“Chronic prostatitis” is a diagnostic label applied to a range of disorders, ranging from acute bacterial infection to chronic pain syndromes. It is a common condition with a life-time prevalence of 5-9%. It is often not well-managed in medical practice and has been described by one eminent urologist as “A wastebasket of clinical ignorance”.

Chronic prostatitis is the commonest reason for men under 50 to visit a urologist and around 50% of men will be affected by prostatitis sometime in their lives.

Around 35% of men experience symptoms consistent with prostatitis in the past 12 months and 8% will find it at least a minor problem.

Its symptoms are variable but may include some, but not all, of the following: perineal and penile pain; lower back, abdominal and inner thigh pain; painful ejaculation; lower urinary tract symptoms; fever; myalgia; decreased sexual motivation; ED. The causes of this syndrome are obscure, despite decades of research, and there is no definitive, universally reliable treatment for it, not least because it is not a single clinical or pathological entity. Bacterial infection is causal in a minority of patients. A range of causes for non-bacterial, non-inflammatory chronic pelvic pain have been proposed; it may be a neuropathic or neuromuscular disorder, rather than a disorder of the prostate itself; pain is thought either to arise from spontaneous signals within pelvic nerves or be due to uncoordinated contractions of the smooth muscle fibres in the prostate gland, rather like colic. Although there is no “cure”, the usual course of events is that episodes become less severe and less frequent over time, although it can take many years for this to happen.

Its management requires a systematic approach to diagnosis, and the National Institutes of Health Classification of Chronic Prostatitis has been an important aid in this process. Treatment for chronic prostatitis should include patient education, psychological and behavioural therapies, as well as medication. For non-bacterial, non-inflammatory chronic pelvic pain, treatment should be aimed at increasing the suffererʼs understanding of the problem and symptom relief during acute episodes. Drugs like amitriptyline may help with neuropathic pain and alpha-blocker drug like doxazosin may help with neuromuscular inco-ordination, but they are best used as one component of an integrated treatment programme.