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Spotlight on Pelvic Floor Problems: Chronic Prostatitis

What is chronic prostatitis?


Chronic prostatitis (CP), also known as chronic pelvic pain syndrome (CPPS), is a condition that affects those with male anatomy and can involve pelvic pain, difficulty emptying the bladder, and the urge to urinate more frequently than normal. It is commonly divided into two types – bacterial and non-bacterial prostatitis. More than 90% of cases are non-bacterial in nature, meaning they are not caused by an active infection of the prostate.


Patients with this condition may report pain in some or all of the following areas:

· Perineum (base of pelvis between the pubic bone and tailbone)

· Bladder

· The area right above the pubic bone

· Testicles

· Penis


Patients also often feel the need to urinate frequently, but despite this urge to go, many patients feel that they still do not fully empty their bladders. They may also report that the flow of urine is quite slow to start.


CP/CPPS has been shown to affect approximately 2-8% of males at any time in their lives, and some researchers believe that the prevalence rates are even higher due to incorrect or absent diagnoses. CP/CPPS can also be difficult to diagnose due to its similarity to other pelvic pain conditions.


In an earlier spotlight post, we learned about interstitial cystitis, or IC, and its cousin, painful bladder syndrome (PBS). In the past, IC/PBS were commonly viewed as conditions primarily affecting people with female anatomy. However, more recent research has demonstrated that males may be affected by the symptoms of IC at a rate very similar to that in females, with up to 4% of male subjects in these studies reporting IC-like symptoms. Recently, the medical field has combined IC/PBS and CP/CPPS into one umbrella syndrome known as urologic chronic pelvic pain syndrome (UCPPS) – how’s that for an alphabet soup!?


What are some symptoms of CP?


Like many pelvic pain conditions, CP/CPPS can present differently from patient to patient: some people may have a constellation of various symptoms, while others may only have one or two. Some common complaints include, but are not limited to, the following:


· Urinary frequency - the urge to empty the bladder more often than every 2-4 hours

· Dysuria: a burning sensation and/or pain with urination

· Urinary urgency – a sudden intense feeling of needing to void the bladder

· Urinary hesitancy – when it takes longer than 10 seconds to start the flow of urine, despite feeling a

need to go

· Slow/weak urinary stream and/or the inability to fully empty the bladder

· Lower abdominal pain and/or pain deep in the pelvis

· Low back pain

· Pain in the genital region, including the perineum, testicles, and/or penis

· Pain with sexual activity, particularly with ejaculation


How is CP diagnosed?


As with related conditions like interstitial cystitis and painful bladder syndrome, chronic prostatitis can easily be misdiagnosed and mistreated, at least early on. A first line of medical investigation is often urinalysis—the good old pee-in-a-cup test—to rule out an active infection like a urinary tract infection (UTI) or a sexually transmitted infection (STI) like chlamydia or gonorrhea.


If an infection is found, your doctor will likely recommend treating it with a course of antibiotics. However, if no infection is present, as is the case for many patients with CP/CPPS, antibiotics are unlikely to resolve your symptoms. In these cases, your doctor may recommend additional testing to rule out other, more serious conditions such as bladder cancer.


These tests may include a cystoscopy, in which a small tube with a tiny camera is inserted through the urethra and up into the bladder, in order to better visualize the lining of the bladder. This can help rule out cancer and it can also detect any damage to the lining of the bladder that may be contributing to symptoms.


Every medical assessment, regardless of your urine testing results, should also include a thorough physical examination: your physician will likely check various points on your abdomen for pain or tenderness, inspect the penis, scrotum, and perineum for any abnormalities, and perform a digital rectal examination to assess the prostate. All these tests also help rule out other conditions, like kidney stones or prostate disease, that could be causing your symptoms. Once other problems are ruled out, then the real work of treating CP can begin.


What are some treatments for chronic prostatitis?


Like many pelvic floor conditions, CP/CPPS usually requires a multidisciplinary approach to treatment, involving a variety of different healthcare providers and interventions. Common members of a patient’s care team include a primary care physician (PCP), a specialist physician called a urologist, and a pelvic floor physical therapist. Physicians will often prescribe medication to help reduce the pain that patients may be experiencing, and sometimes they may also suggest an alpha blocker medication such as FloMax to help with bladder emptying. For many patients with CP/CPPS, however, dysfunction of the pelvic floor muscles can cause persistent symptoms which these medications cannot directly address. This is where pelvic floor PT comes in.


How can pelvic floor physical therapy (PFPT) help patients with CP?


A pelvic health therapist can help patients address imbalances in their pelvic floor in order to reduce CP symptoms. Techniques used may include (but are not limited to): manual therapy (hands-on treatment) to address pain and muscle tightness, exercises to improve the control of the pelvic floor muscles, various types of painless electrical stimulation to aid in muscle coordination, and education in behavioral modifications that can help to manage symptoms.

Pelvic PTs also examine the areas around the pelvic floor, like the hips, back, and diaphragm, to assess whether problems in those regions might be contributing to a patient’s pelvic symptoms.


Patients with CP may also benefit from a variety of other interventions, including dietary modifications and/or alternative therapies such as acupuncture to help manage pain. Physicians and pelvic PTs can help patients determine which additional therapies may be helpful for them.


How do I get help for my CP?


Come see us at Roaring Fork PT! Our pelvic floor specialist, Caitlyn, has the training and skills necessary to evaluate you and help you develop a plan for treating your symptoms, including pelvic pain and difficulty with bladder emptying. If you have Medicare, you’ll need a referral from a physician first - your primary care physician or a specialist physician you see for bladder or pelvic problems can refer you to PT. For most folks with commercial (non-Medicare) insurance, however, a physician referral is not required to see a physical therapist - call us today at 970-927-9319 to learn how we can help!


Acknowledgements:

Clemens, J. Quentin, et al. “Urologic Chronic Pelvic Pain Syndrome: Insights from the MAPP

Research Network.” Nature Reviews Urology, vol. 16, no. 3, 2018, pp. 187–200.,

doi:10.1038/s41585-018-0135-5.


Cozean, Nicole, and Jesse Cozean. The Interstitial Cystitis Solution: a Holistic Plan for Healing

Painful Symptoms, Resolving Bladder and Pelvic Floor Dysfunction, and Taking Back Your Life.

Fair Winds Press, 2016.


Holt JD, Garrett WA, McCurry TK, Teichman JM. Common Questions About Chronic

Prostatitis. Am Fam Physician. 2016 Feb 15;93(4):290-6. PMID: 26926816.


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