Prostatitis - abacterial

About chronic abacterial prostatitis

Your 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. The front of your prostate surrounds your urethra, the tube that carries urine from your bladder and out through your penis.

Chronic abacterial prostatitis is a condition where you have pain or discomfort in your genital and/or pelvic area. It's classed as chronic if you have it for a period of at least three months. Abacterial means there is no evidence of an infection. However, it’s still possible that you could have had an infection that triggered your illness and this just isn’t found.

The term ‘chronic’ refers to how long you have had the condition, not how serious the condition is. A chronic illness is one that lasts a long time.

Symptoms of chronic abacterial prostatitis

Symptoms of chronic abacterial prostatitis last for more than three months and include pain or discomfort:

  • in the area between your scrotum and anus (perineum)
  • at the tip of your penis, testicles and rectum (back passage)
  • in your lower abdomen (tummy) and lower back
  • when you pass urine, ejaculate or during a bowel movement – you may also have a frequent or urgent need to pass urine

You may find that your symptoms remain constant or ease for a while before becoming worse again.

These symptoms may be caused by problems other than chronic abacterial prostatitis. If you have any of these symptoms, see your GP for advice.

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.

Causes of chronic abacterial prostatitis

The exact reasons why you may develop chronic abacterial prostatitis aren't fully understood at present. It may be caused by many different factors rather than one specific thing. However, several theories of the cause of abacterial prostatitis have been put forward including:

  • an infection by a bacterium or virus that hasn't yet been identified
  • a reaction by your immune system to a bacterium or virus inside your body
  • a problem with the nerves in your pelvic area
  • a problem with the way your bladder works
  • an injury to your perineum
  • 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

Your GP will ask about your symptoms and examine you. Chronic abacterial prostatitis is difficult to diagnose as there are few tests that can accurately say whether or not you have the condition. The symptoms of chronic abacterial prostatitis can often be similar to those of other conditions. Therefore, your GP will want to rule these out before he or she diagnoses you. Your GP may 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 that affect the urinary system.

You may have the following tests.

  • Your doctor may ask you for a sample of your urine, which he or she will test with a 'dipstick'. Alternatively, he or she will send the sample to a laboratory for testing to see if you have an infection.
  • Your doctor may do a digital rectal examination (DRE) to examine your prostate. Your doctor will feel your prostate through the wall of your rectum (back passage). If you have prostatitis, this examination may cause pain or discomfort but this will soon go away.
  • Your urologist may do a prostatic massage. He or she will insert a gloved finger into your rectum to manually massage your prostate. Your urologist will also take a sample of fluids from the tip of your penis and will send this to a laboratory for testing. You may also be asked to give urine samples immediately before and after the massage.

Treatment for chronic abacterial prostatitis

Chronic abacterial prostatitis is a difficult condition to treat and there is currently no cure for it. Often, you will need a combination of treatments to manage your condition rather than just one form of treatment.

Medicines

Your doctor may suggest several different types of medicines to manage your symptoms. These may include the following.

  • Painkillers, such as ibuprofen can help to ease any swelling and pain.
  • Laxatives (eg lactulose) may help make your faeces softer and easier to pass. This can help reduce pain during a bowel movement.
  • Antibiotics, such as ciprofloxacin or doxycycline, can clear up any doubt about the presence of a bacterial infection in your prostate. You may be prescribed a four to six-week course – it’s important to always take the full course of antibiotics.
  • Alpha-blockers, such as alfuzosin or tamsulosin, are medicines that relax the muscle fibres that control tension in your prostate gland. They can help to relieve internal pressure and allow your bladder to empty more easily. This treatment is most effective when taken over a long period of time – from eight to 24 weeks.
  • Finasteride is a medicine used to treat an enlarged prostate. It can also be used for prostatitis.

Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

The evidence for these treatments isn’t conclusive and more research needs to be done to prove that they are effective in treating chronic abacterial prostatitis.

If your symptoms are severe and these treatments haven’t worked, your GP may refer you to a pain clinic.

Surgery

Most men with chronic abacterial prostatitis are treated with medicines but if medicines haven’t worked for you, your doctor might suggest surgical treatment. Surgery is usually only recommended if you have a specific problem. For example, an obstruction, such as scar tissue in your urethra, that may be causing prostatitis. Surgical options include:

  • heat therapy (transurethral microwave thermotherapy) or laser therapy to heat and destroy inflamed tissue in your prostate
  • a transurethral resection of the prostate (TURP) operation to remove part of your prostate

Talking therapies

If your symptoms are giving 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.

