Chronic pelvic pain syndrome (CPPS)

CPPS is the most common type of prostatitis – around 19 out of every 20 men (90 to 95 per cent) with prostatitis have it. You might also hear it called chronic non-bacterial prostatitis, chronic abacterial prostatitis or prostate pain syndrome. Chronic means long-lasting.

Men with CPPS usually have symptoms for three months or longer. Even after treatment, you may still have prostatitis for a long time. It might come and go, causing occasional episodes of severe pain, sometimes known as flare-ups.

What causes it?

Nobody knows for certain what causes CPPS. Unlike other types of prostatitis it isn’t usually caused by a bacterial infection. There could be a number of causes, which makes it difficult to diagnose and treat.

There are also a number of things that might trigger it, including:

• urine getting into the prostate
• previous infections in or around the prostate
• an infection that doesn’t show up in tests
• problems with nerves, so that they send pain signals to the brain even when there’s nothing physically wrong
• stress, anxiety or depression
• problems with the pelvic floor muscles (the muscles that support your bladder and bowel and help to control urination).

Some research shows a link between stress, anxiety and depression and CPPS. But this doesn’t mean that CPPS is all in your head. If you’re feeling stressed or depressed, this may cause physical symptoms that trigger CPPS, or make symptoms worse.

There’s some evidence that CPPS may be linked to other conditions such as chronic fatigue syndrome, which causes severe tiredness, and irritable bowel syndrome (IBS), which causes bowel problems.

Some men with CPPS have symptoms of these conditions too. There’s also some evidence that in a small number of men, CPPS may be caused by a sexually transmitted infection. But we need more research to know for sure.

Acute bacterial prostatitis

Acute bacterial prostatitis is an infection of the prostate that is caused by bacteria. Acute means that the symptoms develop very quickly. It isn’t common, but it can be serious and may need treating in hospital.

What causes it?

Acute bacterial prostatitis can develop when certain types of bacteria get into your prostate, causing it to become infected.

Bacteria that normally live in your bowel may spread to the tip of your penis and to the urethra (the tube you urinate through). From here, the bacteria might reach your prostate. Bacteria can also spread to your prostate from your bladder or bloodstream.

Acute bacterial prostatitis can happen if:

• you have a urine infection
• you’ve had difficulty emptying your bladder
• you’ve had a prostate biopsy
• you regularly use a thin tube called a catheter to drain urine from your bladder.

Chronic bacterial prostatitis

Chronic bacterial prostatitis is an infection of the prostate that can last for a long time – at least three months. Chronic means that it is long-lasting. It tends to come and go, causing episodes or flare-ups. It isn’t common.

What causes it?

Chronic bacterial prostatitis is caused by a bacterial infection. It tends to affect men who’ve had lots of urine infections or an inflamed urethra (urethritis) in the past, or who have a damaged or narrow urethra (a stricture). Each episode tends to be caused by the same bacteria, which also cause the urine infections.

It can develop from acute bacterial prostatitis if antibiotics don’t get rid of all the bacteria. This could be because the bacteria were resistant to the antibiotics or because the treatment was stopped too early.

Asymptomatic inflammatory prostatitis

This is prostatitis that doesn’t have any symptoms – the word asymptomatic means there are no symptoms. It is usually detected by chance when you’re having tests for other conditions, such as prostate cancer.

References

Last updated July 2019 | To be reviewed July 2022