Chronic Prostatitis/Chronic Pelvic Pain Syndrome

Many men struggle with chronic prostatitis (CP) or chronic pelvic pain syndrome (CPPS). CP/CPPS is defined as long-standing symptoms of pelvic pain or discomfort not attributed to an infection, cancer, neurologic disorders, or anatomic abnormalities.

In addition to the symptom of pelvic pain, patients will also commonly experience referred pain to their testicles, and overlap with other pain syndromes such as irritable bowel syndrome. Patients can also experience urinary and sexual dysfunction, all of which causing a severe impact on their lives. CP/CPPS necessitates a complex analysis and treatment plan to alleviate symptoms, as studies have not supported the use of a single therapy.

Unfortunately, it is all too common in our society to attribute pelvic pain to infection, even in the absence of evidence of infection. Therefore, the first challenge is to prove to the patient that antibiotics are not the answer here and to move on to other therapies.

A comprehensive approach includes appropriate urologic consultation and discussion of the options outlined below:

• Alpha-blockers
• Anti-inflammatories
• Hormonal agents
• Phytotherapy
• Muscle relaxants
• Suppositories
• Neuromodulatory therapy
• Modulation of bladder physiology
• Physical therapy

In large part, since this pain syndrome is present in both men and women, we no longer use the term prostatitis in an effort to get away from the overusage of antibiotics. This is a chronic pain condition that is frustrating but can be managed appropriately once identified.