Pain in your pelvic region may occur due to various reasons. It is quite likely that no two people may experience the same type of pain. Management of pain requires a distinctive approach for almost each type of this discomfort. This pain syndrome is found to occur more commonly among men. Signs of this painful syndrome are often similar to other prostate related medical conditions. It takes a thorough examination of our medical condition – often by an experienced practitioner to rule out other misleading possibilities.
Pelvic pain among women may be triggered due to formation of cysts, post-delivery pelvic issues as well as pains experienced during menstrual cycles. In men, pelvic pain may be an outcome of chronic pelvic pain syndrome (CPPS) or chronic prostatitis, pains experienced during the movement of bowels and also due to penile health issues.
Prostatitis is a condition wherein your prostate becomes soft and swollen; this is not similar to an enlarged prostate or an incidence of cancers in the prostate. Medical sciences have observed 4 different classes of prostatitis.
#(1) Acute bacterial prostatitis – This is a serious condition in which bacteria enters into the prostate and results in an infection.
#(2) Chronic bacterial prostatitis – Here, bacterial infections may persist for many months. This is often experienced by elderly men.
#(3) Chronic Pelvic Pain Syndrome – CPPS is the most commonly observed prostatitis. Its signs are very similar to those of bacterial prostatitis. The sole differentiator of CPPS is the absence of bacterial strands. Causes for CPPS include damages to the pelvic nerves, abnormal stress levels or injuries in your pelvic areas. Some clinical studies link the incidence of CPPS to irritable bowel syndrome (IBS) and also to a few autoimmune conditions. Doctors suspect the role of changes occurring to the chemical constitution of your urine as well as infections in your urinary tract as likely triggers.
#(4) Asymptomatic prostatitis – This shows up with practically no signs. Your prostate, of course gets swollen. Though no apparent symptoms are noticed, this condition is likely to lead to impotency.
Prostatitis is found to occur if you had an injury in your groin area or have a medical history of infections in the urinary tract. Extended risks include prior use of catheters, biopsy of the prostate and incidence of HIV-AIDS. A medical history of prostatitis is also likely to result in a repeated occurrence of this clinical condition. Medical experts have established a likely link to the role of pelvic muscles and nerves to this condition. Hence, reason for the incidence of CPPS can be an irritation in the pelvic nerve, inflammation of pelvic muscles and a host of other likely disturbances caused onto your pelvic floor. Other reasons such as – chronic constipation, formation of stones in your kidneys, enlargement of the spleen, hernia, fungal infections (yeast) in urinary tract, etc. – may also act as likely triggers of CPPS.
Symptoms of Chronic Pelvic Pain Syndrome (CPPS)
CPPS is a condition wherein you experience persistent pain in the pelvic areas. This pain can be felt in your back (especially, your lower back), thighs and your buttocks. Each person may experience pain at different levels – i.e., in terms of duration, degree and the kind of discomfort you may feel. Clinical studies indicate that duration of pain can be either irregular or persistent; the type of discomfort may vary from being sharp to a dulled type of pain and degree of pain may also vary from being moderate to acute levels. The precise reasons for CPPS remain largely unknown barring a few likely indicators.
The key symptom of CPPS is the presence of pelvic pain that may persist for 3 months or longer. You may often find it difficult to sit in a relaxed or comfortable posture. Pain may not remain the same all through; it can vary from being very mild to extremely painful. You may also experience pain in your bladder, penis (often, at its tip) and testicles. You may find it painful to urinate, and your joints may also radiate pain. CPPS is also signified by the untimely as well as frequent urges to urinate. Another very distinctive feature of CPPS is painful ejaculation – especially, soon after ejaculating during a sexual intercourse. Often, this single feature helps doctors to distinguish it from benign prostatic hyperplasia (BHP) – or, commonly referred as enlarged prostate.
The other signs of CPPS include increased levels of tiredness, pain in your abdomen, reduction of sexual desires (libido), inabilities to sustain an erection as well as other disorders in the penile region. In most cases, pain in the pelvic floor can also be felt in the rectal area; this manifests as difficulties experienced while sitting.
How is chronic pelvic pain syndrome diagnosed?
There is no pre-defined panel of tests to diagnose the incidence of CPPS. Though CPPS is the most widely occurring prostatitis-linked condition, the understanding level is still quite nascent. Formation of pus is one clear indicator to understand the inflammatory status of your prostate. In an inflamed condition, all prostatic secretions – such as semen, urine, etc. – are observed to contain pus. It is not possible to detect traces of pus – however minimal – in the non-inflammatory variants of pelvic pain.
Other indicators leading to the incidence of CPPS are existence of a slightly lesser count of bacteria in the semen of men with CPPS. In other words, healthier men’s semen may have a larger count of bacteria. Comorbid studies confirm that people with chronic pelvic pains may be prone to conditions such as irritable bowel syndrome (IBS) or other chronic fatigue disorders.
Treatment of chronic pelvic pain syndrome
Multiple options exist for the case management of chronic pelvic pain syndrome. Treatment modes include administration of drugs, therapy as well as surgery.
Administration of drugs
A wide variety of drugs are used as part of the treatment plan. Most commonly used drugs fall under the class of alpha blocking medicines. Apart from alpha blocking medications, a few nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen or ibuprofen are also administered.
