What are the symptoms of chronic prostatitis?

Symptoms of Chronic Prostatitis

The hallmark symptom of chronic prostatitis is pelvic pain, which may include pressure or discomfort in the perineum, suprapubic region, testicles, or tip of the penis, often exacerbated by urination or ejaculation. 1

Primary Symptoms

• Pain and Discomfort:

  • Pelvic pain (the defining characteristic)
  • Pain may be described as pressure or discomfort rather than "pain" 2
  • Pain locations include:
    • Perineum
    • Suprapubic region
    • Testicles
    • Tip of penis
    • Lower abdomen
    • Lower back
  • Pain may worsen with:
    • Urination
    • Ejaculation
    • Bladder filling
    • Consumption of specific foods or drinks 2

• Urinary Symptoms:

  • Urinary frequency
  • Sense of incomplete bladder emptying
  • Urinary urgency (though this may be qualitatively different from overactive bladder urgency) 2
  • Nocturia

• Sexual Dysfunction:

  • Painful ejaculation
  • Erectile dysfunction
  • Sexual distress 2

Distinguishing Features from Other Conditions

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) shares many symptoms with interstitial cystitis/bladder pain syndrome (IC/BPS). The key distinction is that:

• In CP/CPPS, pain is primarily related to the prostate and surrounding pelvic structures
• In IC/BPS, pain is perceived to be related to the bladder 2

However, the American Urological Association notes that some men may have symptoms that meet criteria for both conditions, in which case treatment can include approaches for both CP/CPPS and IC/BPS 2.

Symptom Assessment

The NIH-Chronic Prostatitis Symptom Index (NIH-CPSI) is the validated standard for quantifying symptoms in CP/CPPS 1, 3. This 13-item questionnaire assesses three domains:

• Pain (location, severity, frequency)
• Urinary symptoms
• Quality of life impact 3

The International Prostate Symptom Score (IPSS) may also be used to assess urinary symptoms 1.

Clinical Presentation Patterns

CP/CPPS symptoms can vary in presentation and severity. Early symptoms may begin with mild dysuria or urinary urgency, which may progress to severe voiding frequency, nocturia, and suprapubic pain 2.

It's important to note that CP/CPPS is relatively common, with a lifetime prevalence of 1.8% to 8.2% 4, and accounts for more than 90% of chronic prostatitis cases 4.

Common Pitfalls in Diagnosis

• Many patients use words like "pressure" rather than "pain" to describe their symptoms and may actually deny having pain 2
• Symptoms can overlap with other conditions such as:
  • Interstitial cystitis/bladder pain syndrome
  • Benign prostatic hyperplasia
  • Urinary tract infection
  • Pelvic floor dysfunction 4
• Relying solely on the presence of urinary frequency or urgency for diagnosis is insufficient, as these symptoms are common in other lower urinary tract disorders 2

The complexity and variability of symptoms often lead to misdiagnosis, underdiagnosis, or delayed diagnosis of chronic prostatitis 2. Understanding the full spectrum of symptoms and their impact on quality of life is essential for proper diagnosis and management.