Chronic Prostatitis/Chronic Pelvic Pain Syndrome in Males
What is Prostatitis?
The prostate is a gland in front of the bladder that surrounds the urethra. It contributes fluid to help transport sperm during an ejaculation. Inflammation or infection of the prostate is called prostatitis. There are several types of prostatitis:
Acute Prostatitis: Infection in the prostate characterized by relatively sudden onset of urinary symptoms, lower abdominal/genital/perineal pain, fever, chills and flu-like symptoms. This is often treated with a course of antibiotics.
Chronic Prostatitis: This is a prolonged infection of the prostate. Symptoms may be similar to those of acute prostatitis and may include recurrent urinary tract infections. This is treated with a long course of antibiotics.
Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS): Non-infectious genitourinary symptoms including pain in the pelvis, penis and/or perineum, pain or difficulty with urination, or pain with ejaculation or bowel movements. Patients may also have other sexual complaints including erectile or ejaculatory dysfunction and decreased libido. Patients in this category are often mischaracterized as an infectious type of prostatitis and may have been treated with multiple courses of antibiotics without much relief of symptoms.
How is CP/CPPS Diagnosed?
You will work closely with your doctor to evaluate for any cause of your symptoms. A complete physical exam, including a digital rectal exam will be performed. Your urine and potentially prostatic secretions may be tested for infection. As indicated, you may be recommended to undergo urodynamic study (bladder pressure test) or a cystoscopy (direct visualization of the urethra with a camera). Additionally, imaging may be recommended.
How is CP/CPPS Treated?
Unfortunately, there is rarely just one treatment that can cure your symptoms. Rather, we employ a multimodal approach to address each patient specifically based on their symptom profile. Treatments can include medications to improve urinary symptoms, analgesics, antibiotics, anxiolytics/anti-depressants, mental health counseling, dietary and lifestyle changes (increase exercise, decrease alcohol and smoking) and pelvic floor physical therapy. Pelvic floor physical therapy is especially important. The pelvis is composed of many muscles that muscle work in tandem to relax during urination and defecation and also to contract during ejaculation. Malfunction of these muscles can cause or contribute to the symptoms of CP/CPPS. Similar to physical therapy of any other limb or muscle group, during pelvic floor physical therapy, a specially trained physical therapist guides you through learning how to appropriately strengthen, contract and relax these muscles. To learn more about CP/CPPS, you can click this link: https://jamanetwork.com/journals/jama/fullarticle/1104938 or this link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8451687/#cit0037