Chronic abacterial prostatitis

Published by Bupa's Health Information Team, April 2011.

This factsheet is for men who have chronic abacterial prostatitis, or people who would like information about it.

Prostatitis is a swelling (inflammation) of the prostate gland. It can be caused by a bacterial infection (bacterial prostatitis) or it may have an unknown cause – this is called chronic abacterial prostatitis or chronic pelvic pain syndrome.

It's estimated that half of all men have prostatitis at least once during their lifetime. Chronic abacterial prostatitis is the most common type.

About chronic abacterial prostatitis

Your prostate is a gland that produces the liquid part of semen. It's about the size of a walnut and lies at the base of your bladder. The front of your prostate surrounds your urethra, the tube that carries urine from your bladder and out through your penis.

Chronic abacterial prostatitis is a condition where you have pain or discomfort in your genital and/or pelvic area for a period of at least three months, but there is no evidence of infection.

When describing an illness, the term ‘chronic’ refers to how long a person has the illness, not to how serious a condition is. A chronic illness is one that lasts a long time.

Symptoms of chronic abacterial prostatitis

Symptoms of chronic abacterial prostatitis include pain or discomfort:

• in the area between your scrotum and anus (perineum)
• at the tip of your penis, testicles and rectum (back passage)
• in your lower abdomen and lower back
• on passing urine, on ejaculation or during bowel movements

You may find that your symptoms remain constant or ease for a while before becoming worse again.

If you have any of these symptoms, see your GP.

Complications of chronic abacterial prostatitis

The main complication of chronic abacterial prostatitis is the impact it has on you physically and psychologically. Symptoms such as pain and problems with ejaculation can greatly affect both your quality of life and your mental health.

Causes of chronic abacterial prostatitis

The exact reasons why you may develop chronic abacterial prostatitis aren't fully understood at present. It may be caused by many different factors rather than one specific thing.

Several theories have been put forward to explain the cause of the condition. Some are listed below.

• An infection by a bacterium or virus that hasn't yet been identified.
• A reaction by your immune system to a bacterium or virus inside your body.
• A problem with the nerves in your pelvic area.
• An inflamed bladder (interstitial cystitis).
• A cyst on your prostate.
• Prostate stones (prostatic calculi).
• Your prostate holding onto its fluids.
• Your pelvic floor muscles (the group of muscles that wrap around the underside of your bladder and rectum) not working properly.

Diagnosis of chronic abacterial prostatitis

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. Chronic abacterial prostatitis is difficult to diagnose as there are few tests that can accurately say whether or not you have the condition. The symptoms of chronic abacterial prostatitis can often be similar to those of other conditions, so your GP will want to rule these out before diagnosing you.

Your GP will usually ask for a sample of your urine and may examine your prostate by inserting a gloved finger into your rectum to assess it by touch. Your GP may also take a sample of blood and a swab of your urethra to rule out other possible conditions.

Your GP will refer you to a urologist to confirm your diagnosis and manage your condition. A urologist is a doctor who specialises in identifying and treating conditions of the urinary system.

Treatment for chronic abacterial prostatitis

Chronic abacterial prostatitis is a difficult condition to treat and there is currently no cure for it. Often a combination of treatments is needed to manage the condition rather than just one form of treatment.

Medicines

Your doctor may suggest you take ibuprofen to ease any swelling and pain and a laxative (eg lactulose) to help make your faeces softer and easier to pass. This can help reduce pain during a bowel movement.

Your urologist may also suggest trying several other different types of medicines to manage your symptoms. These may include the following.

• Antibiotics, such as ciprofloxacin or doxycycline. You may be prescribed a four-week course to clear up any bacterial infection in your prostate. You should always take the full course of antibiotics.
• Alpha-blockers, such as alfuzosin or tamsulosin. These are medicines that relax the muscle fibres controlling tension in the prostate gland, helping to relieve internal pressure and allowing your bladder to empty more easily. This treatment is most effective when taken over a long period of time – from eight to 24 weeks.
• Finasteride. This is a medicine used to treat an enlarged prostate. It can also be used for prostatitis.

The evidence for these treatments isn’t conclusive and more research needs to be done to prove that they are effective in treating chronic abacterial prostatitis.

Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Surgery

Your urologist may recommend you try heat therapy (transurethral microwave thermotherapy) or laser therapy to heat and destroy the inflamed tissue in the prostate. Alternatively, your surgeon may recommend having a transurethral resection of the prostate to remove some of the prostate tissue.

Psychological therapies

If your symptoms are causing you mental and emotional problems, your urologist may refer you for a psychological assessment and stress management. Stress management teaches you techniques for coping with stress or difficult situations in your life.

Physical therapies

A combination of physiotherapy and relaxation techniques can be helpful in managing symptoms of chronic abacterial prostatitis, especially when it's thought to be caused by reactive muscle pain in your pelvic floor.

Complementary therapies

Many complementary therapies have been suggested, such as quercetin (a bioflavonoid food supplement); however, there is no hard scientific evidence to support the use of these.

Living with chronic abacterial prostatitis

Chronic abacterial prostatitis is a difficult condition to manage. You may find your treatment helps and you have no further symptoms, or that it proves unsuccessful. If your symptoms continue despite treatment, you will have regular follow-up appointments with your urologist to try and find the best combination of treatments to manage your condition. Your doctor will give you help and advice on coping with chronic abacterial prostatitis. There are also support groups that you can contact for further help. 

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.