Alfuzosin – This is a drug used for disorders such as frequent urges to urinate, weakened stream of urine, delay or hesitancy during urination – most of these signs are also triggered by an enlargement of prostate. Muscles of your prostate, neck of your urinary bladder and urethra are all regulated by alpha-adrenergic signal receptors. Alfuzosin blocks these alpha receptors – especially in the bottom part of your urinary tract – to calm the muscles there. This calming or relaxation brings about an improvement in the flow of urine and is used for the treatment of prostate-related ailments such as CPPS.
Some of the side effects of this drug include drowsiness and decrease in blood pressure. If you have prior medical conditions such as hypotension – i.e., low levels of blood pressure, glaucoma or cardiac ailments, you need to talk to a doctor before taking this drug.
Tamsulosin – This is another type of alpha blocking drug. Its main activity is to relax your bladder and prostate; thus bringing needful relief from pain in the pelvic floor. This drug can be more effective in relieving signs such as night-wetting, problems to start urinating as well as weak streams of urine.
As the drug can reduce your BP level, you may experience fainting or a spell of confusion and dizziness. In some remote instances, men have reported of having an erection that persists for several hours. If such side effects are experienced, you are advised to seek medical help without delay. This drug may interact with fellow alpha-blocking drugs – especially, terazosin and the likes.
If you are a habitual drinker of alcohol or consumer of opioids, you need to inform your treating doctor and pharmacist about your lifestyle.
Benzodiazepine – This drug has been seen to be effective while administered to enhance the muscular health of pelvic floor. This drug can help show a marked decrease in pain associated with prostate – i.e., pains experienced while urinating as well as those observed while having sex. These drugs are known for their capability of calming your brain as well as relaxing your muscles. These are also used for the case management of a wide range of stress – including muscular stress. Once you discontinue the intake of this drug, you are likely to develop a few signs of withdrawal. Hence, it is highly recommended to take the advice of your treating doctor with regard to discontinuing this drug.
Amitriptyline – This is a tricyclic antidepressant medication. When used in extremely low dosage levels, this drug is known to treat chronic pain; especially pains experienced in your nerves. Side effects of this medication are dizziness, dryness of mouth, etc. If you have a clinical history of hyperthyroidism (a sensitive thyroid gland) or breathing problems like asthma, bronchitis, etc., it is not recommended to use this drug. This medication may interact with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen, supplements to boost thyroid levels as well as with a few anticoagulants like warfarin, etc.
Gabapentin – This medication is categorized under a class called neuroleptic drugs. It is used for the treatment of common signs linked to chronic pelvic pain syndrome. Of the many signs, this drug is found effective in the treatment of chronic spell of tiredness as well as pain in your pelvic floor; especially discomforts experienced in the external parts of your pelvic area as well as abdomen. It is often combined with a multimodal treatment protocol; when the pelvic floor muscles are too very tight, the treating doctor may recommend a few sessions of physical therapy.
This drug contains a macrolide substance (of polyene genre). It inhibits the reabsorption rates of hormones such as estrogen. It is widely used to treat medical conditions that affect functioning of prostate, bladder and urethra. This drug’s main action rests in its ability to reduce the presence of estrogen in your prostate. This action eventually brings about a reduction in chronic pelvic pain syndrome. Owing to a sizeable drop in pain felt in prostate and urological tract, quality of life of men with CPPS is found to improve significantly.
Drugs under this class are administered when infections are observed. In the absence of infections, antibiotics have met with very limited success while treating people with CPPS. Presence of anti-inflammatory capabilities of antibiotics has been attributed to the partial success in the treatment of CPPS. Most common among antibiotics used are tetracycline, fluoroquinolones, macrolides, etc. These drugs are effective in blocking chemicals that signal inflammation. However, these drugs are not effective if the condition is without any likely risks of infections.
Physical therapy is a common treatment approach for the case management of chronic pelvic pain syndrome. Such therapy can help relax the extremely tightened or stressed muscles of your pelvicloor. The most-often administered therapy is digital therapy (massaging) of the intra-rectal region as well as physical therapy focused onto your pelvic area. These therapies when combined with mind relaxation techniques are found to bring needful relief from pelvic pains. In fact, as per records of American urological association, these therapies are listed as second line treatment options.
Apart from these, multimodal treatment approaches may also include extracorporeal shockwave therapies (ESWT). This is administered by using high-intensity and focused acoustics. A pulse from an external source is applied onto the painful area. Prior to the treatment, you are anesthetized or sedated to eliminate likely pains or discomforts. However, if your muscles are not very tight, anesthesia is only an option. This line of treatment is considered as a substitute to surgeries or other invasive procedures.
In some cases, alternative techniques such as acupuncture have also yielded some relief from chronic pelvic pain. Acupuncture is a clinical approach to set right imbalances of energies in your body. This technique is found to be more successful in treating postpartum pelvic pains among women. The advantages of this approach are the minimal invasions needed to treat patients as well as the relatively lower cost per sitting. These approaches may also score high on the safety aspect, since its side effects are very minimal.
In sum, Chronic Pelvic Pain Syndrome – CPPS – is a commonly observed type of prostatitis. Its symptoms may be the same as bacterial prostatitis; the key thing is the absence of bacterial infections in the former. Causes for CPPS are injuries in pelvis, damages to pelvic nerves, high stress levels, etc. Medical research links CPPS with the incidence of irritable bowel syndrome. It is relatively difficult to treat this condition. Often, a multimodal treatment approach is administered; this includes therapy (physical therapy, acupuncture, extracorporeal shockwave therapy, etc.), medications and as a last option, surgical approaches which best suit your pelvic condition are explored.