What is Chronic Pelvic Pain Syndrome (CPPS)?
CPPS and Chronic Prostatitis are long-term conditions that are poorly understood, challenging to treat, and has no cure. CPPS causes a wide range of disruptive symptoms that include severe pain, erectile dysfunction and urinary and bowel problems. Usually patients find it difficult to cope with and have a negative impact on the quality of life.
CPPS is a nonmalignant pain that is affects structures of the perineum which includes muscles and nerves of the pelvic flood muscles, that is continues or recurrent for at least 6 months. CPPS can encompass several conditions that cause pain in different regions around the prostate that includes various muscles, nerves and bony structures in the pelvis, abdomen and spine. The causes of CPPS are not completely understood, however a number of factors may be involved. Genetic variations have also implications on CPPS.
One leading cause that is commonly associated with CPPS is Prostatitis. Prostatitis is a set of symptoms that originates from an infection or inflammation of the prostate gland. Prostatitis affects men of all ages however its most prevalent in those aged 36-50 years old. The condition can be acute or chronic, bacterial or non-bacterial, and symptoms can occur with or without signs of infections. Prostatitis can be categorized as:
- Acute bacterial prostatitis
- Chronic bacterial prostatitis
- Chronic non-bacterial prostatitis/CPPS
- Asymptomatic inflammatory prostatitis
Chronic non –bacterial prostatitis is the most common type experienced, and it’s defined as a urological pain or discomfort in the pelvic region associated with urinary symptoms and/or sexual dysfunction lasting at least 3 months. Although CPPS is a benign condition, it can reduce the quality of life.
Chronic prostatitis / CPPS could be caused by the following factors:
- An infection that is not identified by tests
- Inflammation of the nerves around the prostate gland
- History of damage to the pelvic floor and muscles
What are the symptoms of Prostatitis/CPPS?
The hallmark of chronic prostatitis and CPPS is persistent and disabling pain; however both conditions may cause a wide range of symptoms relating to pain, urinary function, quality of life and sexual dysfunction. Each patient is affected differently and symptoms may be constant or intermittent.
What are the common symptoms of CPPS?
- Pain in the perineum
- Lower abdominal pain
- Pain on the tip of penis and testicles
- Rectal and lower back pain
- Pain / burning during ejaculation
- Premature ejaculation
- Erectile dysfunction
- Lower urinary tracts symptoms
- Blood in semen.
What are the common symptoms of Prostatitis?
- Pain in the testicles, perineum or tip of penis
- Pain in the lower abdomen, groin or back
- Urinary frequency / urgency
- Pain or stinging during/ or after urination
- Lack of libido
What are the common assessment and investigations?
A detailed history and physical examination will be done by your physician. A symptom scoring is a common test that is done to asses chronic prostatitis symptoms index, in which score issues relating to pain, voiding and quality of life.
If it looks like CPPS/Chronic prostatitis, an abdominal and external genitalia examination is done. Digital rectal examination will also be done for male patient, and may reveal tenderness upon examination.
There may be also involvement of certain sexual / psychological factors, your doctor will take a detailed sexual history prior to further management. Patient who has undergone sexual abuse will be managed sensitively, and with their consent, relevant referrals will be made.
How do we manage CPPS?
Your physician will start you on antibiotics, anti-inflammatory medications and alpha blockers. All of these medications are used to treat chronic prostatitis and CPPS. Use of antibiotics may eradicate the source of infection and may aid in pain management and overall quality of life. Alpha blockers will aid in men with voiding issues or difficulty in passing urine. These medications will help relax the muscle of the prostate and bladder neck.
If all else fails your doctor may talk to you about ESWT. ESWT has shown significant improvement in pain management and overall well-being in patient with CPPS.