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Chronic Prostatitis Chronic Pelvic Pain Syndrome

Treatments That A Specialist May Suggest

How to Cure Chronic Pelvic Pain Syndrome (CPPS) in six months or less

Various treatments have been tried for chronic prostatitis. They may benefit some people but so far there are few research studies to confirm whether they help in most cases. They are not ‘standard’ or routine treatments but a specialist may advise that you try one.

For chronic bacterial prostatitis, possible treatments may include the following:

  • A longer course of antibiotics. If the specialist suspects that you have chronic bacterial prostatitis and your symptoms have not cleared after a four-week course of antibiotics, they may suggest a longer course. Sometimes a course of up to three months is used.
  • Removal of the prostate may be considered if you have small stones in the prostate. It is not clear how much this may help but it has been suggested that these small stones may be a reason why some people have recurrent infections in chronic bacterial prostatitis. However, this is not commonly carried out and is not suitable in everyone. Your specialist will advise.

For chronic prostatitis/CPPS, possible treatments may include the following:

Imaging And Other Investigations

Uroflowmetry is done to measure the rate of urine flow and total volume of urine voided when the subject is peeing.

Abdominal ultrasound examination of the prostate and is often performed to rule out and hydroureter. Incidentally, cysts, tumours, and stones may be found on ultrasound. of more than 100 ml may indicate significant obstruction. Prostate size of 30 cc or more indicates enlargement of the prostate.

Prostatic calcification can be detected through transrectal ultrasound . Calcification is due to solidification of prostatic secretions or calcified . Calcification is also found in a variety of other conditions such as prostatitis, , and prostate cancer. For those with elevated levels of PSA, TRUS guided biopsy is performed to take a sample of the prostate for investigation. Although MRI is more accurate than TRUS in determining prostate volume, TRUS is less expensive and almost as accurate as MRI. Therefore, TRUS is still preferred to measure prostate volume.

Medical conditions


Certain medications can increase urination difficulties by increasing bladder outlet resistance due to increased tone at the prostate or bladder neck and contribute to LUTS. medications, such as with can increase bladder outlet resistance. In contrast, and medications can worsen urinary retention by promoting bladder muscle relaxation. Diuretic medications such as or can cause or worsen urinary frequency and nighttime awakenings to urinate.

Initial Points To Address

As previously stated, CPPS is, despite its name, a condition, not a disease or syndrome. It is similar to other chronic conditions, such as arthritis, that, while treatable, are not curable. No known cure exists for CPPS, but treatments based on the cooperation of patient and physician makes this condition more bearable. Over time, this condition may improve or stabilize on its own.

Many medications and other forms of treatment can help to alleviate the symptoms of CPPS. However, being patient is important try only 1 or 2 new treatments at a time, giving each enough time to take effect. Do not overwhelm the patient with an unreasonable number of simultaneous treatments, which causes only excessive inconvenience and expense. Simultaneous treatments might actually work against one another, and the adverse effects of these treatments might cause more, rather than fewer, problems for the patient.

Reassure the patient that CPPS is not cancer, not a life-threatening condition, not a venereal disease, and not contagious. Explain that the patient did not acquire this condition from someone else, nor will he pass it on to anyone.

In addition, remind the patient that he is not alone, that many men experience this problem. Local and national support groups recommended by the physician can provide additional information and encouragement.

The urologist institutes treatment through, and in close communication with, the patient’s primary care physician, who remains the mainstay of care.

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What Causes Chronic Bacterial Prostatitis

Chronic bacterial prostatitis is a type of infective prostatitis. It is caused by a persistent infection with a germ of the prostate gland. A man with chronic bacterial prostatitis will usually have had recurring urine infections. Chronic bacterial prostatitis is usually caused by the same type of germs that causes the urine infections. The prostate gland can harbour infection and therefore recurring infections can occur. Chronic bacterial prostatitis is not a sexually transmitted infection.

Chronic Pelvic Pain Syndrome

Chronic prostatitis/chronic pelvic pain syndrome, 978

This non-malignant pain is perceived in structures such as the muscles and nerves of the pelvis that has been continuous or recurrent for at least six months the minimum length of time for pelvic pain to be regarded as chronic. Perceived indicates that the patient and clinician, to the best of their ability from the history, examination and investigations have localised the pain as being felt in the specified anatomical pelvic area .

