Overview of Chronic Prostatitis/Chronic Pelvic Pain Syndrome

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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, it is important to seek help because the condition does not go away on its own and treatment can provide relief.

Male doctor and testicular cancer patient are discussing about testicular cancer test report. Testicular cancer and prostate cancer concept.
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Symptoms

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 syndrome 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
  • Abnormal reaction to normal prostate bacterial flora
  • Increase prostate tissue pressure
  • Psychological stress (not a primary cause, but may contribute to the pain)

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

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

Some of the other conditions your doctor may consider include:

  • Acute bacterial prostatitis
  • Urinary tract infection
  • Sexually transmitted infections
  • 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 doctor 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.

Treatment

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, like 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

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

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

A Word From Verywell

CP/CPPS is a complex disease and getting it diagnosed can be a lengthy, tricky process. so it's important to stay persistent and proactive in your care. Once diagnosed, most people benefit from a multifaceted treatment program that includes both medication and non-medication treatments, but getting there can be a windy, bumpy road.

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7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  6. Franco JV, Turk T, Jung JH, et al. Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Cochrane Database Syst Rev. 2018;26;1:CD012551. doi:10.1002/14651858.CD012551.pub2

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