Prostatitis - nonbacterial
NBP; Prostatodynia; Pelvic pain syndrome; CPPS; Chronic nonbacterial prostatitis; Chronic genitourinary painChronic 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.
Infection with bacteria
Prostatitis is inflammation of the prostate gland. This problem can be caused by an infection with bacteria. However, this is not a common cause. A...
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 semen
Blood in the semen is called hematospermia. It may be in amounts too small to be seen except with a microscope, or it may be visible in the ejaculat...
ImageRead Article Now Book Mark Article - Blood in the urine
Blood in the urine
Blood in your urine is called hematuria. The amount may be very small and only detected with urine tests or under a microscope. In other cases, the...
ImageRead Article Now Book Mark Article - 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.
Urine culture
A urine culture is a lab test to check for bacteria or other germs in a urine sample. It can be used to check for a urinary tract infection in adults...
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.
Transurethral resection of the prostate
Transurethral resection of the prostate (TURP) is a surgery to remove the inside part of the prostate gland. It is done in order to treat symptoms o...
Retrograde ejaculation
Retrograde ejaculation occurs when semen goes backward into the bladder. Normally, it moves forward and out of the penis through the urethra during ...
Impotence
An erection problem occurs when a man cannot get or keep an erection that is firm enough for intercourse. You may not be able to get an erection at ...
Incontinence
Urinary (or bladder) incontinence occurs when you are not able to keep urine from leaking out of your urethra. The urethra is the tube that carries ...
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.
Male reproductive anatomy - illustration
The male reproductive structures include the penis, the scrotum, the testicles (testes), the epididymis, the seminal vesicles, and the prostate.
Male reproductive anatomy
illustration
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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