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Chronic abacterial prostatitis
Published by Bupa's health information team, May 2009.
This factsheet is for people who have chronic abacterial prostatitis, or who would like information about it.
Prostatitis is an 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 (CPPS) and is often diagnosed by excluding all other possible conditions.
Chronic abacterial prostatitis is a common condition, especially in men aged 18 to 50. It's estimated that half of all men have at least one bout of prostatitis during their lifetime.
About chronic abacterial prostatitis
The 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 near your back passage (rectum). The front of your prostate surrounds your urethra, the tube that carries urine from your bladder and out through your penis.
The position of the testicles and surrounding structures
Chronic abacterial prostatitis can be difficult to diagnose, as the condition isn't fully understood and there are few tests that can say for certain that you have it. Therefore, doctors consider a diagnosis of chronic abacterial prostatitis if you have had pain or discomfort in your genital and/or pelvic area for a period of at least three months. A chronic condition is one that lasts a long time, sometimes for the rest of the affected person's life. The term chronic refers to time, not how serious a condition is.
Symptoms of chronic abacterial prostatitis
The main symptom of chronic abacterial prostatitis is pain in your pelvic or genital area, specifically in the:
area between your scrotum and anus (perineum)
lower part of your abdomen
penis, especially the tip
Some men also get pain or have problems ejaculating.
Symptoms of chronic abacterial prostatitis usually remain constant, although some men find that their symptoms come and go in severity.
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.
It has been suggested that there may be a link between chronic abacterial prostatitis and male infertility. However, further research is needed to confirm this link.
Causes of chronic abacterial prostatitis
The exact cause of chronic abacterial prostatitis isn't known at present. It may be caused by many different factors rather than one specific cause.
Several theories have been put forward to explain the cause of the condition, including the following:
an infection by an organism that hasn't yet been identified
a reaction by your immune system to an organism inside your body
a problem with the sympathetic nervous system 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
Chronic abacterial prostatitis is difficult to diagnose as there few tests that can accurately say whether or not you have the condition. A diagnosis is usually made by your GP based on a description of your symptoms, as well as testing a sample of your urine and examining your prostate. A prostate examination is carried out by inserting a gloved finger into your rectum and assessing it by touch. Additional tests may also be done to rule out other possible conditions (for example sexually transmitted diseases).
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.
Initially, your GP may prescribe you a four week course of antibiotics, such as ciprofloxacin or ofloxacin, to take while you are waiting for your appointment to see the urologist. These are given to clear up any bacterial infection in your prostate. Always read the patient information leaflet that comes with your medicine.
If you are in pain, your GP will advise you to take painkillers, such as paracetamol or ibuprofen. And if you are in pain when you have a bowel movement, you may be prescribed a laxative such as lactulose to help soften your stools.
Your urologist may try several different types of treatments to manage your symptoms. Currently the most beneficial treatment for chronic abacterial prostatitis is 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, 14 to 24 weeks.
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.
More recently, research has shown that 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.
Many complementary therapies have been suggested as helpful but there is no hard scientific evidence to support the use of these.
Other treatments that may be tried include heat therapy (transurethral microwave thermotherapy), quercetin (a bioflavonoid food supplement), finasteride or dutasteride (a medicine used to treat other prostate conditions such as an enlarged prostate) and anti-inflammatory medicines. However, the evidence for these treatments is not conclusive and more research needs to be done to prove that they are effective in managing symptoms.
Living with chronic abacterial prostatitis
Chronic abacterial prostatitis is a difficult condition to manage and you may find that your symptoms frequently come and go in severity. However, some men do make a full recovery after treatment and have no further symptoms. This is mainly in men who have fewer symptoms and have only had a small number of previous episodes of the condition before.
If your symptoms do continue despite treatment, you will have regular follow-up appointments with your urologist to try and find the best combination of treatments to help you. Your doctor will be able to give you advice on how to cope with the long-term effects of chronic abacterial prostatitis. There are also support groups that you can contact for further help.
- Prostatitis. Clinical Knowledge Summaries. http://cks.library.nhs.uk, accessed 22 December 2008
- United Kingdom National guideline for the management of prostatitis. Clinical Effectiveness Group & British Association of Sexual Health and HIV, 2008
- Chronic prostatitis. Clinical Evidence. www.clinicalevidence.bmj.com, accessed 29 December 2008
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: May 2009