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Nonbacterial Prostatitis - Causes, Symptoms, Diagnosis, and Treatment

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Nonbacterial prostatitis is also known as chronic pelvic pain syndrome. It is a common condition and mainly affects males.

Published At June 6, 2023
Reviewed AtApril 15, 2024


The prostate gland is a crucial organ of the male reproductive system. It is important to know in brief about the gland's anatomy before understanding the prostate gland's problems. It is a small walnut or chestnut-shaped gland located near the neck of the urinary bladder and the urethra. The prostate gland plays an important role in reproduction because it releases a special fluid that forms an integral part of the semen. This semen acts as the transport medium for the sperm into the female genital tract. A tube-like structure known as the urethra passes through the gland's middle. The prostate gland also secretes hormones required for secondary sexual development in males. Therefore, it can be concluded that the gland regulates males' sexual and urinary functions.

What Is Nonbacterial Prostatitis?

As the name suggests, nonbacterial prostatitis is a condition that does not occur due to bacterial infection. It is also known as chronic pelvic pain syndrome because the patient experiences pain in the pelvis and other surrounding organs. Some patients might experience pain and inflammation in the prostate and organs of the lower urinary tract. Though the condition is called nonbacterial prostatitis, it is unlikely that the prostate gland is the cause of pain. The exact cause of nonbacterial prostatitis is still under research, but the doctors are sure of one thing: a bacterial infection does not cause it. It is commonly seen in elderly men suffering from benign prostate hyperplasia.

What Are the Different Types of Prostatitis?

Prostatitis can be classified into the following four types based on their causes:

  • Acute Bacterial Prostatitis - It is a sudden and severe inflammation of the prostate gland that occurs due to bacterial infection. Sometimes, the bacteria might get transmitted due to sexually transmitted diseases. Though the symptoms appear suddenly, the patient responds well to the antibiotics.

  • Chronic Prostatitis - It is the most common type of prostatitis that occurs due to inflammation of the nerves supplying the gland. The condition might last from months to years, and it is difficult to treat the condition.

  • Chronic Bacterial Prostatitis - It might sound similar to acute bacterial prostatitis, but the difference is that the patient experiences symptoms for a prolonged period.

  • Asymptomatic Inflammatory Prostatitis - As the name suggests, the patient does not experience any symptoms during this condition, but it might be discovered during a routine examination.

What Are the Causes of Nonbacterial Prostatitis?

The exact cause of nonbacterial prostatitis is still under research. Therefore, it is difficult to know about the factors that increase the risk of prostatitis. However, scientists are still trying to know who is more likely to experience this condition. Some researchers believe that stress, nerve inflammation, irritation, injuries, or past history of urinary tract infections might predispose the patient to this condition. The other conditions and factors that might cause non-bacterial prostatitis are listed below:

  1. Tightness of the pelvic muscles.

  2. Stones in the prostate gland or the urinary bladder.

  3. A prostate abscess (pus-filled pocket formed in the prostate gland).

  4. Benign prostate hyperplasia (enlargement of the prostate gland).

  5. Bicycle riding.

  6. Vesicoureteral reflux (backflow of urine from the urethra to the bladder).

  7. Urethral stricture (narrowing of the urethra).

  8. Neurological problems of the lower urinary tract.

  9. Sexual abuse.

  10. Prostate cancer and bladder cancer.

What Are the Signs and Symptoms of Nonbacterial Prostatitis?

The signs and symptoms of nonbacterial prostatitis are similar to many other urologic conditions. The symptoms of nonbacterial prostatitis are listed below:

  • Difficulty in passing urine.

  • Difficulty in starting the urine stream.

  • Hematospermia (blood in the semen).

  • Dysuria (painful urination).

  • Burning sensation while passing urine.

  • Painful bowel movements.

  • Pain after ejaculation.

  • Erectile dysfunction.

How Is Non-Bacterial Prostatitis Diagnosed?

The diagnosis of nonbacterial prostatitis is challenging because the condition resembles other urologic diseases. However, the following methods help diagnose nonbacterial prostatitis:

  • Medical History - Medical history is professional communication between the doctor and the patient. It helps the doctor know about the general health of the patient and the symptoms of the condition. Most patients complain of pelvic pain in their medical history.