CPPS can encompass several conditions causing pain in the different anatomical structures around the prostate, including various muscle types, nerves and bony structures in the pelvis, abdomen and spine . The causes are not completely understood CPPS is not thought to be caused by infection, but a number of other factors may be involved . A range of genetic variations have been described that may explain chronic pelvic pain .

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Myofascial Release Therapy And Paradoxical Relaxation

Myofascial release therapy is a combination of internal and external trigger-point release therapy. It has proven more effective than standard external massage therapy alone.

Paradoxical relaxation is a methodology used to train autonomic self-regulation and pelvic muscle tension release. This psychotherapeutic treatment technique is used to help the patient decrease anxiety and nervous system arousal while counteracting the habit of tensing the pelvic muscles under stress. It is termed “paradoxical” because patients are directed to accept their pain and tension as a way of relaxing or releasing it. This approach incorporates group therapy, breathing techniques, and behavioral therapy, among other elements, to help reduce CPPS symptoms.

Anderson et al have developed a protocol that employs a team composed of a urologist, psychologist, and physiotherapist to provide a multifaceted approach to treating patients with CPPS and educating them on how to effectively alleviate their symptoms. This “Stanford protocol” incorporates myofascial trigger point assessment and release therapy, as well as paradoxical relaxation therapy.

Urologic evaluation is completed by the urologist, while myofascial trigger point assessment and release therapy is performed by the physical therapist, and techniques of paradoxical relaxation are taught by the psychologist. This novel approach capitalizes on the patient’s own involvement in the treatment of CPPS.

Chronic Prostatitis/chronic Pelvic Pain Syndrome

Chronic prostatitis/chronic pelvic pain syndrome
Other names

The cause is unknown. Diagnosis involves ruling out other potential causes of the symptoms such as bacterial prostatitis, benign prostatic hypertrophy, overactive bladder, and cancer.

Recommended treatments include multimodal therapy, physiotherapy, and a trial of alpha blocker medication or antibiotics in certain newly diagnosed cases. Some evidence supports some non medication based treatments.

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Physical Medicine Therapist And Physiotherapist

Clinical researchers at Columbia University found that an important subset of patients who had been treated unsuccessfully for symptoms of chronic abacterial prostatitis for between 1.5 and more than 10 years and who were unresponsive to long-term antibiotic and alpha-blocker therapies were actually experiencing pseudodyssynergia . This condition was documented based on electromyographic and fluoroscopic findings. Patients thus identified responded to treatment with biofeedback and behavior modification in 83% of cases.

Lately, authorities have appreciated that, in many cases, symptoms formerly attributed to CPPS may actually reflect pelvic floor spasm and chronic pelvic pain that is not prostatic in origin. In light of this, physiotherapists may provide an important role in helping to diagnostically distinguish and therapeutically ameliorate neuromuscular-based symptoms. For example, patients with palpable myofascial tenderness in the rectal area often chronically unable to relax their pelvic floor musculature. This dysfunction of the pelvic floor muscles is objectively documentable. Moreover, significant symptomatic relief has been achieved through modulation-based therapies such as biofeedback, alpha blockers, and sacral nerve stimulation.

In The Last Issue Dr Jacob Rajfer And Colleagues Presented This Case Report

Treatments for chronic prostatitis/chronic pelvic pain syndrome: a Cochrane systematic review

A 26-year-old male presented to the emergency room with acute onset of right-sided scrotal pain. The pain awoke him from sleep approximately 2 hours prior to presentation and began in the right lower quadrant, then quickly localized to the scrotum. With the onset of pain he noted swelling of the right testicle. There was no fever, chills, nausea, or vomiting. Upon examination, the abdomen was benign. The right scrotum appeared mildly enlarged. Palpation revealed a thickened spermatic cord and a mildly enlarged but tender testicle. The epididymis was palpated in the anterolateral part of the scrotum. The cremasteric reflex could not be demonstrated on either side. Initial laboratory tests including urinalysis were normal except for mild leukocytosis.

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What Is Chronic Prostatitis/chronic Pelvic Pain Syndrome

Prostatitis is inflammation of the prostate gland, the walnut-sized gland located below a mans bladder. The prostate gland secretes fluid that, along with sperm, forms semen.

There are different types of prostatitis, one of which is chronic prostatitis/chronic pelvic pain syndrome . This is the most common type. Young and middle-aged men are more likely to develop CP/CPPS, but it can happen at any age.

