If you suffer from severe and chronic pelvic pain along with urinary issues, you could be suffering from a little-understood condition known as chronic pelvic pain syndrome. In this post, we talk about some of the main symptoms of this condition and treatments that can help.
What is chronic pelvic pain syndrome?
You may experience chronic pelvic pain for many different reasons. For women, pain in the pelvis can be related to endometriosis or pain conditions, like fibromyalgia.
Chronic pelvic pain syndrome, however, refers to a very specific cause and type of pain in the pelvis. The National Institutes of Health categorizes it as a type of prostatitis, or inflammation in the prostate region. Healthcare professionals refer to it as Type III prostatitis, chronic abacterial prostatitis (CPPS), or chronic prostatitis. You could be suffering from chronic pelvic pain syndrome if you’ve been experiencing pain in your pelvic region for three months or more, and the pain can’t be attributed to a urinary tract infection.
While men are disproportionally affected by this condition, some women do experience symptoms too. Worldwide, millions suffer with this condition. It’s not a life-threatening condition, but chronic pelvic pain syndrome symptoms can severely impact a person’s quality of life and self-esteem. Daily activities like sex, urination, or even sitting become unbearable.
What are common chronic pelvic pain symptoms?
No two patients are alike. Some men might experience brief and mild pain symptoms, while others will have symptoms that severely affect their overall quality of life.
Common chronic pelvic pain syndrome symptoms include:
- Urinary issues, including increased need to urinate, the inability to urinate, or pain during urination
- Pain near the pelvis, rectum, perineum, lower abdomen, lower back, or genitals
- Pain during or after sex, that may or may not resolve after ejaculation
- Discomfort or pain when sitting
- Increased discomfort or relief after a bowel movement
- Tenderness in the muscles near the pelvic floor
- Depression or anxiety
- Sleep disturbances
- Decreased self-esteem
To aid with treatment, researchers created the UPOINT classification system. Patients are grouped according to their dominant symptom areas. This allows their healthcare team to tailor treatments for those specific symptoms. The six-point classification system includes:
- U — Urinary symptoms
- P — Psychosocial symptoms
- O — Organ-specific symptoms (such as the prostate)
- I — Infection-related symptoms
- N — Neurologic/systemic symptoms
- T — Tenderness in the muscles and pelvic floor symptoms
Some healthcare professionals add an additional category for symptoms related to sexual functioning.
What causes pelvic pain in men?
While we know that chronic pelvic pain syndrome exists, there are various theories as to what causes it. Initially, many healthcare professionals believed an infection in the prostate caused this condition. But many of those with male chronic pelvic pain didn’t have signs of an infection. This led researchers to dig deeper.
Many now believe that CPPS arises due to a complex relationship between stress, trauma, and heightened sensitivity in the nervous system. Harvard Medical School explains:
“The initiating event may be an undetectable infectious agent or a physical trauma that causes inflammation or nerve damage in the genitourinary area. Over time this causes damage to organs and tissues in the area bladder, ligaments, pelvic floor muscles, and so forth that takes on a life of its own in susceptible individuals. If not controlled quickly enough, this damage and the body’s response to it can lead to a heightened sensitivity of the nervous system. In other words, for some men with chronic pelvic pain syndrome, the pain sensitivity ‘switch’ more readily flicks to the ‘on position. Stress and tension can exacerbate this response.”
Up to 90% of patients with prostatitis may suffer from this form of pelvic pain. Rarer is pain that is caused by infection.
How can I get a diagnosis?
This condition can be difficult to diagnose because it shares symptoms with many other conditions, such as kidney or bladder problems. However, if you’re suffering from chronic pelvic pain syndrome, you may be experiencing pain that is very specific to the pelvic region. Your doctor can rule out other conditions by running a:
- Blood test to determine if an infection is causing your pain
- Digital rectal exam to feel for any abnormalities in the prostate
- Urine test
As the International Society for Sexual Medicine explains, “Young and middle-aged men are more likely to develop CP/CPPS, but it can happen at any age.” The median age of patients is 43 years old.
Once they’ve ruled out other conditions, your healthcare professional can discuss treatment options that could work for you. The sooner you get a diagnosis and treatment, the better your treatment outcomes.
