Chronic Nonbacterial Prostatitis

Chronic nonbacterial prostatitis is a rather specific, severe pathology that does not readily respond to numerous preventive methods currently being studied by specialists. It occurs more frequently relative to other types of prostatitis – in 80-90% of all diagnosed cases of prostatitis.

The disease tends to have a constant, recurring course with diverse subjective and objective symptoms, significantly worsening any man's quality of life. Moreover, given the possible absence of a bacterial etiology of the disease, the uncontrolled prescription of antibiotics and their independent, insufficiently long intake only worsens the patient's condition, not bringing the expected relief of symptoms.

In medical literature, it may also be referred to as "chronic pelvic pain syndrome" (CPPS) or "non-inflammatory chronic pelvic pain syndrome," depending on the subtype.

The exact cause of the pathology remains unclear to this day, however, most researchers consider the following factors as stimulating the development of CNP:

• Detrusor sphincter dysfunction – abnormal relaxation of the bladder leads to urethroprostatic reflux, causing chemical irritation and subsequent inflammatory process;
• Infectious – pathological microflora is present but cannot be identified or cultured by standard methods for various reasons;
• Immune system disorders – increased inflammatory-stimulating cytokines and decreased inflammation-slowing cytokines;
• Anatomical abnormalities in the structure of the penis, urethra, or prostate gland;
• Voiding dysfunction;
• Various types of cystitis (bladder inflammation);
• Neurological diseases – for example, disturbances in the tone (spastic contractions, tensions) of the pelvic floor muscles;
• Local hemodynamic disorders, endothelial dysfunction.

However, most doctors lean towards a multifactorial etiology of the disease – meaning all or several of the listed aspects simultaneously affect the prostate gland. Therefore, patients often experience relapses of nonbacterial chronic prostatitis due to relatively minor reasons:

• Hypothermia;
• Reduced physical activity, prolonged hypodynamia;
• Joining sexually transmitted infections;
• Irregularity in sexual life;
• Psychosexual tension, prolonged abstinence from sexual contacts.

The diagnosis of CNP or chronic pelvic pain syndrome is made by excluding all other possible pathologies, so there are no definitive criteria for this disease in clinical or laboratory presentations. Symptoms of chronic nonbacterial prostatitis typically include:

• Constant pain – the most pronounced, primary manifestation of the pathology;
• Irradiation of discomfort to the rectum, genital organs, perineum, groin, and suprapubic area;
• Increased pain sensations during sexual intercourse or ejaculation;
• Frequent urination, especially at night;
• Reduced urine flow speed or interruption;
• Feeling of incomplete bladder emptying;
• Muscle tension necessary to start or continue urination;
• Erectile dysfunction – inability to maintain adequate erection throughout sexual intercourse, to achieve ejaculation.

Additionally, due to constant pelvic pain and erectile dysfunction, interpersonal relationships and sexual life of partners suffer. Such issues can lead to various psychological disorders – depressive, anxious, etc.

For diagnostic purposes, special tests such as the NIH-CPSI (National Institutes of Health Chronic Prostatitis Symptom Index) and IPSS (International Prostate Symptom Score) are used. They can also be applied for preliminary self-diagnosis, but the tests cannot be the sole method of determining the disease.

Many therapy methods for this pathology have been proposed, but specialists often have opposing views on the possibility of a complete cure. Thus, there is no unified approach to managing such patients – the prescription of many drugs occurs empirically. Currently, patients may be recommended the following treatment options for chronic nonbacterial prostatitis:

• Antibiotics – despite the absence of pathogenic microflora in the prostate gland, broad-spectrum drugs are still prescribed to some patients due to the existing infectious etiology of the disease;
• Alpha-blockers – significant role in the development of the disease is attributed to prostatic reflux, hence drugs that reduce urine turbulence and muscle spasm are used;
• Muscle relaxants and antispasmodics – to reduce spasms of the pelvic floor muscles;
• Nonsteroidal anti-inflammatory drugs and analgesics – help reduce pain syndrome and the inflammatory process itself;
• Massage – allows the removal of accumulating prostate gland secretion;
• Physiotherapy (magnetotherapy, electrophoresis, ozone therapy) – a fairly common treatment method with high tolerability and low cost.

Periodically, natural treatment of chronic nonbacterial prostatitis – prescription of plant extracts – is also used. They cannot be the sole line of therapy but are used to enhance its effect.