What causes chronic nonbacterial prostatitis? What are the symptoms?

Author: Gao Zhan, Chief Physician, Xiyuan Hospital, China Academy of Chinese Medical Sciences

Reviewer: Zhang Kai, Chief Physician, Peking University First Hospital

Prostatitis is a very common disease in clinical practice.

Epidemiological surveys show that the incidence rate is 8.8%, which means that almost 1 in every 12 adult males suffers from prostatitis.

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When talking about prostatitis, the first thing that comes to mind is that it is caused by bacterial infection. In fact, 90%-95% of patients with chronic prostatitis cannot find pathogenic microorganisms in prostate fluid examination, and only 5%-10% have bacterial prostatitis.

Let’s learn about prostatitis and see what types of prostatitis it is divided into.

1. What types of prostatitis are there?

Prostatitis is generally divided into four types:

Type I is acute bacterial prostatitis, which is simply caused by bacterial infection;

Type II is chronic bacterial prostatitis, which is a chronic process and bacteria can be cultured in the prostatic fluid;

Type III is chronic nonbacterial prostatitis. No bacteria are found in the patient's prostatic fluid. The white blood cell count in the prostatic fluid is greater than 10/HP, which is classified as type IIIA. The white blood cell count in the prostatic fluid is less than 10/HP, which is defined as type IIIB.

Type IV is asymptomatic prostatitis, which is usually discovered accidentally during a physical examination of prostatic fluid and generally does not require treatment.

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The most common is chronic nonbacterial prostatitis, accounting for about 90%-95%.

So, what causes chronic non-bacterial prostatitis?

The fact that no bacteria were cultured in the prostatic fluid does not mean that there is no infection with pathogenic microorganisms. It may be infected with mycoplasma, chlamydia, anaerobic bacteria, mold, etc., which cannot be detected by ordinary methods. Some people think that there may be nanobacterial infection; others think that there is no infection with pathogenic microorganisms at all, but it is just that various unhealthy lifestyles induce prostate congestion and cause a series of symptoms.

Can a urinary tract infection cause prostatitis?

5%-10% of prostatitis is bacterial prostatitis, which can be spread from urinary tract infection. For example, patients have bacterial urethritis or gonococcal urethritis. As the disease progresses, they do not receive standardized treatment, or lose the opportunity for treatment, or the treatment course is not enough, and finally develop into chronic prostatitis, but acute prostatitis rarely occurs.

Therefore, if you have urethritis or lower urinary tract infection, you must seek timely treatment to avoid causing infection in other parts of the body.

2. What are the symptoms of chronic prostatitis?

There are four types of symptoms of chronic prostatitis:

First, pain. The pain is centered in the pubic area, radiating up and down, front and back, left and right. The patient may experience discomfort in the lower abdomen, groin, lumbar region, scrotum, testicles, perineum, etc. The pain usually lasts for three months before it can be defined as chronic prostatitis.

Second, urinary tract symptoms, such as frequent urination, urgency, pain, discomfort, burning sensation when urinating, etc.

Third, sexual dysfunction, such as low libido, erectile dysfunction, ejaculation disorders, premature ejaculation, etc.

Fourth, because the disease recurs for a long time and lasts for three months or even longer, the patient will experience mental symptoms such as low mood, depression, and anxiety.

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Why does chronic prostatitis affect sexual function?

The prostate is anatomically located below the bladder, at the beginning of the urethra.

The prostate has two functions: one is an endocrine gland that can secrete prostaglandins; the other is an exocrine gland that can secrete prostatic fluid, etc.

Prostatitis recurs over a long period of time and cannot be cured for a long time. Because prostatitis causes congestion in the posterior urethra, it will stimulate the nerves, making ejaculation more sensitive and possibly causing premature ejaculation. In some patients, because of the long-term illness, the nerves may be stimulated for a long time, which may cause problems with the erectile nerves and lead to erectile dysfunction. Prostatic fluid is part of semen, and prostatitis may cause infertility, but the chance of causing infertility is very low.

3. What tests are needed to diagnose prostatitis?

The gold standard for diagnosing prostatitis is that there must be symptoms. Prostatitis is generally not diagnosed without symptoms.

The examination of prostatitis is relatively simple in clinical practice. After asking about the medical history, the doctor will first do a routine urine test if it is prostatitis. He will also do an ultrasound examination to check the tissue, morphology, and structure of the prostate to rule out other diseases.

In addition, a digital rectal examination is also required. The doctor wears a glove and inserts his finger into the patient's anus to feel the texture, size, toughness of the prostate, the depth of the prostate groove, and whether there is tenderness.

At the same time, take some prostate fluid for examination to see how many lecithin bodies and white blood cells there are in the prostate fluid. If the number of white blood cells in the prostate fluid increases and the number of lecithin bodies decreases, it can generally be diagnosed as prostatitis.