Chronic Pelvic Pain Syndrome (CPPS) in Men: Causes and Treatment

Chronic pelvic pain in men, or Chronic Pelvic Pain Syndrome (CPPS), is a group of symptoms that is met more often, but is usually misunderstood as an infection or as inflammation of the prostate gland. Some patients have a dragging pain in the area of the perineum, the testicles, and the base of the organ; pain when sitting for a long time; frequent urination; or pain during or after ejaculation — but no clear infection is found on examination, and the symptoms do not improve even after receiving antibiotics several times.

In many cases CPPS does not arise from bacteria as the main thing, but may be connected with the muscles of the pelvic floor held in spasm, nerves that are sensitive to stimulation, and a cycle of chronic pain accumulated continuously. This article explains the causes, the symptoms that should be noticed, and the approach to assessment for planning care more on target.

What is CPPS?

CPPS is a group of symptoms of chronic pain in the area of the pelvic floor in men, the symptoms possibly arising in the area of the perineum, the testicles, the base of the organ, the anus, or the area deep inside the pelvic floor. The symptoms are usually continuous or come and go, and there may be other symptoms along with them, such as frequent urination, incomplete urination, pain while urinating, pain during or after ejaculation, or a feeling of discomfort when sitting for a long time.

The important point is that CPPS usually has no clear evidence of bacterial infection, and so should not be looked at as a problem that must always use antibiotics repeatedly, if the other causes have not been assessed along with it.

The medical mechanism behind CPPS

CPPS is usually connected with several systems at the same time, particularly the muscles of the pelvic floor, the nerves, and the body's response to chronic pain.

One of the mechanisms met often is the muscles of the pelvic floor held in spasm, or pelvic floor hypertonicity, particularly the deep muscles, such as the levator ani, the obturator internus, and the muscles around the base of the organ.

When the muscles are in spasm continuously, hidden points of pain, or myofascial trigger points, may arise, and the nerves in the area of the pelvic floor may become more sensitive to stimulation, particularly the pudendal nerve, which is connected with sensation in the area of the perineum and the organ, and with part of the working of the excretory and male systems.

When the muscles, the nerves, and the pain stimulate one another as a cycle, the symptoms may therefore become chronic, even though an infection is not the main cause.

The symptoms met often

The symptoms of CPPS can differ in each person, and may not be limited to only one area. The symptoms met often are

• A dragging pain in the area of the perineum, between the scrotum and the anus
• Pain radiating to the testicles, the base of the organ, or the anus
• Pain or discomfort when sitting for a long time, particularly on a hard chair
• Pain during or after ejaculation
• Frequent urination, incomplete urination, or pain and difficulty while urinating
• A feeling of tightness, spasm, or pressure inside the pelvic floor
• There may be premature ejaculation or erectile dysfunction along with it in some people

If the symptoms recur, are continuous, or affect the living of life, assessment should be received in order to find the true cause. One should not be treated in the same way repeatedly without further assessment.

When should a doctor be seen?

If the pain in the pelvic floor is continuous for longer than several weeks, does not respond to antibiotics, or has symptoms affecting sitting, excretion, or sexual life, systematic assessment should be received from a doctor with experience in the area of the pelvic floor, in order to avoid treatment that does not match the cause.

The examination and assessment at PYONG MEN

At PYONG MEN, the assessment of CPPS does not look only at the prostate gland or at the pain at a particular point, but assesses the pelvic system as a whole — the muscles, the nerves, the circulation, the structure, and the pattern of the body's working.

The approach to assessment may consist of

• Pelvic Floor Mapping & Trigger Point Assessment: in order to identify hidden points of pain inside and outside the pelvic floor
• Genitourinary & Prostate Evaluation: in order to distinguish other lesions of the prostate gland
• Postural & Core Stability Evaluation: in order to assess the balance of the pelvic bone and the core muscles
• Transrectal Color Doppler Ultrasonography (TRUS): for assessing the structure of the prostate gland and the deep system of blood circulation
• Uroflowmetry & Biofeedback: for measuring the rate of flow of the urine and the rhythm of the working of the muscles of the pelvic floor

The approach to restoration

Care for CPPS should begin with finding the main factor stimulating the symptoms in each person, because some have the main problem in the muscles, some are connected with the nerves, and some have the urinary system or posture involved as well.

At PYONG MEN, the plan of restoration may consist of several approaches together, such as

• Pelvic Floor Release & Neuromuscular Rehabilitation: emphasising reducing the held spasm of the muscles of the pelvic floor, restoring their release, and adjusting the working of the muscles connected with excretion and sexual capacity
• Doctor's Selection Pain Recovery: Western Medical Dry Needling may be used together with High Power Laser in some cases, in order to help reduce the points of muscle pain, reduce the tightness and pulling, and support the restoration of the tissue
• Transrectal QMR: using energy waves of a non-thermal kind, in order to support the restoration of the deep structure of the pelvic floor, the nervous system, and the tissue involved
• Focused Shockwave Therapy: stimulating the restoration of the tissue, the circulation, and the response of the nerves in the target area
• Advanced Pelvic Neuro-Vascular Protocol: using technology connected with the nervous system and the blood vessels, in order to support the release of the deep muscles and restore the working of the pelvic floor systematically

The plan of treatment and the frequency of the procedures will depend on the result of the examination, the main cause of the symptoms, and the response of each individual.

In brief

• CPPS is a state of chronic pain in the pelvic floor that usually does not arise from an infection
• The main cause is connected with the muscles of the pelvic floor held in spasm, hidden points of pain, and nerves that are sensitive to stimulation
• If there is no evidence of infection, the use of antibiotics may not answer the root cause of the symptoms
• Suitable assessment should include Pelvic Floor Mapping, assessment of the prostate gland, TRUS, Uroflowmetry, and analysis of the working of the pelvic floor
• The plan of restoration is designed individually according to the cause found on examination

Frequently asked questions (FAQ)

1. How does CPPS differ from inflammation of the prostate gland from an infection? Inflammation of the prostate gland from an infection has evidence of bacteria and responds to antibiotics, while CPPS has no clear infection and the symptoms are usually connected with the muscles and the nerves, so it requires a different approach.

2. Why does it not heal after taking antibiotics? If there is no infection, antibiotics will not deal with the true cause, which is usually the muscles held in spasm and the sensitivity of the nerves.

3. Does CPPS affect sexual capacity? Yes. Some patients may have pain during ejaculation, premature ejaculation, or erectile dysfunction along with it, because the muscles and the nerves involved are linked to one another.

4. Is examination through the anus necessary? TRUS and the assessment of the internal points of pain have an important role in detecting the tightness of the deep muscles of the pelvic floor and in assessing the prostate gland, so that the plan of treatment is more precise.

5. Must CPPS last a lifetime? Not necessarily. Many people respond to restoration that matches the cause. The outcome depends on the length of time it has been there, the cause, and the continuity of the treatment.

6. Can stress make CPPS worse? Stress may stimulate spasm of the muscles of the pelvic floor, which may play a part in making the symptoms more severe. But this does not mean that CPPS is a "psychological problem" alone.