Condition: Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) - Males
Brief Overview: According to UpToDate, “Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a clinical syndrome in males defined by pain or discomfort in the pelvic region, often accompanied by urologic symptoms or sexual dysfunction. Despite the use of the term "prostatitis," it is unclear to what degree the prostate is the source of symptoms. A number of other terms have been used to describe the syndrome now commonly called CP/CPPS. These include prostatodynia (painful prostate) and abacterial prostatitis.”
Prevalence: According to UpToDate, “CP/CPPS is a common condition worldwide, affecting approximately 2 to 10 percent of adult men.”
Etiology: The etiology of CP/CPPS is unknown.
Risk Factors May Include:
- History of pelvic trauma or infection
- Pelvic floor dysfunction
- Prior urethral instrumentation
- Urologic or sexual dysfunction
Commonly Associated Conditions:
- Erectile dysfunction
- Lower urinary tract symptoms (LUTS)
- Anxiety and depression
- IBS, IBD
- Myofascial pain syndrome
Common Medications:
- Alpha blockers
- NSAIDs
- 5-alpha-reductase inhibitors
- Phosphodiesterase 5 inhibitors
- Pregabalin for neuropathic pain
Common Labs, Imaging, and Tests:
- Urinalysis, urine culture
- Urine cytology may be indicated
- Imaging: ultrasound, MRI
- Postvoid residual testing (PVR)
Common Symptoms:
- Pain – perineal, testicular, suprapubic, penile
- Dysuria
- Painful ejaculation
- Urinary frequency, urgency
- Sexual dysfunction
Common Treatments:
- Physical therapy
- Cognitive behavioral therapy (CBT)
- Acupuncture
- Aerobic exercise, as tolerated and approved by healthcare provider
- Sitz baths may be helpful for some
Physical Findings:
- Tender prostate in some cares
- Muscle spasms/myofascial tenderness with palpation of the perineum, pelvic sidewalls, or pelvic floor
Potential Complications and Contraindications:
- Sexual dysfunction
- Anxiety and depression
- Chronic pain sensitization
- Decreased quality of life
General Health and Lifestyle Guidance:
- Encourage regular follow-up with all healthcare providers, including urology and pelvic floor therapy.
- Promote pelvic floor relaxation and stress management.
- Adequate hydration and avoidance of bladder irritants (caffeine, alcohol).
- Encourage movement, stretching, and posture awareness as tolerated and approved by healthcare provider
- Encourage patient to address mood and mental health proactively with their healthcare provider
Suggested Questions to Ask Patients:
- How long have you had pelvic pain?
- Do you have urinary symptoms or sexual discomfort?
- Have you had infections or procedures in the past?
- How does stress affect your symptoms?
- Have you tried physical therapy or medications before?
- How does the pain impact your daily life?
Suggested Talking Points:
- Pelvic floor therapy can be as important as medication.
- Managing stress and addressing both physical and emotional health can help improve outcomes.
- Even if no single cause is found, symptoms can typically be treated.
- Follow-up care and persistence with treatment often lead to improvement.
- Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.
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