Non-Bacterial Prostatitis: Symptoms, Diagnosis, and Treatment

About Non-bacterial Prostatitis

Hello, Doctor.
For the past two to three months, I have been experiencing intermittent issues with frequent urination and a feeling of incomplete bladder emptying.
I have seen several doctors, and just yesterday, I had a digital rectal exam for prostate evaluation.
After the exam and a urinalysis, the doctor diagnosed me with non-bacterial prostatitis, stating that it is only a mild inflammation.
The lab results were as follows: RBC: 0-1, WBC: 0-1, Bacteria: 0, Epithelial cells: 0.

I would like to ask why my doctor said I have mild inflammation when I read online that a white blood cell count in prostate fluid below 10 indicates no inflammation.
Could it be that abnormalities in the urinalysis after the digital rectal exam can also indicate prostatitis? Additionally, does non-bacterial prostatitis necessarily require antibiotics? My prescription includes Iprofen F.C.
200mg, Solaxin 200mg, Cernilton Tab, and Urogen S.C.
50mg.
Furthermore, could my symptoms resemble interstitial cystitis? I urinate about 8 to 11 times a day, and I have recorded urine volumes of approximately 150 to 250 ml, while after drinking a lot of water, I can urinate up to 400 ml.
My bladder does not feel painful when full, and the frequency of urination fluctuates, with no nocturia.
The doctor mentioned that men rarely get this condition and that being able to urinate 400 ml rules it out, but I am still a bit concerned.
Thank you, Doctor, for your assistance.

A-Ting, 20~29 year old female. Ask Date: 2015/06/03

Dr. Fu Shizhang reply Urology

For the treatment of non-bacterial prostatitis, a so-called combination therapy may be employed, and it is not necessarily required to use antibiotics.
According to the medication list, the treatment should be effective.
Additionally, if there is no pain during bladder fullness and the bladder capacity can reach 400 ml, it is indeed unlikely to be interstitial cystitis.
Chronic prostatitis is a frustrating condition that often requires a long duration of treatment.
It is recommended to follow the physician's advice and return for regular follow-up appointments.

Reply Date: 2015/06/03

More Info

Non-bacterial prostatitis, also known as chronic pelvic pain syndrome (CPPS), is a complex condition that can be quite challenging to diagnose and treat. It is characterized by pelvic pain and urinary symptoms without evidence of a urinary tract infection or bacterial infection. Understanding the symptoms, diagnosis, and treatment options is crucial for managing this condition effectively.

Symptoms
The symptoms of non-bacterial prostatitis can vary widely among individuals. Common symptoms include:
- Frequent Urination: Many patients report an increased urge to urinate, often leading to multiple trips to the bathroom throughout the day and night.

- Pain or Discomfort: This can manifest as pain in the pelvic area, lower abdomen, perineum (the area between the scrotum and anus), and even the lower back or thighs. Some patients may also experience pain during or after ejaculation.

- Urinary Issues: Patients may experience a sensation of incomplete bladder emptying, urgency, or difficulty starting urination.

- Sexual Dysfunction: While many individuals do not experience direct sexual dysfunction, some may find that their symptoms worsen after sexual activity.

Diagnosis
Diagnosing non-bacterial prostatitis typically involves a thorough medical history, physical examination, and various tests. A digital rectal exam (DRE) is often performed to assess the prostate's condition. Urinalysis and urine cultures are conducted to rule out bacterial infections. In some cases, prostate secretions may be analyzed, but the absence of white blood cells does not definitively rule out inflammation.

The criteria for diagnosing non-bacterial prostatitis can be somewhat subjective, as there are no definitive laboratory tests. The presence of symptoms, along with the exclusion of other conditions, is key to diagnosis. It’s important to note that even if prostate secretions show low white blood cell counts, inflammation can still be present based on clinical symptoms.

Treatment
Treatment for non-bacterial prostatitis is often multifaceted and may include:
1. Medications: While antibiotics are commonly prescribed for bacterial prostatitis, they are not effective for non-bacterial forms. Instead, treatment may involve:
- Anti-inflammatory medications: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help alleviate pain and inflammation.

- Alpha-blockers: These medications can help relax the muscles around the bladder and prostate, improving urinary symptoms.

- Muscle relaxants: These may be prescribed to relieve pelvic floor muscle tension.

- Other medications: Herbal supplements like Cernilton and other agents may be used, although their efficacy can vary.

2. Physical Therapy: Pelvic floor physical therapy can be beneficial for patients experiencing muscle tension or dysfunction in the pelvic area.

3. Lifestyle Modifications: Patients are often advised to adopt a healthy lifestyle, including regular exercise, stress management techniques, and dietary changes (avoiding spicy foods, caffeine, and alcohol).

4. Heat Therapy: Warm baths or heat pads can provide relief from pelvic pain.

5. Counseling: Psychological support or counseling may be beneficial, especially if stress or anxiety exacerbates symptoms.

Prognosis and Complications
While non-bacterial prostatitis can be a chronic and frustrating condition, it is generally not associated with severe complications or progression to more serious diseases. However, the persistent pain and discomfort can significantly affect quality of life. Regular follow-up with a healthcare provider is essential to monitor symptoms and adjust treatment as necessary.

In conclusion, managing non-bacterial prostatitis requires a comprehensive approach that addresses both physical and psychological aspects of the condition. If symptoms persist or worsen, it is crucial to maintain open communication with your healthcare provider to explore alternative treatment options and ensure that other potential causes of symptoms are adequately investigated.

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