Chronic prostatitis is pelvic or perineal pain without evidence of urinary tract infection lasting longer than three months. The National Institutes of Health (NIH) classifies prostatitis into four syndromes. This article discusses the four prostatitis syndromes listed in the medical research and by the NIH.
What is Chronic Prostatitis?
Chronic prostatitis is pelvic or perineal pain without evidence of urinary tract infection lasting longer than three months.
The National Institutes of Health (NIH) classifies prostatitis into four syndromes.
- Acute bacterial prostatitis;
- Chronic bacterial prostatitis (CBP)
- Chronic nonbacterial prostatitis (CNP) also called Chronic pelvic pain syndrome (CPPS);
- Asymptomatic Inflammatory Prostatitis (formerly known as Prostatodynia)
The greatest number of cases of prostatitis have no known cause, despite chronic inflammation (1).
Acute Bacterial Prostatitis
Acute Prostatitis is when your prostate gland becomes enlarged and tender suddenly.
Acute Prostatitis is usually caused by the same bacteria that cause urinary tract infections or sexually transmitted diseases.
Patients with Acute Bacterial Prostatitis have:
- sudden onset of urinary frequency (abnormally frequent urination),
- urgency (a sudden urge to urinate),
- nocturia (urination more than two times during the night), and
- dysuria (painful urination) associated with
- fever and chills,
- low back pain,
- perineal pain,
- generalized malaise, and
- varying degrees of bladder outlet obstruction.
Some men with acute bacterial prostatitis require hospitalization (2).
Chronic Bacterial Prostatitis
Chronic Bacterial Prostatitis can develop from acute bacterial prostatitis.
Symptoms are variable and include:
- dysuria (painful urination) ,
- frequency (abnormally frequent urination),
- nocturia (urination more than two times during the night),
- ejaculatory pain, and
- discomfort in any area of the perineum or external genitalia.
The prostate is usually tender and patients usually have a history of recurrent urinary tract infections (UTIs).
This syndrome is difficult to treat. Surgery is the treatment of last resort as impotence and incontinence are both possible results (2).
Chronic Non-Bacterial Prostatitis
Non-Bacterial Prostatitis has clinical symptoms and physical findings similar to those of chronic bacterial prostatitis; however the patient does not have a history of recurrent UTIs.
Treatments that occasionally help include hot sitz baths, and avoidance of alcohol and foods that aggravate the problem (2).
Asymptomatic Inflammatory Prostatitis (formerly Prostatodynia)
The patient with Asymptomatic Inflammatory Prostatitis (formerly Prostatodynia) does not have inflammation and will not benefit from a trial of antibiotics.
Patients with Asymptomatic Inflammatory Prostatitis (formerly Prostatodynia) have no history of a documented UTI.
No infectious agent can be located in the cultures, and there is no inflammatory response in the prostatic secretions.
It is important to clinically eliminate all extra-prostatic causes for the symptoms, such as interstitial cystitis, carcinoma of the bladder, and other conditions that could cause pelvic pain.
Usually this chronic disorder remains undefined despite repeated investigations and treatment (2).
- Meares EM. Prostatitis and related disorders. In: Walsh PC, Gittes, RF, Perlmutter AP, Stamey, TA, Eds. Campbell’s urology. Philadelphia, Penn: WB Saunders Co, 1986:868-85.
- J. Curtis Nickel, MD, FRCSC, Prostatitis Syndromes, “A continuing enigma for the family physician,” Canadian Family Physician, Vol. 37: April 1991