Non-Bacterial Prostatitis
by Julie Chacko, M.D.
• Definition: Inflammation of the prostate that is not due to infection.
• Overview:
· This syndrome should be distinguished from prostatodynia which is prostatic pain without evidence of inflammation or infection.
· Non-bacterial prosatitis is more common than bacterial prostatitis and can be far more bothersome for patients.
· The cause of chronic non-bacterial prostatitis is unknown.
• Types:
· This is distinct from acute bacterial prostatitis, chronic bacterial prostatis and prostatodynia.
• Symptoms:
· The symptoms are similar to chronic bacterial prostatitis with episodic or sometimes low-level chronic pain in the perineum between the scrotum and anus, low back, low abdomen and with ejaculation. Burning with urination and discomfort in the penis may be present.
• Complications:
· There usually are not complications associated with this diagnosis though patients with chronic pain can develop depression or anxiety related to the chronic pain syndrome.
• Clinical Findings/signs:
· The prostate is sometimes tender on examination.
· Prostate massage to obtain expressed prostatic secretions (EPS) or the urine collected after massage should demonstrate white cells indicative of the inflammation but the culture of that fluid should not grow any organism.
· There are few other physical signs or symptoms.
• Treatment:
· Lifestyle: If ejaculation is not painful, regular ejaculation may help to relieve symptoms in some patients. Stress reduction and warm baths (submerging the prostate area) can be helpful for some.
· Medication: Many patients are treated initially with antibiotics until it is clear that the symptoms are not infection-related. Antibiotics aimed at less common organisms may also be tried in an effort to define the condition. Antibiotics aimed at less common organisms may also be tried in an effort to define the condition. Once clear that there is no infection present, medications to relieve symptoms can be used and may include any of the following: anti-inflammatory medications, Flomax* or other alpha-blocker medications, anti-spasmodics for the bladder and urinary analgesic medications such as Pyridium* or Prosed*. Some patients may benefit from referral to a pain management specialist if symptoms are severe.
· Surgery: No clear indication for surgical intervention with this disease.
• Prognosis:
· Prognosis is fair.
· Many patients learn lifestyle modifications that help to control and alleviate symptomatology but this is generally a chronic condition that results in intermittent or chronic symptoms for many.
Posted on April 16, 2009
