Chronic Prostatitis

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Overview

CP/CPPS denotes a multitude of problems that may lead to chronic pelvic and/or genital pain. Symptoms can include:

  • Perineal discomfort
  • Pain with ejaculation
  • Lower back discomfort
  • Orchalgia
  • Urinary frequency
  • Difficulty initiating a urine stream
  • Burning with urination
  • Pain at the tip or shaft of the penis

CP/CPPS may be broken down into the following categories...

  1. Category I (formerly termed "acute prostatitis"). This condition is a severe infection of the prostate gland and is not actually a chronic condition. Category I prostatitis is uniformly associated with an active urinary tract infection. Fever, chills, and urinary retention (the inability to pass urine) may occur. Patients may need hospitalization.
  2. Category II (formerly termed "chronic bacterial prostatitis"). Patients with this condition may present with all or some of the above noted symptoms. In this instance, infection is harbored within the ducts of the prostate gland. Typically, patients with this condition have intermittent documented urinary tract infections when the bacteria "spill over" into the bladder. Management of Category II prostatitis usually entails antibiotics administered for many weeks. Clearing infection, when it exists, can be difficult. Why? Not all antibiotics will penetrate into the prostate gland. Bacteria may also encase themselves within a mucous-like coating, called a "biofilm," protecting themselves from antibiotics. The bacteria may also "hide" within small prostatic calcifications which are present in most men.
  3. Category III Chronic Pelvic Pain Syndrome (CPPS). This is the most common cause of pelvic pain in men, accounting for the vast majority of patient visits. Category III is broken down into two subcategories:
    1. Category IIIA (formerly termed "nonbacterial prostatitis" or "abacterial prostatitis") This form of prostatitis is characterized by the presence of inflammation in the prostate and/or its secretions, however, no overt infection can be identified to account for that inflammation.

    2. Category IIIB (formerly termed "prostatodynia"). This form of chronic pelvic pain appears to have little to do with the prostate, but may be associated with "prostatitis-like" symptoms. Category III B CPPS is likely related to dysfunction of the nerves and/or muscles of the pelvic floor (see below). Category III B CPPS is frequently identified in conjunction with other categories of chronic pelvic pain.

  4. Category IV Patients with Category IV prostatitis have no symptoms. In this instance, inflammation of the prostate tissue and/or its secretions are incidentally found upon evaluation of other urological problems (for example, during evaluation for infertility or prostate cancer). No therapy or further evaluation is usually required.