Chronic nonbacterial prostatitis: Causes, symptoms, diagnosis, and treatment

Chronic nonbacterial prostatitisNonbacterial prostatitis is characterized by symptoms of prostatitis, swelling, and inflammation of the prostate gland, all without signs of bacterial infection in diagnostic tests. Generally, an infection of the bladder occurs due to infection from a particular bacterium, as seen in cases of acute bacterial prostatitis, prostatic abscess, chronic bacterial prostatitis, and bacterial prostatitis.

Chronic nonbacterial prostatitis can be a very time-consuming and difficult disease to treat. Doctors can only prescribe antibiotics on a trial basis in hopes that it will resolve the condition. Typically, these would help treat a case of bacterial prostatitis, but in cases of non-bacterial prostatitis, it may not. All testing produces only signs of inflammation, which can originate from any number of different causes.

What causes chronic nonbacterial prostatitis?


Chronic nonbacterial prostatitis can be hard to identify and usually stems from issues unrelated to the prostate itself. Because most men with prostatitis are diagnosed with this type, a condition not typically caused by any sort of bacteria, its causes are worth exploring. The following are some of the most common nonbacterial prostatitis causes:

Pelvic floor disorders

It is estimated that 50 percent of men with this condition experience some sort of chronic tension or stress of the pelvic floor. This could be voluntary or involuntary tensing of muscles in the body. For example, those who tense their shoulder or neck muscles often experience neck pain and stress headaches. If men do this with the pelvic muscles, it could lead to chronic pelvic pain and nonbacterial prostatitis.

Pelvic trauma

Injury to the pelvic area may lead to chronic prostatitis. Common injuries include sports accidents to the groin area, excessive bicycle or motorcycle riding, occupational injuries or vibrations, and other trauma to the pelvic region.

Medical procedures

Ironically, procedures designed to help diagnose or treat disorders may actually cause them. Some medical procedures can injure tissue or cause inflammation in the pelvic area, leading to pelvic pain. These include catheter insertion, vasectomy, or obtaining a prostate biopsy.

Sexual activity

Having multiple sexual partners or engaging in anal sex without protection can lead to sexually transmitted diseases, including HIV. Bacteria can travel through the urethra, leading to infection. However, it is worth mentioning that those who are not as highly sexually active also have a risk of contracting prostatitis, as not ejaculating regularly can lead to semen accumulation, causing inflammation.


Prostatitis may be caused by bacteria, viruses, parasites, and even fungi. Some experts think that men with chronic nonbacterial prostatitis may actually have a hidden bacterial infection that is not being seen in routine testing and examination. A study conducted in 2011 found that a virulent strain of E. coli can be responsible for starting pelvic pain in men with a certain genetic predisposition. What was more surprising was that the pain persisted despite the bacterial infection having been resolved.

Autoimmune disorders

Characterized by the body’s own immune system recognizing a part of the body as being foreign and attacking it. Mast cells, part of the immune system, produce chemicals that cause inflammation. Another inflammatory component called cytokines also leads to inflammation. However, men who suffer from prostatitis generally have an increased level of inflammatory cytokines during testing.

There are many identified causes of autoimmune reactions that can be induced by antibiotic use, chemical exposure, or possibly due to some genetic disorder.

Lifestyle factors

Lack of sleep, smoking, drinking alcohol, and even a lack of social support are all factors that can decrease immunity and lead to the development of prostatitis. Therefore, it is recommended to practice preventing factors that may lead to prostatitis. These include engaging in safe sex, managing stress, and protecting your genitals when playing sports.

Diet and environmental factors

Food intolerances or food allergies may lead to the development of prostatitis. Common foods causing this can be spicy foods, acidic foods, wheat, gluten, and caffeine.

Medical problems

These may include dysfunctions or malformations such as blocked ejaculatory ducts, phimosis, dysfunctional epithelium, urethral stricture, prostatic calcification, regional pain syndrome, genetics and hormones, and stop-and-go urination or other urinary problems.

Risk factors for chronic nonbacterial prostatitis

The following are some of the most common risk factors that may increase your chances of developing chronic nonbacterial prostatitis:

  • Injury to the genitals or urinary area
  • A previous bout with prostatitis
  • Poor emotional health
  • Living in a cold climate
  • Stress

What are the symptoms of chronic nonbacterial prostatitis?

Symptoms of nonbacterial prostatitis tend to develop over a period of time. Men between the ages of 30 and 50 are the biggest demographic affected. While the symptoms may mirror that of bacterial prostatitis, a lack of fever is an important distinction. Common symptoms nonbacterial prostatitis include:

  • Difficulty urinating or straining to urinate
  • Frequent or urgent need to urinate
  • Blood in semen
  • Pain or burning with urination
  • Pain during bowel movements
  • Pain with ejaculation
  • Pain in the low back and pelvis, above the pubic bone, between the genitals and anus, on the tip of the penis, or in the urethra
  • Sexual dysfunction
  • Genital pain after urination

Chronic nonbacterial prostatitis diagnosis

Your doctor will review your medical history, looking for any potential cause for your currently presenting pelvic pain symptoms. Next, comes the physical exam looking for any visible signs of injury or pain to light touch.

Once the preliminary aspects of the diagnosis have been taken care of, testing can commence. This will often come in the form of the following tests:

  • Prostate exam
  • Prostate ultrasound
  • Tests for sexually transmitted diseases
  • Urinalysis
  • Evaluation of the urinary tract

How to treat chronic nonbacterial prostatitis?

The treatment of nonbacterial prostatitis with antibiotics remains controversial, as the condition provides no evidence of a bacterial infection. Some doctors will still prescribe antibiotics thinking they could help treat a possible infection that hasn’t been identified. However, the following treatments are commonly used for the treatment of nonbacterial prostatitis include:

Prostate muscle relaxants: Includes alpha-adrenergic blockers, the same medications used to treat other prostate conditions such as benign prostate hypertrophy.

Pain medications: Includes tricyclic antidepressants, prescription pain medication, or nonsteroidal anti-inflammatory drugs.

Plant extracts: Includes herbal supplements such as pollen extract cernilton and bioflavonoid quercetin. Both have proven to be effective.


Alternative treatments and other natural remedies for ongoing pain include:

  • Warm baths
  • Acupuncture
  • Relaxation exercises
  • Using a cushion or pillow when sitting for long periods
  • Massage therapy
  • Avoiding spicy foods, caffeine, and alcohol that can irritate the bladder
  • Relaxation techniques

It is important to speak to your doctor to make sure that you are managing your disorder. Reaching a diagnosis of nonbacterial prostatitis can be a long and trying endeavor, but with the aid of an experienced doctor, you can be sure that you are getting the best care possible.

Related: Avoid these 4 foods for a healthier prostate

Author Bio

Mohan Garikiparithi got his degree in medicine from Osmania University (University of Health Sciences). He practiced clinical medicine for over a decade before he shifted his focus to the field of health communications. During his active practice he served as the head of the Dept. of Microbiology in a diagnostic centre in India. On a three-year communications program in Germany, Mohan developed a keen interest in German Medicine (Homoeopathy), and other alternative systems of medicine. He now advocates treating different medical conditions without the use of traditional drugs. An ardent squash player, Mohan believes in the importance of fitness and wellness.


Related Reading:

Eating walnuts may reduce risk of heart disease and prostate cancer, improve colon health

How to keep your prostate healthy

Popular Stories