What chronic pelvic pain treatment should I try?
If you’re in pain, there is help. A report on Medscape notes that:
“No known cure exists for CPPS. However, many medications and other forms of treatment can help to alleviate the symptoms of CPPS and make the condition more bearable. Over time, this condition may improve or stabilize on its own.”
You’ll work closely with your doctor to find treatments that are targeted to your specific type of pain. Likely, you’ll work with your primary care physician and a urologist, as well as a pain specialist in severe cases. When beginning treatment, tell your doctor about all of your symptoms frankly and completely. Know that some treatments take a while to see results, but in these cases, pain relief can be long-lasting.
While there are some chronic pelvic pain syndrome home remedies that you can do, always work under the direction of a doctor before attempting them yourself. You’ll want to work with a doctor to ensure you’re not suffering from another condition that needs immediate treatment.
For brief reduction of pain while undergoing chronic pelvic pain syndrome treatment, you can:
- Take a hot bath or apply a heating pad to painful areas
- Keep track of diet, and reduce foods that exacerbate symptoms (commonly spicy foods or caffeinated drinks)
- Avoid activities like bicycle or horseback riding
- Use pillows while sleeping or sitting to reduce pressure on the pelvis
Many patients with CPPS first use over-the-counter pain medications, like ibuprofen, to manage their pain. For brief flare-ups of pain, this can help reduce inflammation and symptoms. However, this treatment plan doesn’t resolve the underlying cause of your pain. Because of this, it’s only recommended in combination with other therapies or for short periods of time.
Other medications that may show some benefit include:
- Antibiotics (in cases where an infection is present)
- Alpha blockers
Harvard Medical School writes that alpha blockers, in particular, can be an effective treatment for some because:
“They relax muscles in the urinary tract, allowing urine to flow more freely and thus alleviating urinary dysfunction. The research indicates that these medications are not only effective treatments for chronic pelvic pain syndrome, but should be used more often, and in a more targeted way, for greater effect.”
The Wise-Anderson Protocol
For the majority of patients, a blended treatment approach will be most effective. Leading this type of therapy is the Wise-Anderson Protocol. It’s sometimes also called the Stanford Protocol. This treatment acknowledges that pelvic pain can stem from both physical and mental effects, and they incorporate this into their approach.
The National Center for Pelvic Pain Research notes that:
“The fundamental error of conventional chronic pain treatment is that it does not grasp the fact that it is both a systemic and local problem — systemic in that the nervous system, typically frequently aroused, chronically tightens up the pelvic muscles. It is a local problem in that chronic worry, anxiety and nervous arousal in certain individuals results in the local pain and dysfunction of the pelvic muscles. Without effectively treating both aspects, CPPS remains.”
Healthcare professionals use the following to treat your pain:
- Psychological therapies, especially progressive relaxation techniques in the pelvic floor
- Physical therapies, aimed at trigger point release therapy in the pelvis and abdomen
A survey from the Indian Journal of Urology found that this multidisciplinary approach gives patients the best chances for symptom relief. The National Center for Pelvic Pain Research notes that this protocol can help patients reduce sensitivity and pain from a 7/10 to a 4/10 in six months.
If these treatments don’t work, you can talk to your doctor about treatment approaches. While there isn’t as much evidence for the use of these, they may work if other measures haven’t.
These approaches include:
- Focused prostate massage
- Botox injections for muscle spasms in the pelvis
- Transurethral needle ablation of the prostate surgery (for severe cases)
Finally, always reach out for support. Ask your doctor about support groups in your area or try an online support group. As one man recounts for the Pelvic Pain Foundation of Australia: “I was left feeling frustrated, isolated and helpless for such a long time I thought I was never again going to be at peace with my soul.”
Chronic pelvic pain syndrome can severely affect your quality of life and enjoyment of everyday activities. But, just because you’re in pain today, it doesn’t mean you will be tomorrow. There are treatments that do work, and researchers are constantly looking for new therapies to help. If you’re ready to talk to a specialist about your pain, click the button below. There you’ll find doctors who have dedicated experience working with pain patients like you. They’ll work closely with you to help you find the treatments you need to relieve your pain.