Chronic Nonbacterial Prostatitis

What is it?

Chronic nonbacterial prostatitis is one sub-category (3B) underneath the categorization of different types of prostatitis. It accounts for as many as 95% of all cases diagnosed as “prostatitis” and is commonly referred to as “chronic pelvic pain syndrome.”

• Category 1: Acute bacterial prostatitis
• Category 2: Chronic bacterial prostatitis
• Category 3: Chronic prostatitis/Chronic pelvic pain syndrome
  
  • A: Inflammatory
  • B: Non-inflammatory (formerly referred to as prostatodynia)
• Category 4: Asymptomatic inflammatory prostatitis

It’s not uncommon for a male with category 3B prostatitis to be prescribed antibiotics, which initially appear to resolve the symptoms, but then for the same symptoms to reoccur. In some cases, antibiotics are repeatedly prescribed. However, in this situation, repeat urine cultures are often negative for any sign of bacterial growth or infection. Other investigations typically come back as normal as well. The cause of and risk factors for chronic nonbacterial prostatitis continue to remain unknown.

Symptoms

Urinary

• Urinary hesitancy
• Dysuria: painful urination
• Nocturia: waking up with a need to void (urinate) at night
• Increased urinary frequency and urgency
• Decreased urine stream
• Feeling of incomplete emptying after voiding

Pain

• Rectal
• Suprapubic: above the pubic bone
• Perineal: area between base of penis and anal opening
• Penile
• Coccyx: tailbone
• Groin
• During and after ejaculation
• Low back pain
• Feels like sitting on a golf ball (or another foreign object)

Physiotherapy Treatment

First off, it is imperative to have the necessary medical investigations conducted to rule out the presence of an infection or underlying medical condition. However, in the presence of negative lab and examination results and subsequent diagnosis of chronic nonbacterial prostatitis, pelvic health physiotherapy is integral to a patient’s recovery plan.

Areas of treatment and techniques in physiotherapy may include:

• Breathing techniques.
• Bowel and bladder education:
  
  • Bladder irritants.
  • Bladder diary.
• Toileting/voiding positioning and techniques.
• Diet modification:
  
  • Adequate water and fiber intake.
• Therapeutic exercise:
  
  • Whole body reconditioning.
• External myofascial techniques.
• Internal myofascial techniques.
• Pelvic floor muscle training:
  
  • Proprioceptive training.
  • Lengthening/relaxing muscles.
    
    • Pelvic pain.
• Tips for intimacy.
• Mindfulness/meditation:
  
  • Pain.
  • Anxiety/stress/depression.
  • Relaxation.
• Visceral mobilization.
• Pain education.
• Treatment of the nervous system.

Treatment of chronic nonbacterial prostatitis requires a collaborative approach, one that addresses the physical, psychological, and social aspects of the symptomatic individual. Living with chronic nonbacterial prostatitis can have a major impact on daily life, but the treatments above can offer understanding of how the body works, ways to improve its function, and increased control over one’s symptoms.