptoms of chronic nonbacterial prostatitis. Instead, make an appointment with your doctor. There are a variety of treatments that may help.

The National Institutes of Health (NIH) describes four categories of prostatitis:

  • Acute bacterial prostatitis happens when bacteria, like sexually transmitted organisms, cause an infection in the prostate. Symptoms typically develop suddenly, and usually respond well to antibiotics.
  • Chronic bacterial prostatitis is an ongoing problem. It’s also more difficult to treat. It’s often associated with ongoing urinary tract infections.
  • Asymptomatic inflammatory prostatitis has no symptoms. It’s usually discovered while undergoing other tests. It appears to be more common in men who smoke and drink regularly.
  • Chronic (nonbacterial) prostatitis/chronic pelvic pain syndrome is the most common type of prostatitis. But the exact cause is unknown. It causes a variety of symptoms that can be difficult to treat. Doctors suspect it may be due to a prior infection or a small injury that causes inflammation.

The cause of chronic nonbacterial prostatitis is unknown. This makes it difficult to predict who is at risk for this condition. However, research into the cause is ongoing. Once a cause is discovered, doctors will be able to identify risk factors and target treatment.

Your doctor will review your medical history and likely ask you to fill out a questionnaire about your symptoms. They will also perform a prostate exam. And they will likely request a urine sample to look for infection.

During a prostate exam, your doctor will insert a lubricated, gloved finger into your rectum. They do this so they can feel for a tender, soft, or swollen prostate, which indicates inflammation or infection. Depending on the results of your exam, your doctor may perform the following:

  • prostate ultrasound
  • tests to rule out a sexually transmitted infection
  • studies to evaluate urine flow
  • further evaluation of the urinary tract

The goal of treatment is to help improve symptoms. Taking antibiotics to treat this condition is controversial.

Some doctors don’t give antibiotics because the condition may be chronic and not caused by an active infection. Some doctors will prescribe antibiotics, thinking it could help treat an infection that may not be easily identified.

Other common treatments include:

  • medications to relax the prostate muscles called alpha-adrenergic blockers — the same medications used to treat other prostate conditions, like BPH (benign prostate hypertrophy)
  • other medications like muscle relaxants or tricyclic antidepressants to help with pain
  • prescription pain medication or nonsteroidal anti-inflammatory drugs to reduce pain and swelling
  • plant extracts, like some herbal supplements (pollen extract cernilton and bioflavonoid quercetin) that have evidence of effectiveness

Alternative and natural remedies that may reduce ongoing pain include:

  • warm baths
  • acupuncture
  • relaxation exercises
  • using a cushion or pillow when sitting for long periods
  • massage therapy
  • avoiding spicy foods, caffeine, and alcohol that can irritate the bladder
  • biofeedback, a relaxation technique

Talk to your doctor before taking any herbal supplements. Some combinations of herbs may reduce the effectiveness of certain medications.

Chronic nonbacterial prostatitis/chronic pelvic pain syndrome can be an ongoing, painful condition. Exercise and pelvic floor physical therapy may improve your symptoms. According to the American Urological Association, having prostatitis does not increase your risk of prostate cancer.

To cope with anxiety or depression triggered by chronic pain and inflammation, talk with your doctor about treatments to improve your mental health. Other treatments may include anxiety medication and antidepressants. Joining a support group, getting private counseling, or participating in behavioral therapy can also help you cope with the condition.