  • Digital Rectal Examination - It is a physical examination done to detect abnormalities in the prostate gland. The patient might feel uncomfortable during a digital rectal examination. The doctor checks the rectum for swelling, inflammation, and tenderness during the procedure.

  • Blood Test - Sometimes, the doctor might recommend a blood test to analyze the body's health. The laboratory technician will inject a needle into the patient’s arm to draw small blood. This blood sample will be examined, and the doctor will analyze the blood reports.

  • Urinalysis - Urinalysis is not much significant in diagnosing non-bacterial prostatitis, but the doctor might recommend this test to rule out pelvic pain due to urologic problems. It is a simple procedure where the patient collects urine in a sterile bag. After the laboratory technician examines the urine sample and sends the report, the doctor knows about the urologic problems.

  • Urine Culture - It is a simple procedure wherein the urine sample is left unattended in the laboratory for a few days. A urinary tract infection or acute bacterial prostatitis can probably be suspected if bacteria grow rapidly in the urine sample.

  • Prostate Ultrasound - Prostate ultrasound is nothing but a normal ultrasound wherein the doctor runs a transducer over the patient’s abdomen. It sends sound waves to the body, which bounce back, and images of the prostate gland are obtained on the computer screen. These images help detect prostate abnormalities.

  • Computed Tomography Scan - Doctors usually recommend the patient undergo a CT scan to provide three-dimensional images of the internal organs. As a result, the prostate gland, abdomen, and other urinary tract organs are visible clearly. The images are sent to the doctor who prescribed the test.

How to Manage Chronic Nonbacterial Prostatitis?

It is difficult to treat chronic nonbacterial prostatitis because scientists are still in the dilemma of whether the patient should take antibiotics or not. It is because antibiotics are effective against bacteria, and this condition does not occur due to bacteria involvement. There is always a difference of opinion among doctors regarding antibiotics. Some doctors might prescribe medication because they feel that some active infections might not be visible upon examination. In contrast, some doctors do not prescribe antibiotics, thinking it is a long-standing condition and not due to an active infection. The other methods commonly used to treat non-bacterial prostatitis are listed below:

  • The drugs known as alpha-adrenergic blockers, help relax the prostate gland muscles and are effective against other prostate conditions like benign prostate hyperplasia.

  • Other medications that help relax the prostate gland muscles are tricyclic antidepressants.

  • Non-steroidal anti-inflammatory drugs like Aspirin and Ibuprofen help relieve pain.

  • Diazepam and Cyclobenzaprine help relax the pelvic muscles and reduce muscle spasms.

  • Some people have benefitted from plant extracts and herbal supplements like Cernitin and Allopurinol.

Some of the natural methods that help overcome pelvic pain due to nonbacterial prostatitis are listed below:

  • Acupuncture.

  • Warm baths.

  • Massage therapy.

  • Relaxation exercises.

  • Keep a cushion or a pillow under the legs when sitting for a prolonged period.

  • Avoid spicy foods, caffeine, and alcohol.

How to Cope With Chronic Nonbacterial Prostatitis?

As the name suggests, chronic nonbacterial prostatitis is a long-standing condition, and the patient might experience the symptoms for a prolonged period. Therefore chronic non-bacterial prostatitis might be a painful condition for some. In extreme cases, people might require surgical intervention. However, pelvic muscle exercises and physical therapy might be helpful for some people. Nonbacterial prostatitis does not increase the risk of prostate cancer. Sometimes, the pain due to chronic non-bacterial prostatitis is unbearable, and people might have anxiety and depression issues. The patient must contact a psychiatrist to improve mental health in such situations.


Nonbacterial prostatitis is a long-standing and painful condition that commonly affects elderly men over 50. As the patient experiences the symptoms for a prolonged period, the patient might feel depressed. Sometimes, the patient is embarrassed to discuss the problem with the doctor and might consider it a part of the aging process. However, the patient must not lose hope because medications and surgeries are available to treat the condition. People who feel that their mental health is affected due to the condition can join support groups, get private counseling, and participate in behavioral therapy. Consult a urologist to know more about the treatment of chronic nonbacterial prostatitis.

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Dr. Samer Sameer Juma Ali Altawil
Dr. Samer Sameer Juma Ali Altawil



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