Chronic Prostatitis Treatment and Symptoms (Chronic Pelvic Pain Syndrome)

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a type of prostatitis, formerly known as chronic nonbacterial prostatitis. This disorder causes long-term pain in the pelvic area and symptoms related to the lower urinary tract; Without any signs of bacterial infection.

The exact cause of this syndrome is still unknown, and to diagnose it, other possible causes such as bacterial prostatitis,Benign prostate enlargement, overactive bladder and cancer are rejected.

Due to the unknown cause of this disease, there is no definitive treatment for chronic prostatitis; But different methods are used to reduce and manage symptoms. Based on the individual's symptoms, the doctor may prescribe methods such as drug therapy, physiotherapy, nerve stimulation, surgery, etc.

In the following, we will examine the symptoms of this disease and its diagnosis and treatment methods. Be with us.

Signs and symptoms of chronic prostatitis/chronic pelvic pain syndrome

The signs and symptoms, which occur predominantly in men, include a complex array of pains and problems related to the urinary and reproductive systems.

These signs and symptoms may appear differently in each person and their severity may also vary. Pain and discomfort associated with CP/CPPS can have a significant impact on people's quality of life and require careful management and care.

1. Chronic pain and discomfort

• Pain in the perineum
  This area, which is located between the scrotum and the anus, is one of the most common pain points. The pain may be burning, pressing, or a dull ache.

• Pain in the lower abdomen
  Many men experience pain or discomfort in the lower abdomen, near the bladder or genital area.

• Pain in testicles and penis
  The pain may spread to the testicles or penis and feel like a dull ache, pressure, or even burning.

• Pain in the anus or lower back
  In some cases, the pain spreads to the anus or lower back, which may be felt as a chronic or throbbing pain.

2. Pain associated with urination

• Burning or pain during urination
  Some men may experience burning, shooting or pain when urinating.

• Urinary urgency
  A sudden and strong urge to urinate, which may be accompanied by an inability to hold urine.

• Urinary frequency
  A frequent need to urinate, even at night, is a common symptom that can disrupt sleep and daily activities.

• Difficulty starting or stopping the flow of urine
  Some men may have difficulty starting or stopping urination, which may occur as frequent stops and starts of the flow of urine.

3. Sexual problems

• Pain during ejaculation
  One of the key symptoms of CP/CPPS is severe pain or discomfort during or immediately after ejaculation. This pain can be felt in the perineum, testicles or penis.

• Decreased libido
  Persistent pain and related problems can lead to decreased libido or avoidance of sexual activities.

• erectile dysfunction
  Some men may experience erection problems, which can be due to pain or anxiety caused by the condition.

4. Feeling of pressure and discomfort in the pelvis

• A feeling of heaviness or pressure
  Many people with CP/CPPS have a feeling of pressure or heaviness in the pelvic area, which can be constant or intermittent.

• Sensitivity to touch
  Touching painful areas may aggravate the pain or discomfort.

5. Gastrointestinal symptoms

• Constipation or diarrhea
  In some cases, people may have gastrointestinal symptoms such as constipation or diarrhea that can accompany pelvic pain.

• Bloating and feeling full
  A feeling of bloating or fullness in the abdomen, even without eating, can be accompanied by pelvic pain.

6. Changes in mental status

• Anxiety and depression
  Chronic pain and problems caused by CP/CPPS can cause anxiety, depression, and reduced quality of life.

• tiredness
  Feelings of fatigue and low energy are common due to persistent pain and sleep disturbances.

7. Changes in urinary pattern

• Poor flow of urine
  Urine flow may be weaker than usual.

• Feeling of incomplete discharge
  After urinating, some people feel that the bladder has not been completely emptied.

8. Muscular and skeletal pain

• Pain in the back or thigh
  Pain may also be transmitted to the muscles of the back or thighs, which can cause discomfort and limitation of movement.

9. Aggravation of symptoms in certain situations

• Aggravation of pain after physical activity
  Some people experience aggravation of pain after physical activities or prolonged sitting or standing.

• Aggravation of symptoms in the cold
  Symptoms may worsen in cold weather or during stress.

Diagnosis methods of chronic prostatitis syndrome / chronic pelvic pain

The diagnosis of CP/CPPS is based on the exclusion of other possible causes of symptoms.

