The majority of chronic prostatitis cases fall into this category. The exact causes and pathogenesis of this condition remain unclear. Potential factors include microorganisms such as Chlamydia trachomatis, Mycoplasma, Trichomonas, fungi, and viruses. Other factors may involve abnormal immune responses, irritation from urinary reflux, and psychological components. Irregular sexual activity, prolonged sitting, excessive alcohol consumption, and spicy foods may trigger or exacerbate symptoms of prostatitis. It has been proposed that chronic non-bacterial prostatitis be renamed "prostate pelvic syndrome" (PPS), as this name better reflects the nature of the disease. The development of symptom-centered diagnostic and efficacy assessment criteria is being emphasized, with reducing symptoms and improving quality of life as the primary treatment objectives.
Clinical Manifestations
The symptoms resemble those of chronic bacterial prostatitis, characterized primarily by persistent and recurrent pain or discomfort in areas such as the perineum and lower abdomen. Symptoms may also include urinary frequency and a feeling of incomplete bladder emptying. Variable degrees of sexual dysfunction, reduced fertility, and psychological symptoms may coexist as part of a broader syndrome. Unlike chronic bacterial prostatitis, recurrent urinary tract infections are absent. Physical examination findings may not correspond to the reported symptoms. Ultrasound often reveals prostatic calcifications. During digital rectal examination, the prostate may appear slightly swollen, relatively soft, and mildly tender. Cases presenting with chronic prostatitis symptoms, especially significant pelvic and perineal pain, but normal prostatic fluid tests and negative bacterial cultures, are referred to as prostatodynia.
Treatment
α-receptor antagonists can provide relief from muscle spasm and improve symptoms. Certain plant-based formulations have demonstrated some effectiveness in alleviating symptoms. For patients with psychological disturbances, antidepressants or anti-anxiety medications may be appropriate. Nonsteroidal anti-inflammatory drugs (NSAIDs) may help manage pain. In patients with symptoms of overactive bladder, M-receptor antagonists may be beneficial. Additional therapeutic options include daily warm sitz baths, weekly prostatic massage, and addressing lifestyle factors that contribute to pelvic and prostatic congestion, which can yield favorable results. Therapies such as low-energy treatments, biofeedback, psychological counseling, and acupuncture may also offer varying degrees of symptom improvement.