CP/CPPS may be classified as inflammatory or non-inflammatory.

In inflammatory cases, urine, semen, and fluid secreted by the prostate contain infection-fighting cells. But these fluids dont contain bacteria.

When CP/CPPS is non-inflammatory, no infection-fighting cells and no bacteria are found in the fluid.


  • Men with CP/CPPS can experience chronic discomfort or pain in the groin, genitals, perineum , or bladder.
  • They may have pain with urination and ejaculation as well. Many feel anxious about the situation.

But symptoms dont happen to every man with CP/CPPS. Also, symptoms may come and go on their own.


TreatmentCP/CPPS can also be difficult to treat and, unfortunately, it cannot always be cured. It can also take some time to find what best relieves a mans symptoms. Some strategies for treating CP/CPPS symptoms include the following:

Men with severe CP/CPPS may require surgery.

Sometimes, CP/CPPS gets better on its own.

Evaluation Of The Diary

After a series of good days and bad days have been recorded, the patient can review these recordings with the physician, looking for patterns in diet, exposure, or activity that characterize either type of day. The idea is to reduce factors associated with flare-ups and to maximize factors associated with relief.

This exercise should not be undertaken with the expectation of a cure for CPPS, but rather with the hope that clearer insight will be gained into some of the factors influencing the condition, which may provide the patient with better control over it.

Contributor Information and Disclosures

Richard A Watson, MD Professor of Surgery , Department of Surgery, Division of Urology, Rutgers New Jersey Medical School, Hackensack University Medical CenterRichard A Watson, MD is a member of the following medical societies: Academy of Medicine of New Jersey, American Urological Association, Association of Military Surgeons of the US, Society of University UrologistsDisclosure: Nothing to disclose.

Edward David Kim, MD, FACS Professor of Urology, Department of Urology, University of Tennessee Graduate School of Medicine Consulting Staff, University of Tennessee Medical CenterDisclosure: Serve as a speaker or a member of a speakers bureau for: Endo, Antares.

Robert J Irwin, Jr, MD Chair, Harris L Willits Professor, Department of Surgery, Division of Urology, University Hospital, University of Medicine and Dentistry of New Jersey

Disclosure: Nothing to disclose.

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Records Of The Variables

From the available records that we obtained from the CP/CPPS patients according to some studies of the risk factors for CP/CPPS and the pain of CP/CPPS , the 11 variables were about basic information, lifestyle, and medical history were selected for further analysis. The sedentary lifestyle was defined as sitting or lying down when took part in an activity, such as reading, watching television, driving . Holding back urine was defined as that waiting until the last second to go to the bathroom to pee . In China, the main contraceptive method was the use of condoms, so in our study, the contraceptive method was set as the use of condoms. The questionnaire of the Self-Rating Anxiety Scale was used to judge whether patients with CP/CPPS had the diagnosis of anxiety. When the scores of SAS was more than 50, the patients were diagnosed with anxiety . 100 ml of beer per week differed significantly from 100 ml of liquor or spirits. To accurately assess the alcohol intake of patients, we uniformly defined the patients alcohol intake as grams of alcohol intake per week. According to the number of cigarettes daily in Pauls study, we divided smokers into two groups: daily smoker of< 10 cigarettes and daily smoker of10 cigarettes . Skewed data were log-transformed or coded as categorical variables, and the detailed information was presented in Additional file : Table S1.

The Pharmacists Role In Managing Chronic Prostatitis/chronic Pelvic Pain Syndrome


Mena Alrais Dellarocca, PharmD, RPhAdjunct Instructor of Pharmacy Practice University of Southern California, School of PharmacyLos Angeles, California

US Pharm. 2020 45:HS-11-HS-16.

ABSTRACT: Prostatitis, an inflammation of the prostate gland, is a common condition, with prevalence peaking in middle-aged men. Chronic prostatitis/chronic pelvic pain syndrome is characterized by pelvic pain, variable urinary symptoms, and sexual dysfunction. Focused multimodal therapy appears to be more successful than empiric monotherapy, which may add complexity to the drug regimen and calls for collaboration with a pharmacist for an effective continuum of care, management of pain, and antibiotic stewardship.

