What Is Chronic Pelvic Pain Syndrome, And How Is It Treated?

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 area. 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 had 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 more likely to be affected by this condition, some women do experience symptoms too. Worldwide, millions suffer with this condition. It’s not life-threatening, but chronic pelvic pain syndrome symptoms can severely impact a person’s quality of life and self-esteem. Daily activities like sex, urinating, 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
  • Ultrasound
  • MRI
  • Biopsy

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 doctor can discuss treatment options that could work for you. The sooner you start treatment, the better you’ll feel.

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