What to Know About Chronic Prostatitis or Chronic Pelvic Pain Syndrome

What to Know About Chronic Prostatitis or Chronic Pelvic Pain Syndrome

Fridar Gichuki |Apr 7, 2021

CP and CPPS: What is It?

Chronic prostatitis or chronic pelvic pain syndrome is a condition that affects the urinary or genital organs. The disease is an inflammation of the prostate and irritation of the nerves around it characterized by chronic pain and discomfort intervals.

The disease is poorly understood and presently has no cure. It causes erectile dysfunction, urinary and bowel problems that undermine a man’s quality of life and often lead to depression.

Symptoms and Causes of Chronic Prostatitis/Chronic Pelvic Pain Syndrome

Chronic prostatitis or chronic pelvic pain syndrome is the most common form of prostatitis. Some symptoms include:

  • Pelvic pain
  • Sexual dysfunction, including painful ejaculations
  • Difficulty or pain passing urine, voiding challenges, or burning sensation while urinating
  • Irregular intervals of pain in the bladder, testicles, and penis and up to the anus

For a person to get a CPPS diagnosis, the pelvic pain must have persisted for at least six months. While the exact cause of CPPS is unknown, doctors think either a recurring infection or inflammation of the prostate due to physical trauma may be the cause of it. The initial infection or physical trauma to the pelvic goes undetected, causing nerve damage to the genitourinary (urinary and genital organs) area. With time, the damage spreads to the bladder, ligaments, and pelvic floor muscles. If treatment is not given immediately, it results in pain sensitivity in the pelvic area.

Some risk factors of CPPS include occasions for bacteria entering your body, such as:

  • A catheter or an equivalent device that’s placed in the urethra to help drain urine.
  • Urinary tract disorders such as urinary tract infections (UTI) or interstitial cystitis, among others.

Diagnosis

A CPPS diagnosis entails using a scoring matrix to eliminate other diseases and checking against any prevalent comorbidities. The tool used to score the symptom is called the International Prostate Symptom Score.

Another tool called the UNPOINT is increasingly becoming popular in the diagnosis of CPPS. The tool classifies the symptoms according to:

  • Urinary
  • Psychosocial
  • Organ-specific
  • Infection
  • Neurological/systemic
  • Tenderness

After the scoring, the doctor or examiner will then undertake physical examinations to assess the abdomen and external genitalia. The examiner may also perform a digital rectal examination. The digital exam will show if the prostate is tender on palpation. It also enables the doctor to examine the pelvic floor muscles and their ability to contract or relax.

Lastly, the medical examiner may want to rule out other pain-causing pathogens. The examiner may carry out additional tests such as:

  • Urine dipstick test or an early morning urine specimen
  • Urethral swab and culture if urethritis becomes a concern
  • Uroflowmetry to calculate the flow rate of your urine
  • Retrograde urethrography and a bladder scan to determine the ease at which urine flows from the bladder
  • Cystoscopy to examine the lining of the bladder and exclude other causes such as a stricture
  • Magnetic resonance imaging (MRI) and computerized tomography (CT) to help rule out the possibility of pus in the prostate
  • A blood test to measure prostate-specific antigen PSA levels to rule out prostate cancer

Afterward, the examiner will check for evidence of sexual abuse and will test for depression and generalized anxiety disorder (GAD) as comorbidity. He or she may also subject you to a self-assessment questionnaire to better understand your pain levels and mental health.

Treatment Options for CPPS

CPPS is treated using antibiotics, anti-inflammation medication, or alpha-blockers.

Antibiotics

Antibiotics are used to treat bacterial infections that may be the underlying cause of CPPS. However, there is some controversy around using antibiotics because doctors prescribe them even when patients do not test positive for bacterial infection.

The doctors who prescribe antibiotics without a negative test believe bacteria may be present in the prostrate's glands or stroma without entering the urinary tract.

However, antibiotics can only be used for a limited time, usually four weeks, especially for newly diagnosed patients. The antibiotics used in this case are those with non-inflammation properties.

Anti-inflammation Medication

Aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen reduce the pain men experience when dealing with chronic prostatitis or chronic pelvic pain syndrome. However, NSAIDs are not effective by themselves and are used together with alpha-blockers.

Alpha-Blockers

Doctors use alpha-blockers to treat Benign Prostatic Hyperplasia (BPH) prescribed for CPPS because it relaxes the urinary tract muscles, allowing the free passing of urine. However, research shows that men newly diagnosed with CPPS are more likely to respond positively to alpha-blockers. The effectiveness of alpha-blockers diminishes after a six-month treatment course.

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