Nonbacterial Prostatitis Clinical Presentation

Updated: Nov 25, 2019
  • Author: Sunil K Ahuja, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Patients with abacterial prostatitis/chronic pelvic pain syndrome (CPPS; category III in the 1995 National Institutes of Health prostatitis classification system) have the same symptom complex as those with chronic bacterial prostatitis. The chief symptom reported by patients with abacterial prostatitis/CPPS is pain. Genitourinary symptoms include perineal, penile tip, testicular, rectal, lower abdominal, or back pain.

Patients can also have irritative or obstructive urologic symptoms such as frequency, urgency, dysuria, decreased force of the urinary stream, nocturia, and incontinence. Other symptoms are a clear urethral discharge, ejaculatory pain, hematospermia, and sexual dysfunction.

Many patients with abacterial prostatitis have emotional strife and some psychological difficulties (ie, socially, sexually, or both). Patients should be questioned with regard to their overall social adjustment. Stress level is important because stress is responsible for increased tension of the pelvic floor and the internal urinary sphincter, resulting in the symptoms of prostatitis.


Physical Examination

In most cases, physical examination findings are nonspecific. Many patients have normal findings, others may have an exquisitely sensitive prostate or other pelvic trigger points on internal and external perianal examination, and still others may have an enlarged, boggy prostate.