Chronic Pelvic Pain Syndrome
Chronic pelvic pain syndrome is the most common types of prostatitis. The exact cause of this non-bacterial prostatitis condition is unknown. However, the disease could stem from persistent infection, inflammation and/or pelvic muscle spasms. Inflammation in the prostate can also occur without symptoms. For patients experiencing symptoms they do include; pain in the genitals and pelvic area, difficulty or pain urinating, and sometimes pain during or after ejaculation.
Possible Causes of Chronic Pelvic Pain Syndrome
Chronic pelvic pain syndrome may be caused by atypical organisms such as chlamydia, mycoplasma (which may be transmitted by sexual contact) urea plasma or may also be due to a chemical or immunologic reaction to an initial injury or previous infection. The nerves and muscles in the pelvis may cause pain in the area, either as a response to the prostate infection or inflammation or as an isolated problem itself.
Symptoms of Chronic Pelvic Pain Syndrome
The symptoms of chronic prostatitis/chronic pelvic pain syndrome include difficult and sometimes painful urination, discomfort or pain in the perineum, bladder, testicles and penis as well as difficult and painful ejaculation. In some cases, these symptoms can be indistinguishable from those described above for chronic bacterial prostatitis.
How is prostatitis diagnosed?
The correct diagnosis is very important because the treatment is different for the different types of prostatitis syndromes. In addition, it is extremely important to make sure the symptoms are not from other conditions such as urethritis, cystitis, an enlarged prostate or cancer. To help make an accurate diagnosis, several types of examinations are useful.
One of the tools doctors use in diagnosis is the National Institutes of Health Chronic Prostatitis Symptom Index.
The index is a series of questions about prostatitis symptoms and how much they currently are affecting the patient. Filling it out and sharing the results with your physician helps the patient stay active in their medical care. The questions to this index may be asked several times however, it is important to take the test so the results from the tests can be compared to one another. This is important because it helps determine the effectiveness of treatment.
In addition to completing the questionnaire your physician may request a physical exam. To examine the prostate gland, the physician will perform a digital rectal examination (DRE). The DRE is a simple examination in which the doctor inserts a lubricated, gloved finger into the rectum. The prostate is located just in front of the rectum and below the bladder; the DRE allows the doctor to easily press and feel the prostate.
From the DRE, the physician will be able to determine whether the prostate is enlarged or tender. Lumps or firm areas can suggest the presence of prostate cancer. The physician will also assess the degree of pain or discomfort the patient experiences as he presses the muscles and ligaments of the pelvic floor and perineum. If a man has prostatitis, this examination may produce momentary pain or discomfort but it causes neither damage nor significant prolonged pain.
If the physician requires a closer look at the prostate gland or decides that a biopsy is necessary, he may order a trans-rectal ultrasound, which allows him to visualize the prostate gland. If you are at risk for cancer, your physician will consider ordering a PSA test. During a prostate infection however, the PSA can be falsely elevated.
If your physician suspects that you have prostatitis or one of the other prostate problems, he may refer you to an urologist, a doctor who specializes in diseases of the urinary tract and male reproductive system, to confirm the diagnosis.
The urologist will repeat some of the examinations already performed by the first physician. The urologist will also assess the degree of pain or discomfort the patient experiences as he presses the prostate. The urologist may analyze various urine specimens as well as a specimen of prostatic fluid obtained by massaging the prostate gland during the DRE. When the prostate is massaged a fluid known as the expressed prostatic excretion (EPS) comes out of the penis. Urine specimens and EPS are analyzed for signs of inflammation and infection. These samples may help the urologist determine whether your problem is inflammation or infection and whether the problem is in the urethra, bladder or prostate. Some doctors may check blood and/or semen samples. With all of these, they are looking for the presence of microorganisms, white blood cells or other indications of infection.
Other tests the urologist may consider using include cystoscopy in which a small telescope is passed through the urethra into the bladder permitting examination of the urethra, prostate and bladder. The urologist may also order urine flow studies, which help measure the strength of your urine flow and any obstruction caused by the prostate, urethra or pelvic muscles.
The patient may not need antibiotics, if they are diagnosed with chronic pelvic pain syndrome. Frequently, physicians have difficulty trying to decide whether a patient has bacterial or nonbacterial prostatitis. This is because of the difficulties in obtaining a specimen and, sometimes, previous antibiotic therapy obscures the diagnosis. An organism that responds to antibiotics, but is difficult to diagnose may also cause chronic pelvic pain syndrome. For these reasons, antibiotics may be prescribed, at least initially, even when a definitive diagnosis of bacterial prostatitis has not been made with the appropriate tests. Your response to the antibiotic therapy will decide whether or not it should be continued. Many patients without a true infection may feel better during antibiotic therapy because many antibiotics have direct anti-inflammatory effects. Depending on your symptoms, you may receive one of a variety of other treatments. Some doctors prescribed alpha-blockers which help relax the muscles around the prostate and the base of the bladder, relieving any spasms or muscle tightness that contribute to pain with urination. Often anti-inflammatory drugs, pain medications, muscle relaxants, plant extracts (quercetin and/or bee pollen) are used. Repetitive prostatic massages (to drain the prostate ducts) are common treatments to release the fluid that is causing pressure in the prostate.
Hot sitz baths or other various heat therapies (including local heat therapy with hot water bottle or heating pad) relieve the discomfort associated with the infection. If sitting does become too uncomfortable patients are advised to use a pillow or an inflatable cushion. Biofeedback and relaxation exercises may also help to alleviate some of the symptoms. You may be advised to discontinue some foods (e.g. spicy) and drinks (e.g. caffeinated, acidic) and avoid circumstances (e.g. bicycle riding) that exacerbate the problem.