Unlocking the mystery of chronic pelvic pain syndrome
The condition is an all-too-real problem for men, and one of the more difficult to treat.
After age 50, men often have periods of discomfort “down there.” It could be a cramping, aching, or throbbing pain in and around your pelvis and genitals. You also may have issues in the bedroom and bathroom. While the problems are real, the cause is often difficult to pinpoint.
It’s called chronic pelvic pain syndrome (CPPS) — also known as chronic prostatitis — and it’s one of the most puzzling and difficult-to-manage conditions for older men.
“It is often regarded as an ‘orphan disease,’ as it has no known cause or proven treatments,” says Dr. Michael O’Leary, a urologist, and professor of surgery at Harvard-affiliated Brigham and Women’s Hospital. “This makes it tough to diagnose and frustrating for men seeking relief.”
CPPS is characterized by pelvic pain symptoms lasting at least three months out of a six-month period without documented infections.
While not life-threatening, CPPS has a profound impact on quality of life. Besides often-debilitating pain, CPPS can be associated with erectile dysfunction and painful ejaculations. Many men with the disorder complain of frequent and urgent urination and a burning sensation when voiding. In turn, CPPS can lead to anxiety and depression.
CPPS is often tough to diagnose. The problems can come and go. For example, the discomfort may suddenly vanish, only to return weeks or even months later. When the symptoms do recur, they may be more or less severe than before, or new ones may appear. In addition, symptoms can be similar to a prostate infection and or an enlarged prostate gland.
“For years, men would come into their doctor’s office and complain about their problems and leave with a prescription for antibiotics, and that was that,” says Dr. O’Leary. “But rarely did it cure the problem.”
It can take time and patience for both a man and his doctor to conclude that CPPS is responsible for the symptoms.
CPPS is primarily a diagnosis of exclusion — that is, it is diagnosed when the symptoms are suggestive and no other explanation can be identified.
Your doctor will perform a physical exam, including a rectal exam, and usually order urine and blood tests to look for signs of infection and check kidney function. You may have additional testing, such as CT, MRI, or cystoscopy (a procedure to look inside your bladder). Your doctor also may employ the UPOINT system (see “On point with UPOINT”). If your evaluation shows no other problems, CPPS is the likely diagnosis.
On point with UPOINT
Some doctors use a system called UPOINT to help diagnose chronic pelvic pain syndrome. It rates a person’s symptoms and their severity and location. UPOINT stands for
- Urinary symptoms
- Psychosocial symptoms
- Organ-specific symptoms (for instance, those affecting only the prostate)
- Infection-related symptoms
- Neurologic symptoms
- Tenderness in the muscles and pelvic floor.
According to Dr. O’Leary, even if CPPS is diagnosed, there is no defined approach for treatment. “It’s a trial-and-error approach,” he says.
Still, there are many helpful options. Here are some strategies that are often used to ease and manage symptoms. It’s typical for people to try more than one before finding one that works, or a combination of treatments may be necessary.
Antibiotics. Doctors may still prescribe a course of antibiotics because a prostate infection can be present even with normal urine and blood tests, says Dr. O’Leary.
Alpha-blockers. Alpha-blockers such as tamsulosin (Flomax) can help relax the muscle in and around the prostate and the bladder’s base.
Anti-inflammatories. Some over-the-counter or prescription-strength nonsteroidal anti-inflammatory drugs — such as ibuprofen (Advil, Motrin) or naproxen (Aleve) — can help relieve pain.
Physiotherapy. Pelvic floor muscle spasm is an underrecognized cause of CPPS. A physical therapist can help reduce tension in the pelvic muscles and tissues that surround them. It’s known as myofascial release therapy. At home, you can do Kegel exercises, which also improve pelvic floor muscle function. Kegels are done by tightening and relaxing the muscles you would use to stop urine flow or hold back gas.
Nutrition. Avoid certain foods and beverages that can aggravate symptoms, such as coffee, hot peppers, alcoholic drinks, tea, chili, and other kinds of spicy foods.
Exercise. A 2015 study in Medicine & Science in Sports & Exercise found that men who did low-intensity exercise, like walking, for at least 10 hours per week had a 28% lower risk of developing CPPS compared with a control group.
Home remedies. Taking hot baths or applying heating pads to painful areas can soothe discomfort during flare-ups.
Stress management. Adopting stress-reducing practices can help manage both the physical and emotional discomfort of CPPS. Some examples include biofeedback, meditation, breathing exercises, and cognitive-behavioral therapy.
The good news is that most men can manage their CPPS and get better over time.
“Never feel that the pain is just in your head,” says Dr. O’Leary. “CPPS is real, so talk with your doctor about your symptoms. The more information you can share about your condition, the easier it can be to begin with a treatment program that best fits your particular symptoms.”
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