Welcome back to part 2 of our Movember blog posts. Today we are talking about Chronic Prostatitis/ Chronic Pelvic Pain Syndrome
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition that causes severe symptoms, bother, and quality-of-life impact in the 8.2% of men who are believed to be affected (Magistro et al. 2016). The cause is unknown and does not appear related to lifestyle factors in general (Zhang et al. 2015).
Prostatitis is swelling or inflammation of the prostate, a gland that sits immediately under the bladder. If the prostate is swollen it can impact urinary function, cause burning and discomfort. Prostatitis can be caused by bacteria and an acute onset presents as a UTI and may be accompanied by symptoms that mimic a flu, such as fever, chills, nausea and vomiting (Mayo Clinic: www.mayoclinic.org ). In this case it is treated with antibiotics, but sometimes they may or may not clear up the infection. In some cases the infection might be cleared up but occurs again and possibly again. Oftentimes men will report symptoms to their physicians and are given antibiotics in the absence of a culture, as seen by myself and many pelvic PTs nationally; however the symptoms do not change. The reason for that is that we are usually looking at a non bacterial cause of their symptoms and that is due to the pelvic floor or CPPS. The NIH (National Institutes of Health) created a classification system which looks like (Doiron and Nickel 2018):
Type 1: Acute Bacterial Prostatitis (caused by bacteria)- acute UTI
Type 2: Chronic Bacterial Prostatitis (caused by bacteria)- recurrent UTI
Type 3: CPPS- pelvic pain symptoms but no UTI
Type 4: Asymptomatic inflammatory prostatitis (AIP)- prostate inflammation but no genitourinary tract symptoms
Typically chronic pain and/ or chronic symptoms achieve this description when they have been present for at least 6 consecutive months. Patients with CPPS present with symptoms that maybe varied in nature, but may include: bladder pain, burning with urinations, hesitation with urination, pain at and around the genitals, bowel and bladder symptoms including incomplete emptying, psychological impact, sexual dysfunction, not limited to pain, altered sensation, erectile issues and premature ejaculation.
So what can we do to address CPPS?
Well the answer unfortunately is not that easy and will be very patient and symptom specific. There is not a one size fits all remedy but what is known is that a multidisciplinary and comprehensive approach is needed. Pelvic floor physical therapy has been shown to significantly reduce symptoms associated with CPPS (Anderson et al. 2015). Other interventions have been shown to be helpful in some capacity. These include: behavioral modifications, shockwave therapy, accupuncture, mindfulness and medication, breath work and even refer to mental health or sex therapists.
For more information and if you think you might have symptoms, I encourage you to take this questionnaire: NIH-Chronic Prostatitis Symptom Index (NIH-CPSI)
1. Magistro, Giuseppe, Florian M. E. Wagenlehner, Magnus Grabe, Wolfgang Weidner, Christian G. Stief, and J. Curtis Nickel. 2016. “Contemporary Management of Chronic Prostatitis/Chronic Pelvic Pain Syndrome.” European Urology 69 (2): 286–97.
2. Zhang, Ran, Siobhan Sutcliffe, Edward Giovannucci, Walter C. Willett, Elizabeth A. Platz, Bernard A. Rosner, Jordan D. Dimitrakoff, and Kana Wu. 2015. “Lifestyle and Risk of Chronic Prostatitis/Chronic Pelvic Pain Syndrome in a Cohort of United States Male Health Professionals.” The Journal of Urology 194 (5): 1295–1300.
3. Mayo Clinic: www.mayoclinic.org
4. Doiron, R. Christopher, and J. Curtis Nickel. 2018. “Evaluation of the Male with Chronic Prostatitis/chronic Pelvic Pain Syndrome.” Canadian Urological Association Journal = Journal de l’Association Des Urologues Du Canada 12 (6 Suppl 3): S152–54..
5. Anderson, Rodney U., Richard H. Harvey, David Wise, J. Nevin Smith, Brian H. Nathanson, and Tim Sawyer. 2015. “Chronic Pelvic Pain Syndrome: Reduction of Medication Use after Pelvic Floor Physical Therapy with an Internal Myofascial Trigger Point Wand.” Applied Psychophysiology and Biofeedback 40 (1): 45–52.