This diagnosis is especially raised when the patient has suffered from discomfort symptoms such as pelvic pain, urinary problems, or sexual disorders for at least 6 months and after careful evaluations and necessary tests, no other specific cause can be found to justify these symptoms.

In such a situation, and after ruling out other diseases such as bacterial infections,Urinary stones, or structural problems, CP/CPPS can be considered as a possible cause of the symptoms.

In the following, we describe the methods of investigation and examination to rule out other causes

1. Clinical history and medical history

• Collect a complete medical history
  By carefully reviewing the patient's medical history, the urologist gathers information about the onset and duration of the pain, the severity and exact location of the pain, and any accompanying symptoms such as urinary or sexual problems.
  Risk factors such as previous urinary tract infections, history of prostate diseases, stress, and lifestyle are also investigated.

• Assessing the impact of symptoms on quality of life
  The urologist learns more about the severity of the condition by examining how the pain and other symptoms affect daily activities, sleep, and sex life.

2. Physical examination

• Pelvic and genital examination
  The urologist carefully examines the pelvic area, perineum, testicles, and penis to detect any tenderness, swelling, or abnormalities.

• Prostate examination through the anus
  examination DRE (Digital Rectal Exam) involves palpating the prostate through the rectal wall with a finger. The urologist will look for any abnormal tenderness, enlargement, or hardness of the prostate, which may be a sign of inflammation or other prostate problems.

• Assessment of pelvic floor muscles
  There may be tension or tenderness in the pelvic floor muscles, which can be related to pelvic pain.

3. Urine and prostate fluid tests

• Urine test
  The urine sample is checked for infection, blood, or other abnormalities. This test can help diagnose urinary tract infections or other problems.

• Quadruple test (Meares-Stamey)
  This experimental method includes collecting four different samples of urine and semen before and after prostate massage. These samples are checked for bacteria or white blood cells that may indicate infection or inflammation.

• Check test seminal fluid
  Semen obtained through prostate massage is analyzed to check for inflammatory cells or possible infection.

4. Imaging tests

• Transrectal ultrasound (TRUS) It allows the urologist to examine the prostate and surrounding areas using a probe that is inserted into the rectum. This test can help identify structural abnormalities or inflammation in the prostate.

• MRI or CT scan They are rarely used to diagnose CP/CPPS, but an MRI or CT scan may be ordered if the urologist suspects structural abnormalities or other diseases.

5. Laboratory tests

• Blood tests Blood tests may be done to check inflammatory markers (such as ESR and CRP) and check the function of the kidneys and other organs.

• Prostate-specific antigen (PSA) test
  This test is usually used to diagnose prostate cancer, but in some cases CP/CPPS may show elevated PSA levels, which could be due to Inflammation of the prostate be

6. Urodynamic tests

• These tests evaluate the function of the bladder and urethra. Urodynamic tests can detect problems such as urethral obstruction or abnormal bladder function that may be associated with symptoms of CP/CPPS.

7. Psychological assessment

• Due to the close relationship between chronic pain and psychological issues such as anxiety and depression, the urologist may refer the patient to a psychiatrist for a psychological evaluation. This assessment can help identify stressors or psychological problems that may be contributing to CP/CPPS symptoms.

8. Other specialized tests

• Some specialists may use tests to check for nerve sensitivity or irritability in the pelvic area.Evaluation of nerve sensitivity and excitability They can help identify the possible role of neurological problems in pelvic pain.

• To check the function of pelvic nerves and their possible effect on urinary symptoms or pelvic pain.Nerve reflex tests may be done.

Treatment methods for CP/CPPS

Treatment of CP/CPPS requires a multifaceted and personalized approach.

Depending on the severity and type of symptoms, one or more treatment methods may be used simultaneously. Close cooperation between the patient and the doctor is very important to adjust and adjust the treatment plan in order to obtain the best possible results.

1. Drug treatment

Drug therapy for management or treatment Prostate diseases are used and according to the disease and the purpose of drug therapy, different drugs may be prescribed. Note that these drugs are not suitable for all people who have prostate problems and should be prescribed by a doctor according to your problem.

Antibiotics

• Although CP/CPPS is generally considered a non-infectious condition, in some cases, urologists may prescribe antibiotics for a short period. This treatment is especially important when the diagnosis of bacterial infection is suspected, although in many cases, antibiotics are ineffective in reducing symptoms.

• Antibiotics such as ciprofloxacin and doxycycline may be used.

