What Is Chronic Prostatitis (Chronic Pelvic Pain Syndrome)?

What it is and its types

The prostate is a walnut sized gland that sits just below the bladder in men and surrounds the urinary channel. Prostatitis is the general name used for inflammation or a painful condition of this gland and the surrounding pelvic region. Chronic prostatitis describes a picture in which the complaints continue, either constantly or intermittently, for at least three months.

Although the name suggests inflammation, in most of these cases no bacterium can be grown from the urine or from prostatic secretions. For this reason the most widely accepted classification today divides prostatitis into four groups:

• Acute bacterial prostatitis. It begins suddenly with fever, chills, severe pain and difficulty passing urine, and requires urgent assessment.
• Chronic bacterial prostatitis. Complaints last for months and may be accompanied by recurrent urinary tract infections; a bacterium is demonstrated on testing.
• Chronic prostatitis / chronic pelvic pain syndrome. This accounts for the great majority of cases. There is pain and there are urinary complaints, but no bacterium can be shown. It is divided further according to whether inflammatory cells are present in prostatic secretions.
• Asymptomatic inflammatory prostatitis. The person has no complaints at all; it is found incidentally during testing done for another reason.

Even though the word prostatitis appears within the name chronic pelvic pain syndrome, it is known that the problem does not always arise from the prostate alone. The pelvic floor muscles, the way nerve endings respond to stimuli and the sensitivity of the bladder wall may all contribute to the picture.

Why it develops

No single cause can be shown in chronic pelvic pain syndrome; several factors are thought to act together. The headings that stand out in research are these:

A previous infection. In some people the complaints begin after a urinary tract infection and continue after the infection has cleared. In that situation the source of the pain is no longer taken to be a microorganism but the sensitivity that has been left behind.

Tension in the pelvic floor muscles. The muscles at the base of the pelvis may remain contracted for long periods. This tension can lead to pain that increases on sitting, to difficulty passing urine and to discomfort after emptying. Long hours of seated work, heavy lifting and stress are among the headings said to increase this tension.

How the nervous system processes pain. In long lasting pain the nerve pathways may come to respond to stimuli at a lower threshold. This is one of the mechanisms considered in explaining why pain continues even after the original cause has gone.

Reflux of urine into the prostatic ducts and the immune response. These are explanations put forward in connection with disturbances of urine flow, and research on them continues.

Accompanying conditions. Constipation, irritable bowel complaints, anxiety and disturbed sleep frequently accompany the picture. They may not be the cause of the pain, but they affect its severity and the burden it places on daily life.

Symptoms

Complaints fall under three main headings: pain, urinary complaints and complaints related to sexual function.

Pain is the defining finding. It is felt most often in the area between the anus and the testicles, that is in the perineum. Besides this it may be felt in the groin, the testicles, the tip of the penis, the lower back and the lower abdomen. The pain is usually dull and feels like pressure; it may increase with long periods of sitting, with cycling and with tight clothing.

Urinary complaints include passing urine frequently, a sudden urge, burning on passing urine, a weaker stream and a feeling that emptying is not complete. A fuller account of these complaints can be found in our articles on dysuria and benign prostatic hyperplasia.

Pain during or after ejaculation, reduced sexual desire and complaints about erection are also reported. Complaints that come and go, with good and bad periods following one another, are typical of this picture; periods of worsening may coincide with heavy workloads, poor sleep and stress.

Chronic prostatitis is a benign condition. It does not turn into prostate cancer and has not been shown to increase cancer risk. The criteria for assessing prostate cancer, which is a separate condition, are different.

Assessment and diagnosis

The diagnosis is made first of all by ruling out other causes. The doctor takes a detailed history, asking when the complaints started, in what circumstances they increase, about urinary and bowel habits and about previous infections.

