- Nonbacterial prostatitis (NBP), also known as chronic pelvic
pain syndrome (CPPS), is the most common and least understood form of prostatitis. It is a
condition in which the patient exhibits many of the symptoms of prostatitis without any
demonstrable infection.
- Causes
- Unfortunately, little is known about what
causes NBP. It is believed to occur eight times more often than bacterial prostatitis.
- What are the signs and symptoms of the condition?
- The symptoms of NBP typically resemble those of chronic
bacterial prostatitis: rapid onset, chills, fever, pain in the lower back and genital
area, body aches, burning or painful urination, increased urinary frequency and urgency,
often at night, and occasionally visible blood in the urine. In cases of NBP, however,
urinary tract infections are rare.
Symptoms come and go, disappearing and reappearing without
warning or apparent reason. The patient will experience good and bad spells. This can be
frustrating and debilitating, as the patient typically will seek treatment on the basis of
symptoms he and his physician assume are associated with bacterial prostatitis.
Medications prescribed for bacterial prostatitis may appear to work when the condition
wanes, misleading them to think the problem has been cured. This can give rise to great
anxiety when symptoms return, and in fact many men report a worsening of their symptoms
during times of stress.
- How is this condition diagnosed?
- A diagnosis of NBP
usually is made after repeated unsuccessful attempts to treat
what is presumed to be bacterial prostatitis. Although microscopic examination of prostate
massage specimens may show increased numbers of white blood cells, ultimately, no definite
source of infection can be identified. Urine and prostatic fluid routinely fail to show
the presence of any infecting organisms. Often the diagnosis is made only after various
unsuccessful drug treatments, numerous doctor's visits and considerable expense.
Occasionally, doctors will diagnose patients whose NBP
develops from a lack of sexual activity. This so-called "congestive prostatitis"
is thought to be the result of a lack of ejaculation. when semen stays too long in the
prostate and causes inflammation.
A converse diagnosis of "exhaustive prostatitis" or
"overuse prostatitis" may be made in men whose NBP symptoms appear to be caused
by excessive ejaculation. In both cases, a sexual history is essential to accurate
diagnosis, and modification of sexual activity usually is prescribed.
- What are the treatments?
- There is no known cure for NBP. Because
antibiotics generally are ineffective at combating it, treatment often devolves on
lessening the patient's symptoms with a variety of pain-relief medications and "home
remedies." These include:
- Hot baths ("sitz baths")-A helpful temporary
treatment for all forms of prostatitis, warm water and relaxation can soothe the prostate
and relieve symptoms.
- Drinking plenty of water-This dilutes the acidity and salt in
urine and from such food irritants as caffeine, cranberry or citrus acid, colas, spices,
alcohol, etc..
- Stress management techniques-These may help patients who note
their symptoms worsening during periods of anxiety or stress.
- "Alpha blockers"-These drugs relax the bladder's
sphincter muscles, and may provide relief to patients who experience difficulty urinating.
- "Parasympathetic blockers-These drugs relax the muscles
that surround the bladder, making them less sensitive, and may provide relief to patients
who have urgency and frequency of urination.
- Nonsteroidal anti-inflammatory medications - Over-the-counter
medicines like ibuprofen and naproxen, as well as stronger anti-inflammatory drugs, may
provide some symptom relief.
- Transurethral Microwave Therapy (TUMT)-Heating the prostate
with a microwave probe inserted through the penis or rectum has provided symptom relief in
some experimental situations.
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