Prostatitis refers to inflammation of the prostate gland. There are two main types of Prostatitis: Bacteria and Non-Bacteria. Among these two types of Prostatitis there are 4 categories:
Category 1: Acute Bacterial Prostatitis (tender point, flu-like symptoms)
Category 2: Chronic Bacterial Prostatitis (triggered by urinary tract infection)
Category 3: Non-bacterial/Non-Inflammatory Prostatitis; this is not to imply inflammation is not present; also known as Pelvic Floor Dysfunction (PFD), Chronic Pelvic Pain Syndrome (CPPS in men), Chronic Pain (CP) or Prostatodynia. This type is often treated inappropriately with antibiotics that are ineffective due to no bacteria present.
Category 4: Asymptomatic Inflammatory Prostatitits (no symptoms, leukocytosis may be present)
It is important to understand that Pelvic Floor Dysfunction can occur with any of these categories or types of Prostatitis due to the inflammation or bacteria being the stressor that triggers the pelvic floor muscles to respond. Stress, bacteria, and/or inflammation can cause the pelvic floor muscles to elicit a protective response, tightening of the muscles to protect against the stressor. Unfortunately sometimes the pelvic floor muscles stay in a hyperprotective or hypertonic state and this can cause pain due to the tight or spastic muscles. Therefore, it’s possible to start with a bacterial type prostatitis and end up with Pelvic Floor Dysfunction or Non-bacterial Prostatitis. At this point the antibiotics will no longer be useful or effective.
Symptoms of Category 3 Non-Bacterial Prostatitis or Pelvic Floor Dysfunction:
The cause is often unknown, symptoms are triggered or exacerbated by dietary factors, and unlike Benign Prostate Hypertrophy (BPH) pain is may be present with urination and sexual activity. Other symptoms include:
- Difficulty starting urine stream/feeling of incomplete emptying
- Urinary frequency/nocturia (excessive nighttime voids)
- Low/weak urine flow
- Pain in sitting, “sitting on a golf ball or rock”
- Rectal pain/pain that wakes at night (Prostatic Fugax)
- Pain during and/or after a bowel movement or urination
- Constipation (See Constipation)
- Pain during or after intercourse
- Pain with erection
- Hard flaccid
- Erectile Dysfunction
Treatment is the same as how pelvic pain is treated in women (See Treatment for Pelvic Pain) with the main difference being the physical therapist will perform manual therapy rectally as well as work on the external pelvis and correlating musculature (See Manual Therapy). Internal rectal treatment is the best way to access the pelvic floor muscles in men. Men with any type of Prostatitis will also benefit from bowel and bladder retraining (see Treatment for Bowel and Bladder Retraining).