Physical therapies

A combination of physiotherapy and relaxation techniques can be helpful in managing the symptoms of chronic abacterial prostatitis, especially if it may be caused by muscle pain in your pelvic floor.

Complementary therapies

Acupuncture has been shown to help reduce pain. Many other complementary therapies have also been suggested, such as quercetin (a bioflavonoid food supplement). However, there is no hard scientific evidence to support the use of these.

Living with chronic abacterial prostatitis

Chronic abacterial prostatitis can be difficult to manage. You may find your treatment helps and you have no further symptoms, or that it proves unsuccessful. If your symptoms continue despite treatment, you will have regular follow-up appointments with your urologist. He or she will try and find the best combination of treatments to manage your condition. Your doctor will give you help and advice on coping with chronic abacterial prostatitis. There are also support groups that you can contact for further help.

Can prostatitis cause an increase in prostate-specific antigen (PSA) level?

Answer

Yes, it’s possible for prostatitis to increase the level of a protein produced by your prostate gland, called prostate specific antigen (PSA). This can be picked up if you have a PSA test.

Explanation

The PSA test is designed to identify abnormalities of your prostate gland. It tests the level of PSA protein in your blood. A raised PSA level can be a sign of prostate cancer. However, most men who have a raised PSA level don’t have cancer. It’s more likely to be due to a number of other less serious prostate-related conditions, such as prostatitis, an enlarged prostate and infections. Your PSA level can also be raised by exercise, ejaculation or by recently having a prostate biopsy, or prostate or bladder surgery.

The PSA test isn’t routinely offered as part of a screening programme in the UK. However, you can ask your GP for a test. He or she will discuss the pros and cons of having the test with you.

Can bacterial prostatitis be passed on to sexual partners?

Answer

No, it's not possible to pass on bacterial prostatitis through sexual contact.

Explanation

You can't pass on bacterial prostatitis to sexual partners. There is no need to tell your sexual partners that you have the condition, unless you choose to.

However, some of the symptoms of bacterial prostatitis can be similar to those you get with several sexually transmitted infections (STIs). When you see your GP about your symptoms, he or she may carry out tests to rule out any STIs, or you may be referred to a sexual health clinic for tests. It's important to wait for the results of these tests before having sex to prevent the risk of spreading possible STIs.

If you have any questions or concerns about bacterial prostatitis or STIs, talk to your doctor.

Are there any side-effects to taking alpha-blocker medicines for chronic abacterial prostatitis?

Answer

Alpha-blocker medicines are often used to treat chronic abacterial prostatitis. As with all medicines, there are some side-effects associated with taking them, including headaches and a drop in blood pressure.

Explanation

Your doctor may try several different types of treatments to manage your symptoms, including alpha-blockers, such as alfuzosin or tamsulosin. These help to relax the muscle fibres in your prostate to allow urine to flow through your urethra more easily. Your urethra is the tube that carries urine from your bladder and out through your penis. This may reduce your symptoms. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

All medicines have some side-effects associated with them. Side-effects are the unwanted but mostly temporary effects you may get after taking a medicine. With alpha-blockers, the main side-effects are headaches and low blood pressure. There is a risk your blood pressure may drop when you move from lying to sitting or sitting to standing (called postural hypotension). This can make you feel dizzy and disorientated, and may cause you to faint. Other side-effects of alpha-blockers can include drowsiness, depression, a dry mouth and upset stomach.

If you experience any of these side-effects, it's important to talk to your doctor before you stop taking your medicine. He or she will be able to give you advice on how to manage your side-effects or may be able to recommend an alternative medicine to take.

My doctor has told me that I may have asymptomatic inflammatory prostatitis. What is this?

Answer

Asymptomatic inflammatory prostatitis is when your prostate is inflamed but you don't have any symptoms.

Explanation

Asymptomatic inflammatory prostatitis is often diagnosed by accident when your doctor is carrying out other tests, for example, fertility tests or checking prostate-specific antigen levels (PSA test). There are no symptoms associated with it so you won't know there is anything wrong.

The exact reasons why you may develop asymptomatic inflammatory prostatitis aren't fully understood at present. As this condition has no symptoms you don’t usually need treatment. However, your doctor may prescribe antibiotics if you have signs of an infection. For more advice, see your GP.