Painkillers and anti-inflammatories

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can help reduce pain and inflammation.

• In more severe cases, stronger pain relievers such as tramadol may be used, but should be used with caution and in a limited manner.

Alpha blockers

• These drugs can improve urinary symptoms by relaxing the muscles of the bladder neck and prostate.

• Medicines such as tamsulosin and alfozosin are commonly prescribed and can help reduce pressure on the urethra and improve urine flow.

Antidepressants and anticonvulsants

• These drugs are not only useful for managing psychological symptoms such as anxiety and depression, but can also be effective in reducing chronic pain.

• Tricyclic antidepressants (such as amitriptyline) and anticonvulsants (such as gabapentin and pregabalin) are particularly helpful in reducing nerve pain.

Herbal medicines and supplements

• Quercetin
  is a natural bioflavonoid that may help reduce inflammation and pain in patients with CP/CPPS.

• Saw palmetto
  Some evidence shows that this herbal supplement can be effective in improving the symptoms of chronic prostatitis.

2. Non-pharmacological methods

Physiotherapy

• One of the most important components of CP/CPPS treatment is physical therapy that focuses on relaxing and strengthening the pelvic floor muscles. This method can help reduce pain and improve bladder and bowel function.

• These methods can help to retrain the pelvic floor muscles and reduce tension and spasm in these areas.

Prostate massage

• In some cases, prostate massage can help reduce prostate congestion and improve symptoms. This procedure should be performed by a urologist and is especially useful in cases where prostate congestion is diagnosed.

Sitz Baths

• This method involves sitting in warm water for 15 to 20 minutes, which can help relax the pelvic muscles and reduce pain and discomfort. Regular sitz baths can provide temporary but effective relief.

Lifestyle changes

• High intake of caffeine, alcohol, and spicy foods may aggravate symptoms. Reducing the consumption of these substances can help improve the patient's condition.

• Regular exercise can help reduce muscle tension and improve mood. Activities such as yoga and swimming can be helpful.

3. Behavioral and psychological therapies

Psychotherapy and counseling

• Chronic pain such as CP/CPPS can have significant psychological effects such as anxiety, depression, and reduced quality of life. Counseling and psychotherapy can help patients manage these psychological aspects.

• Cognitive-behavioral therapy (CBT) is particularly effective in helping patients change negative thought patterns and manage stress.

Stress management interventions

• Breathing exercises, meditation, and relaxation techniques can help reduce stress and tension in the pelvic muscles.

• Educating patients about different pain management methods can help them cope with chronic pain.

4. Advanced interventions and surgery

Nerve injections

• In cases where the pain is severe and resistant to treatment, the urologist may suggest nerve injections, such as injecting steroids or anesthetics into the pelvic nerves. These methods can provide temporary pain relief.

Neuromodulation

• Sacral or tibial nerve stimulation This method involves the use of mild electrical stimulation to modulate nerve activity in painful areas. This method is considered as an option for patients with pain resistant to conventional treatments.

surgery

• Surgery is rarely recommended for chronic pelvic pain syndrome and may only be considered in very severe cases resistant to all other treatments. Surgery may involve removing part of the prostate or structurally correcting certain abnormalities.

5.Complementary and alternative therapies

Acupuncture

• Acupuncture as a complementary treatment can help reduce pain and improve symptoms in some patients. This method helps to reduce pain by stimulating certain points of the body.

Prevention of chronic prostatitis

Unfortunately, there is no proven and guaranteed way to prevent chronic prostatitis. Because the main cause of the disease is unknown and the scientific evidence related to the risk factors of this disease are contradictory. However, a healthy lifestyle that includes a balanced diet, physical activity, stress management, and healthy sexual habits can reduce the risk of many chronic diseases.

Summary

chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a complex and chronic disorder that can have profound effects on patients' lives.

The syndrome is characterized by a variety of symptoms, including chronic pelvic pain, urinary problems, and sexual discomfort, and the exact cause usually remains unclear.

Treatment of CP/CPPS is challenging due to the unknown etiology and requires a multifaceted approach.

Treatment methods include drug treatments such as anti-inflammatory drugs and antibiotics, the use of physical therapy and relaxation techniques, and lifestyle changes such as dietary modification and stress management.

Although there is no definitive treatment for chronic prostatitis/chronic pelvic pain syndrome, a combination of these methods can help improve patients' quality of life and reduce symptoms.

Frequently asked questions