Chronic prostatitis/chronic pelvic pain syndrome is a common condition worldwide, affecting approximately 2% to 10% of men. The prevalence seems to peak in the fifth decade and decline thereafter and shows no apparent racial predisposition. The symptomatic, chronic forms of prostatitis as defined by the National Institutes of Health , are chronic bacterial prostatitis and CP/CPPS . Most men diagnosed with prostatitis have CP/CPPS rather than acute or chronic bacterial prostatitis. Despite having a significant negative impact on patients quality of life and presenting diagnostic and therapeutic challenges for physicians, CP/CPPS has received relatively little attention in the literature, in comparison with other urologic conditions.1-8

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Signs And Symptoms Of Chronic Pelvic Pain Syndrome

There are many symptoms related to CPPS, including:

  • Pelvic floor pain/ perineal pain without evidence of urinary tract infection, lasting more than 3 months is the key symptom of CPPS.
  • Abdominal pain

As mentioned by four elements are essential to diagnose CP/CPPS, including

  • Symptoms occurring in perineal and/or low abdominal region
  • Infection and/or inflammatory changes of the prostate with laboratory evidence of abnormal findings
  • Clinical presentations derived from or associated with the prostate and lower urinary tract
  • Symptoms appearing more or less after an inducible cause with varied incubation times.
  • A set of associated symptoms include, but are not always limited to, pain and/or discomfort with urinary alteration, abnormal secretion from the urinary tract, and ejaculation pain.

    The following are conditions that can mimic CPPS:

    • Granulomatous prostatitis

    Chronic Pelvic Pain Syndromes

    Patients with chronic pelvic pain syndromes experience pelvic pain for at least six months, frequently with simultaneous urinary symptoms. Men and women are impacted by these conditions, which include interstitial cystitis/painful bladder symptom, a bladder disorder characterized by urinary urgency, frequency and pain. Men may also have prostatitis, which causes pain and difficult urination due to swelling and inflammation of the prostate.

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    What Is Chronic Nonbacterial Prostatitis

    Chronic nonbacterial prostatitis, also known as chronic pelvic pain syndrome, is a common condition that affects men. It causes pain and inflammation in the prostate, pelvis, and the lower urinary tract. The prostate gland is located right below the bladder in men. It produces fluid that helps transport sperm. In the United States, chronic nonbacterial prostatitis affects around

    Dont ignore any of the symptoms of chronic nonbacterial prostatitis. Instead, make an appointment with your doctor. There are a variety of treatments that may help.

    National Institutes of Health describes four categories of prostatitis:

    • Acute bacterial prostatitis happens when bacteria, like sexually transmitted organisms, cause an infection in the prostate. Symptoms typically develop suddenly, and usually respond well to antibiotics.
    • Chronic bacterial prostatitis is an ongoing problem. Its also more difficult to treat. Its often associated with ongoing urinary tract infections.
    • Asymptomatic inflammatory prostatitis has no symptoms. Its usually discovered while undergoing other tests. It appears to be more common in men who smoke and drink regularly .
    • Chronic prostatitis/chronic pelvic pain syndrome is the most common type of prostatitis. But the exact cause is unknown. It causes a variety of symptoms that can be difficult to treat. Doctors suspect it may be due to a prior infection or a small injury that causes inflammation.

    What Treatment Options Are Available

    Chronic Nonbacterial Prostatitis / Male Chronic Pelvic Pain Syndrome (Pelvic PSA 12)

    The goal of treatment is to help improve symptoms. Taking antibiotics to treat this condition is controversial.

    Some doctors dont give antibiotics because the condition may be chronic and not caused by an active infection. Some doctors will prescribe antibiotics, thinking it could help treat an infection that may not be easily identified.

    Other common treatments include:

    • medications to relax the prostate muscles called alpha-adrenergic blockers the same medications used to treat other prostate conditions, like BPH
    • other medications like muscle relaxants or tricyclic antidepressants to help with pain
    • prescription pain medication or nonsteroidal anti-inflammatory drugs to reduce pain and swelling
    • plant extracts, like some herbal supplements that have

    Alternative and natural remedies that may reduce ongoing pain include:

    • warm baths
    • using a cushion or pillow when sitting for long periods
    • massage therapy
    • avoiding spicy foods, caffeine, and alcohol that can irritate the bladder
    • biofeedback, a relaxation technique

    Talk to your doctor before taking any herbal supplements. Some combinations of herbs may reduce the effectiveness of certain medications.

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