Chronic prostatitis/chronic pelvic pain syndrome





Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), refers to long-term pelvic pain and lower urinary tract symptoms without evidence of a bacterial infection.


It affects about 2-6% of men.


In the general population, chronic pelvic pain syndrome occurs in about 0.5% of men in a given year.


Its peak incidence in men aged 35–45 years.


Its overall prevalence of symptoms suggestive of CP/CPPS is 6.3%.


Its prevalence is much higher in teenage males than once suspected.


Together with interstitial cystitis/painful bladder syndrome, it makes up urologic chronic pelvic pain syndrome (UCPPS).


Differential diagnosis:


Bacterial prostatitis, benign prostatic hypertrophy, overactive bladder, cancer: diagnosis requires  ruling out other potential causes of the symptoms.


Frequency about 4%


Its cause is unknown.


It is characterized by pelvic or perineal pain without evidence of urinary tract infection, and lasts longer than 3 months.


CP/CPPS symptoms may wax and wane. 


Pain can range from mild to debilitating. 


Pain may radiate to the back and rectum, perineum, testicles, tip of penis, pubic or bladder area.


It may make sitting uncomfortable. 

It may be associated with: dysuria, arthralgia, myalgia, unexplained fatigue, abdominal pain, constant burning pain in the penis, and frequency.

Post-ejaculatory pain, mediated by nerves and muscles, is a hallmark of the condition.


Some with  CP/CPPS report  low libido, sexual dysfunction and erectile difficulties.


The cause of CP/CPPS  is unknown.


However, there are several theories of causation.


Pelvic floor dysfunction may be a psychoneuromuscular disorder.


Anxiety or stress resulting in chronic, unconscious contraction of the pelvic floor muscles, leading to the formation of trigger points and pain.


The pain increases anxiety and worsens the condition.


CP/CPPS may result from an interaction between psychological factors and dysfunction in the immune, neurological, and endocrine systems.


Studies suggest the peripheral nervous system is responsible for starting the condition, but the  central nervous system (CNS) is responsible for continuing the pain even without continuing input from the peripheral nerves.


Stress-driven hypothalamic-pituitary-adrenal axis dysfunction and adrenocortical hormone abnormalities, and neurogenic inflammation are implicated in the CP/CPPS.


Patients  with and without CP/CPPS have  equal counts of similar bacteria colonizing their prostates,  elating bacteria as an etiology.


Healthy men have slightly more bacteria in their semen than men with CPPS.


CPPS and bladder pain syndrome/interstitial cystitis (BPS/IC) are related conditions.



no definitive diagnostic tests for CP/CPPS. 


It accounts for 90–95% of prostatitis diagnoses.


CP/CPPS may be categorized as inflammatory or non-inflammatory, based on levels of pus cells in expressed prostatic secretions.


In the inflammatory form of CP/CPPS, the urine, semen, and other fluids from the prostate contain pus cells.


The non-inflammatory form of CP/CPPS no pus cells are present in these secretions.


Both categories of CP/CPPS show evidence of inflammation, like cytokines,


Extraprostatic abdominal/pelvic tenderness is present in >50% of patients with CP/CPPS.


Healthy men have slightly more bacteria in their semen than men with CPPS.


Men with CP/CPPS are more likely than the general population to suffer from chronic fatigue syndrome (CFS), and Irritable Bowel Syndrome (IBS).


Differential diagnosis: bladder neck hypertrophy and urethral stricture may both cause similar symptoms through urinary reflux.


Treatment for  CP/CPPS is difficult:  to education regarding the condition, stress management, and behavioral changes.


Physical therapy with stretches to release overtensed muscles in the pelvic or anal area, intrarectal digital massage of the pelvic floor, physical therapy to the pelvic area, and progressive relaxation therapy to reduce stress.


Kegel exercises are not recommended.


Psychological therapy might be helpful in its management.


Treatment with antibiotics is controversial. 


The effectiveness of alpha blockers (tamsulosin, alfuzosin) is questionable in men with CPPS


Alpha blockers may increase side effects like dizziness and low blood pressure.


5-alpha reductase inhibitors probably help to reduce prostatitis symptoms in men with CPSS.


Anti-inflammatory drugs may reduce symptoms.


Botulinum toxin A (BTA) injected into the Prostate may cause a decrease in prostatitis symptoms. 


There is anecdotal evidence for  gabapentin, benzodiazepines and amitriptyline.


The  prognosis for CP/CPPS has improved with multimodal treatment aimed at quieting the pelvic nerves through myofascial trigger point release, anxiety control and chronic pain therapy.







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