What to Know About Chronic Prostatitis/Chronic Pelvic Pain Syndrome

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) affects approximately 2 to 10% of adult males and causes chronic pelvic pain and urinary and sexual problems. The cause of this condition is not known, and diagnosis of CP/CPPS can be challenging because many other health conditions have similar symptoms.

If you have any of the symptoms of CP/CPPS, it is important to seek help because the condition does not go away on its own and treatment can provide relief.

This article will discuss the symptoms and possible causes of CP/CPPS. It will also go through the diagnosis process and potentially similar medical conditions. Common treatments for CP/CPPS are also discussed.

Symptoms of Chronic Prostatitis/Chronic Pelvic Pain Syndrome

The symptoms of CP/CPPS syndrome include the following:

• Pain in the perineum, pelvis, or rectum
• Pain in the lower back, bladder/lower abdomen, testicles, and penis
• Pain with ejaculation
• Difficult painful urination and/or weak urine stream
• Urgency to urinate or increased urinary frequency
• Erectile dysfunction
• Anxiety and depression

With CP/CPPS, a person usually experiences episodes or flares over many months.

Causes

It's unclear what causes CP/CPPS in males. While a bacterial infection of the prostate used to be the suspected culprit, research has found no evidence of bacteria in prostate tissue in affected individuals, and most experts now believe that CP/CPPS is a non-infectious syndrome.

Experts are considering the following as possible causes for the condition:

• Inflammation from trauma
• Autoimmune process—when your immune system mistakenly attacks your own healthy cells
• Infrequent ejaculation
• Abnormal reaction to normal prostate bacterial flora
• Increase prostate tissue pressure
• Stress, which can tighten the pelvic muscles

More specifically, many experts believe that one of the conditions above may trigger a phenomenon called central sensitization. This may lead to persistent neuropathic pain, similar to what is seen in other chronic pain conditions like fibromyalgia and irritable bowel syndrome.

Diagnosis and Related Health Conditions

The diagnosis of CP/CPPS can be tricky because many other health conditions mimic its symptoms.

Some of the other conditions your healthcare provider may consider include:

• Acute bacterial prostatitis
• Urinary tract infection
• Sexually transmitted infections (STIs)
• Colorectal, prostate, bladder, or testicular cancer
• An inguinal hernia
• Benign prostatic hyperplasia
• Pelvic floor dysfunction
• Bladder stones
• Neurogenic bladder
• Pudendal neuralgia

CP/CPPS is a diagnosis of exclusion, meaning other health problems need to be ruled out first. Your healthcare provider will need to do a thorough medical history and physical examination to determine the cause of your symptoms.

In addition to a history and physical examination, laboratory tests are also performed, such as a urinalysis and urine culture. Depending on the risks and symptoms, a prostate-specific antigen (PSA) blood test, urine cytology, urethral discharge culture, and a complete blood count (CBC) may be done as well.

Various imaging tests may also be warranted based on individual symptoms and laboratory results. For example, if you have blood in your urine, a cystoscopy to exclude bladder cancer will likely be performed. Likewise, testicular pain warrants a scrotal ultrasound, and lower abdominal pain often warrants a computed tomography (CT) scan of the abdomen and pelvis.

Treatments for Chronic Prostatitis/Chronic Pelvic Pain Syndrome

The treatment of CP/CPPS usually begins with a combination of three medications: an antibiotic, an alpha-blocker like Flomax (tamsulosin), and a pain medication such as Tylenol (acetaminophen) or a nonsteroidal anti-inflammatory (NSAID). Sometimes, a medication to treat nerve pain like Lyrica (pregabalin) is also prescribed.

Non-medication therapies are also often used for managing the symptoms of CP/CPPS.

According to a Cochrane Review, these therapies may help ease the symptoms of CP/CPPS:

• Acupuncture
• A physical activity program

Additionally, research suggests that cognitive-behavioral therapy (CBT) can help relieve the symptoms of CP/CPPS, especially pain, urinary problems, and depression. CBT has also been found to improve a person's overall quality of life.

Lastly, pelvic physical therapy to achieve myofascial trigger point release may be useful for those who experience pelvic pain related to pelvic floor muscle spasms.

Summary

People with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) can experience chronic pelvic pain and urinary and sexual problems. The cause is unknown, and diagnosis can be tricky because CP/CPPS symptoms can also appear in other health conditions. There are treatments available, including medications, acupuncture, and physical activity.

CP/CPPS is a complex disease and getting it diagnosed can be a lengthy process. Once diagnosed, most people benefit from a multifaceted treatment program that includes both medication and non-medication treatments.