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Chronic Pelvic Pain Syndrome

What is Chronic Pelvic Pain Syndrome?

 Chronic Pelvic Pain Syndrome (CPPS) occurs just in men. It is a persistent discomfort or pain that you feel in your lower pelvic region-mainly at the base of your penis and around your anus. The source of the pain is thought to be the prostate gland. The prostate gland is only found in men. It lies just beneath the bladder. It is normally about the size of a chestnut. The urethra, a tube that passes urine from the bladder, runs through the middle of the prostate. The prostate helps to make semen. However, most semen is made by the seminal vesicle.

Currently, the National Institute of Health refers to Chronic Pelvic Pain Syndrome as Category IIIa Prostatitis or Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS). Chronic Pelvic Pain Syndrome is another name for Chronic Nonbacterial Prostatitis (or close medical condition association). The Noninflammatory Chronic Pelvic Pain Syndrome was formerly called Prostatodynia.

 

Causes of Chronic Pelvic Pain Syndrome

The cause is not known although symptoms are thought to come from the prostate gland. Many theories have been put forward as to the cause. These include:

• Infection of the prostate with a germ that has not yet been identified
• Nerve problems in the prostate
• Tiny cysts or stones in the prostate
• Partial blockage of fluid made in the prostate

In some cases, there is some inflammation of the prostate (prostatitis). However, the cause of the inflammation is not known. (Another name for this sub-group of Chronic Pelvic Pain Syndrome is Chronic Abacterial (Non-infective) Prostatitis). In other cases of chronic pelvic pain syndrome, there is no inflammation.

 

Diagnosis of Chronic Pelvic Pain Syndrome

A typical diagnosis includes:

• A urine sample - to rule out urine infection
• A sample of fluid (secretions) from the prostate may be collected to rule out infection in your prostate. To do this, a doctor can gently massage your prostate with a gloved finger in your rectum. By doing this, fluid from the prostate is pushed out into the urethra and comes out from the penis to be collected and tested for bacteria (germs). If you have chronic pelvic pain syndrome, no bacteria are found in the prostate fluid or urine. (Prostate infection can cause symptoms similar to chronic pelvic pain syndrome.)
• Other tests may be advised to rule out other conditions of your prostate or nearby organs if your symptoms are not typical.
 

Symptoms of Chronic Pelvic Pain Syndrome

The common symptoms associated with Chronic Pelvic Pain Syndrome include:

• Pain or discomfort - lasting several months, and often longer
• Pain is usually at the base of the penis, and around the anus and lower back
• Sometimes the pain spreads down to the tip of the penis and/or into the testes
• Painful ejaculation - pain may vary in severity from day to day
•  Mild urinary irritation - mild pain when you pass urine
• Urine urgency - at times, some hesitancy when trying to pass urine
• Poor urinary stream
• Tired feeling
• General aches and pains

 

How to Address the Symptoms of Chronic Pelvic Pain Syndrome

• Reassurance and explanation are sometimes helpful. Some people worry that they may have a serious disease such as prostate cancer. Worry and anxiety can make symptoms worse. Therefore, it may be  useful to know that you have chronic pelvic pain syndrome and not some other disease. However, you will have to accept that pain or discomfort is likely to persist.
• Painkillers such as paracetamol or ibuprofen may ease the pain. Painkillers can keep discomfort to a
minimum.
• Antibiotics. A four week course may be advised. This is to be absolutely sure that no infection is present. Tests for bacteria are not 100% foolproof, so it may seem sensible to treat a possible infection even though urine tests for infection are negative. There is a small chance that antibiotics will help.
 
Various other ways to address CPPS have been tried. 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 ways to address CPPS, but a specialist may advise that you try one. They include the following:

• Alpha-blockers are medicines that are used to treat prostate enlargement. They relax the muscle tissue of the prostate and the outlet of the bladder. There are several different brands. There is some evidence that they help in chronic pelvic pain syndrome, and one may be worth a try.
• Other medicines such as allopurinol and finasteride (a medicine which may 'shrink' the prostate).
• Removal of the prostate (prostatectomy) may be considered if you have small stones (calculi) in the    prostate. It is not clear how much this may help. Your specialist will advise.
• Other surgical techniques to the prostate. For example, prostatic thermotherapy. This involves heating the prostate. The theory is that this may help clear inflammation of the prostate, or affect nerve fibers that may be the cause of the pain. Again, it is not clear how much this may help.
• Stress management and other pain relieving techniques are sometimes tried to help cope with the
persistent pain.
 

The principle proposed natural method to address the symptoms of chronic pelvic pain syndrome by promoting prostate health.

• Bioflavonoid (e.g. quercetin)- A class of water-soluble plant coloring agents, which have anti-inflammatory and antioxidant properties.