Q. I have persistent discomfort in the pelvic and genital areas. Treatment with a long course of antibiotics for chronic prostatitis didn’t help. Is this common in men? What else might help relieve the symptoms?
While commonly called chronic prostatitis, the symptoms may not be related to an inflamed prostate. That’s why it is also known as chronic pelvic pain syndrome in men, and it is quite common.
Chronic pelvic pain syndrome (CPPS) is characterized by pelvic pain symptoms lasting at least three months out of a six-month period without documented infections. The exact cause of CPPS is often not identified and finding relief can be challenging.
The symptoms of CPPS may have a profound impact on quality of life. Besides the discomfort, 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.
Chronic pelvic pain syndrome 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.
Chronic pelvic pain syndrome is primarily a diagnosis of exclusion—that is, it is diagnosed when the symptoms are compatible and no other explanation can be identified. Evaluation starts with a physical exam, including a rectal exam, and usually order urine and blood tests to look for signs of infection and check kidney function. Your doctor may order additional testing, such as CT scan [computerized tomography], MRI [magnetic resonance imaging], or cystoscopy (a procedure to look inside your bladder). If your evaluation shows no other problems, CPPS is the likely diagnosis.
There is no defined treatment approach [for CPPS]. Doctors often start with a trial of antibiotics, just as you did. Here are other potential therapies in no particular order:
- Alpha blockers.
Alpha blockers such as tamsulosin (Flomax) can help relax the muscle in and around the prostate and the bladder’s base.
Over-the-counter or prescription-strength nonsteroidal anti-inflammatory drugs—such as ibuprofen (Advil, Motrin) or naproxen (Aleve)—sometimes help relieve pain.
Pelvic floor muscle spasm is an under-recognized cause of CPPS. A physical therapist can help reduce tension in the pelvic muscles and tissues that surround them.
- Dietary changes.
Some men find relief by avoiding certain foods and beverages, such as coffee, hot peppers, alcoholic drinks, tea, chili, and other kinds of spicy foods.
- Stress management.
Adopting any kind of stress-reducing practice can help manage both the physical and emotional discomfort of CPPS. Some examples include biofeedback, meditation, breathing exercises, and cognitive-behavioral therapy.
Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.
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