A considerable number of patients go for treatment with antibiotics several rounds over, for symptoms of pain in the pelvic floor, pain in the perineum, or pain after ejaculation, but do not improve as they had hoped. The question that usually follows is "why has it still not healed after taking the medicine?"
The answer in medical terms usually comes back to understanding the state called CPPS, or Chronic Pelvic Pain Syndrome, which for the most part does not arise directly from bacterial infection.
This article gathers the questions met often about CPPS straightforwardly, in order to help the reader understand the mechanisms behind the symptoms, the reason why antibiotics may not help, and the approach to assessment that may be more suitable in a case where the symptoms recur or are chronic.
What is CPPS?
CPPS (Chronic Pelvic Pain Syndrome) is a group of symptoms of chronic pain in the area of the pelvic floor, the perineum, the testicles, or the base of the male organ, the symptoms being continuous for a long time, with no clear evidence of bacterial infection.
The symptoms of CPPS may be met together with abnormality of the passing of urine, pain during or after the ejaculation of semen, as well as a feeling of discomfort when sitting for a long time.
This state differs from inflammation of the prostate gland from an infection, which usually has evidence of bacteria and responds to antibiotics more clearly.
Why do antibiotics not help in CPPS?
The short answer is that if there is no infection, antibiotics cannot of course deal with the main cause of the symptoms.
In most men, the cause lying behind CPPS is not bacteria, but is connected with 2 important mechanisms.
The first part is abnormality of the structure of the muscles of the pelvic floor, the muscles possibly being in a state of held spasm (Hypertonicity) until hidden points of pain (Myofascial Trigger Points) arise in the levator ani and obturator internus muscles and the muscles around the base of the organ.
The second part is the sending of signals by the peripheral nervous system being too sensitive to stimuli, particularly the pudendal nerve, which may be compressed by the muscles held tight for a long time.
Therefore, antibiotics do not help release the muscles, do not reduce the sensitivity of the nerves, and do not put right the mechanical factors that still feed the cycle of chronic pain.
Why is assessment important?
Receiving antibiotics repeatedly, several rounds over, without a new assessment, may take the patient further and further from the approach to care that matches the cause of the symptoms.
- A real infection that requires care according to the standard
- Abnormality of the muscles of the pelvic floor
- Sensitivity of the peripheral nerves
- Other accompanying factors, such as the behaviour of sitting, accumulated stress, or accompanying states that have a bearing on the pressure in the pelvic floor
The assessment may consist of examination by palpation in Pelvic Floor Mapping, Transrectal Color Doppler Ultrasonography (TRUS), Uroflowmetry, and assessment of the prostate gland, so that the overall picture of the mechanisms connected with the symptoms is seen more clearly.
Can CPPS be treated?
The words "can be treated" in the context of CPPS mean reducing the symptoms, restoring the working of the muscles and the nerves, and helping cut the cycle of chronic pain that recurs continuously.
Care for CPPS usually requires an integrated plan designed according to the result of the assessment of each individual. The outcome depends on the length of time it has been there, the factors involved, and the continuity of the care.
The approach to care at PYONG MEN
At PYONG MEN, the plan of care for CPPS may consist of Doctor's Selection (Dry Needling together with High Power Laser) in order to release the hidden points of pain; Transrectal QMR in order to support the repair of the deep cells; Focused Shockwave Therapy in order to dissolve fibrous tissue and adjust the response of the nerves; the Advanced Pelvic Neuro-Vascular Protocol in order to support the release of the muscles at a deep level; and the injection of Activated Concentrated Growth Factors in a case where the repair of compressed nerves must be supported.
The plan of care will be designed specifically for the individual, with reference to the symptoms, the result of the assessment, and the mechanisms involved in each patient.
In brief
- CPPS is a state of chronic pain in the pelvic floor that usually does not arise from an infection
- Antibiotics do not put right the cause of the symptoms, if there is no evidence of infection
- The main mechanisms are usually connected with the muscles of the pelvic floor held in spasm and nerves sensitive to stimuli
- Comprehensive assessment helps determine the suitable direction of care
- Most of the treatment is designed as an integrated plan specific to the individual
Frequently asked questions (FAQ)
1. Is CPPS a communicable disease? No. CPPS is not a communicable disease, and for the most part does not arise from bacterial infection.
2. Why did the previous doctor prescribe antibiotics? In some cases the symptoms of CPPS may be similar to inflammation of the prostate gland from an infection, so giving antibiotics in the first stage may be a reasonable clinical assessment initially. However, if the symptoms do not respond to the medicine, a new assessment will help show a direction of care that matches the mechanism of the symptoms better.
3. Can CPPS heal by itself? In some people the symptoms may improve temporarily, but if the symptoms are chronic and there are hidden points of pain, it usually has to be put right with care that matches the cause.
4. Is stress a cause of CPPS? Stress may stimulate the muscles of the pelvic floor to spasm more, and can play a part in making the symptoms more severe, but CPPS is not a psychological state alone.
5. How long does treating CPPS take? The plan of care in general usually has to be continuous for several weeks to several months, depending on the causes involved, the length of time it has been there, and the response of each individual.
6. Where should one begin? One should begin by seeing a doctor with experience in the area of the pelvic floor, in order to receive a comprehensive assessment before deciding on the approach to care.