Chronic pelvic pain syndrome (CPPS), also known as chronic non-bacterial prostatitis (as it makes the prostate gland tender), is a widespread male genitourinary condition which is not caused by bacteria. It is defined by persistent pain in the region around the prostate gland, and episodes of sporadic intermittent discomfort. It can also entail issues with urination, and inflammation. Indeed, as Harvard Health points out, there is little doubt that: “chronic pelvic pain syndrome degrades the quality of a man’s personal and work life and leaving him confounded and depressed” [1].
“Within clinical practice, Type III is by far the most common form of CPPS” [2]
The National Institutes of Health (NIH), notes that from the four categories of prostatitis which they have defined: Type I (acute bacterial prostatitis); Type II (chronic bacterial prostatitis); Type III (chronic pelvic pain syndrome/chronic non-bacterial prostatitis); and Type IV (asymptomatic inflammatory prostatitis): “chronic pelvic pain syndrome [pain experienced in the area between the scrotum (the muscular bag containing the testicles), and the anus], is most common, accounting for about 90% of all cases. It’s also notorious for being the most difficult type of prostatitis to live with” [1].
Symptoms of chronic non-bacterial prostatitis comprise:
• Lower back pain
• Pain in the genitals (rectum, testicles, penis)
• Blood in the semen
• Blood in the urine
• Excessive urination
• A weak urinary flow
• Erectile dysfunction
• Aggravated pain during sexual intercourse
• Pain whilst ejaculating
• Pelvic pain after sexual intercourse
• Pain which becomes worse due to prolonged sitting
• Painful urination
• Painful bowel movements [1].
While it has to be said that these symptoms can be detrimental to your quality of life, and your relationships, it is nonetheless, important to know that once patients are given suitable treatment/s for their individual condition, the majority of suffers will find that over time, their condition ameliorates [2].
“Researchers don’t know why CPPS occurs. CPPS typically generates pelvic pain which comes and goes” [1]
What Are the Risk Factors For CPPS?
This condition can surface at any age, however, in the majority of cases, it is between 30 and 50 years of age. Although in a large number of cases, there are no precise risk factors, some of the known ones include: recently undergoing an urethral instrumentation (having a catheter inserted); issues or tightness with the muscles of the pelvic floor; urinary problems; abnormality of the congenital urinary tract; enlargement of the prostate; IBS (irritable bowel syndrome); fibromyalgia; immunosuppression; and diabetes [2].
Getting a Diagnosis for Chronic Pelvic Pain Syndrome
As pinpointing the precise root cause of non-bacterial prostatitis is not so easy, treatment is sometimes experimental. Indeed, Harvard notes that the treatment the patient receives is:
“guided by a doctor’s clinical experience and instincts [1],” so to that end, it is essential that you only see a consultant who has had substantial experience in the field. The patients who have not taken this route, often end up trying to find a solution themselves, particularly after becoming exasperated with multiple appointments with one non-specialist after another. Moreover, patients are also driven to trawl through online chat groups, and to read “Patients’ Stories,” hoping that they will find the help they are looking for. Clearly, this type of action not advisable, as an in-person visit with a specialist consultant who can look at your personal medical history, and conduct a comprehensive examination, is crucial [1].
How Chronic Pelvic Pain Syndrome is Diagnosed
This condition is connected to three different categories of symptoms (some of which are associated with other urologic disorders). These comprise: Number 1: Pain – the paramount characteristic of chronic pelvic pain syndrome (such as experiencing an unpleasant sensation while urinating); Number 2: issues with passing urine (voiding). And Number 3: sexual dysfunction [1].
Of note, generally speaking, the symptom listed as Number 1, enables your specialist to distinguish it from a common condition which comes about as men age – enlargement of the prostate gland (known medically as benign prostatic hyperplasia (BPH). If you are experiencing pain in the pelvic region, or burning or painful urination, then your medic will check for markers of infection or inflammation by taking a urine sample, conducting a digital rectal examination, and possibly testing the secretions coming from your prostate gland [1].
Checking For Excessive White Blood Cells & Bacteria
In order to determine whether you have an infection, your consultant will carry out a simple urine test, that is then examined for surplus white blood cells and bacteria, which signal that you have an infection. Should this be the case, then in all likelihood, your condition is a bacterial type of prostatitis. Conversely, if, as is most often the case: only surplus white blood cells are discovered, then you might have a non-bacterial form of prostatitis [1].
Why Does Non-Bacterial Prostatitis Develop?
Research studies suggest that the development of non-bacterial prostatitis is due to an intricate series of interrelated issues, which appear to accumulate together, thus generating the main symptoms of ejaculatory and urologic dysfunction, as well as pelvic and genitourinary pain. The start of the issue, which brings on nerve damage or inflammation within the genitourinary region, could be down to a physical trauma or an undetectable infectious agent. In some instances, there might be pain emanating from the nerves or muscles within the area; while in others, there could be inflammation which cannot be attributed to a certain cause [1].
Men who are susceptible, find that the damage that these events inflict on the tissues and organs within the area (namely, the pelvic floor muscles, ligaments, bladder, and so on), spiral and take on a life of their own, further exacerbating the problem. If the right medical help is not sought after and dealt with within an appropriate time frame, then the body’s reaction along with the generated damage, may result in the nervous system being in a state of elevated sensitivity. It is important to add that if you are suffering from tension and/or stress, then your body’s response to these factors can be exacerbated [1].
References
[1]. Harvard Health Publishing (2019). “Chronic nonbacterial prostatitis (chronic pelvic pain syndrome).”
https://www.health.harvard.edu/newsletter_article/chronic-nonbacterial-prostatitis-chronic-pelvic-pain-syndrome
[2]. University of California, Department of Urology (2020). “Prostatitis (male pelvic pain).”
“https://urology.ucsf.edu/patient-care/adult-non-cancer/male-sexual-and-reproductive-health/prostatitis”https://urology.ucsf.edu/patient-care/adult-non-cancer/male-sexual-