The steps commonly used in assessment are these:

• A symptom index. The question list known as the NIH-CPSI scores pain, urinary complaints and quality of life. It serves both in the first assessment and in following the course over time.
• Urine testing and culture. Whether or not a bacterium can be shown is decisive in determining which type is being dealt with.
• Physical examination. This covers assessment of the abdomen, the groin and the pelvic floor muscles, and where needed a digital rectal examination.
• Blood tests. Depending on age and history the doctor may request further tests. Because inflammation of the prostate can raise the PSA value temporarily, the timing and interpretation of that test are decided by the doctor.
• Imaging. Ultrasound may be used to measure whether urine remains in the bladder or when another condition is suspected.

Which of these tests are needed varies from person to person. Question lists found online may give an idea, but they do not establish a diagnosis.

Daily life and follow-up

The course of the complaints in chronic prostatitis varies from person to person. The headings that come up most often in daily life are these:

• How you sit. Sitting for long uninterrupted periods may increase the complaints; taking breaks, standing up and reviewing the seating surface come into consideration.
• Fluid intake and bowel habit. Taking enough fluid and avoiding constipation are among the suggestions aimed at reducing strain in the pelvic region.
• Personal dietary triggers. Some people report that their complaints increase after spicy food, caffeine or alcohol. There is no list that applies to everyone; you can notice your own triggers by keeping a diary and share this with your doctor.
• Activity and the pelvic floor. Regular, measured physical activity is generally advised. The form that pelvic floor work should take varies from person to person and is set with the assessment of a doctor or physiotherapist; contraction exercises done incorrectly may increase the complaints.
• Sleep and stress. Sleep pattern and the management of anxiety are considered among the headings that affect the burden of pain in daily life.
• Warmth. Measures such as a warm shower or a sitz bath are reported to be soothing.

Chronic prostatitis is usually addressed not with a single approach but with a follow-up plan arranged according to the complaints that stand out in each person. This plan is drawn up by your doctor; do not stop a treatment your doctor has started on your own decision because the complaints have eased.

When to see a doctor

Medical assessment should not be delayed in the following situations:

• Fever, chills and severe pelvic pain occurring together.
• Being unable to pass urine at all, or a feeling that the bladder cannot be emptied.
• Visible blood in the urine or in the semen.
• Sudden severe pain and swelling in the testicles.
• Unexplained weight loss or night sweats alongside the complaints.

Apart from these, pelvic pain and urinary complaints lasting more than three months should also be assessed. Complaints that last a long time do not mean a serious illness, but medical assessment is needed to distinguish the cause and to set up a follow-up plan. For recurrent urinary complaints our article on urinary tract infection may also be a guide.

This page is intended as general health information; for diagnosis and treatment consult your physician, and for questions about medicines consult your pharmacist.

Frequently asked questions

Is chronic prostatitis contagious?

No. Chronic prostatitis and chronic pelvic pain syndrome are not sexually transmitted diseases and do not pass to a partner. Your doctor may request urine testing to determine whether the complaints are related to an infection.

Does chronic prostatitis turn into prostate cancer?

No. Chronic prostatitis is a benign condition and does not turn into cancer. Inflammation of the prostate can, however, raise the PSA value temporarily; your doctor decides when that test is done and how the result is interpreted.

My complaints keep going away and coming back. Is that usual?

Good and bad periods following one another are typical of this picture. Periods of worsening may coincide with heavy workloads, poor sleep or stress. Do not miss your follow-up appointments so that the course can be monitored.

Does chronic prostatitis cause infertility?

The complaints may affect sexual life and ejaculation. If you wish to have children, assessment is a separate heading; you can read the framework in our article on sperm health and discuss your own situation with your doctor.

Does cycling make the complaints worse?

Some people report that the feeling of pressure in the perineal area increases after long periods of cycling. There is no prohibition that applies to everyone; you can follow your own triggers and share them with your doctor.

Are antibiotics needed in every case of chronic prostatitis?

The treatment decision is made by the doctor. Cases in which a bacterium is shown and cases in which it is not are assessed differently, so the approach is set for each person. For questions about medicines you can consult your pharmacist.

Aymed İlaç Sanayi manufactures authorised medicinal products in urology and nephrology. This page does not contain diagnostic or treatment advice; it is intended as general health information.