Chronic Pelvic Pain Syndrome/ Chronic Prostatitis

Chronic Pelvic Pain Syndrome/ Chronic Prostatitis

Chronic Bacterial Prostatitis (CBP) and Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) are common, debilitating conditions, with 35–50% of men reported to be affected by symptoms at some time in their life.

The most common symptom of Chronic Pelvic Pain Syndrome is pain or discomfort in one or multiple urogenital regions including the:

– Perineum (the area between the anus and the scrotum)
– Suprapubic region (the area above the pubic hair)

– Testicles
– Penis (especially penile tip pain)
– Lower back, abdomen or rectum

Some patients also experience pain during urination and ejaculation as well as LUTS, which includes urine voiding symptoms (for example weak stream, straining and hesitancy) or urine storage symptoms (for example: urgency with or without incontinence, increased urinary frequency, nocturia, and dysuria).

Unfortunately; all these symptoms taken together can have a significant impact on the quality of life for men, leading to stress, anxiety, and even depression as well as result in sexual dysfunction including erection and ejaculation issues.

Understanding Chronic Pelvic Pain Syndrome

The pain generally starts at an older age in men and may have been present for a shorter time in the time preceding identification of symptoms.

Surveys regarding pelvic pain have revealed that:

– the age of those affected varied from 19-84 years with an average age of 41 years

– the pain had been present for less than 12 months in 57%, 12-24 months in 21% and over 2 years in 22%

– 80% of men affected described their stress levels as high, 20% as normal

– pain location was described as Testicular in 66%, Perineal in 65%, Penile in 46%, Suprapubic in 36%, Rectal in 29%, Hip/groin in 25%, Lumbar spine in 14%, and Buttocks in 9%.

Pain is experienced by a majority, if not all, people across a lifetime and, on most occasions, the pain experienced is due to an acute injury or inflammatory process. The body’s natural response to pain is to try to protect the injured area, usually by altering posture or muscle tone around this area while the injury, inflammation or infection is healing. Once healing has completed, the pain resolves and any postural and muscular changes return to normal.
However, in a small proportion of people who suffer an injury, inflammation or infection, the sensation of pain continues, despite the resolution of healing to the underlying problem. This sometimes happens because the pain nerves themselves have been damaged by the original injury or inflammation and, as a result, have become sensitised. Other factors that increase the risk of this happening include genetic reasons, psychological problems associated with the original injury (eg, anxiety) and prior experience of pain in the injured or inflamed area. In these circumstances, the ongoing pain sensation is due to over-sensitisation of the pain nervous system located in the affected area. The pain experienced by the patient is very real, but no longer provides a useful purpose as the injury has already healed or the infection has already resolved.

Thus, in patients with CPPS, the original infective or inflammatory episode of ‘prostatitis’ has resulted in sensitisation of the pain nervous system that supplies the prostate and surrounding area. The sensation of pain (which may mimic the pain of the original ‘prostatitis’) continues, despite the fact that, in the vast majority of patients, any underlying infection has completely resolved.

However, the human body will react to pain by trying to protect the painful area, irrespective of whether the signal is due to a genuine injury or an abnormality in the nervous system. If the pain experience is prolonged, these protection mechanisms become entrenched. In the longer term, the changes in posture and muscular function can lead to secondary pain problems, resulting in increased disability and worsening of the pain condition.

The Challenges of Treating Chronic Pelvic Pain Syndrome

Most patients suffering from CPPS have tried various treatments, usually with little success. Because there are no clear treatment protocols, CPPS presents a challenge for both patients and physicians.
The most common pharmaceutical treatment options CPPS have not proven very effective in alleviating pain. Even prolonged treatment with antibiotics and an anti-inflammatory agent or alternatively, an alpha-blocker, seldom results in rapid resolution of the symptoms and is commonly completely ineffective and importantly some of these medications have significant side-effects.
Other treatment options for CPPS include pain management techniques such prostate massage, acupuncture, pelvic floor exercises and bio-feedback. Whereas these pain management techniques might be effective in individual patients, they are time-consuming, costly, require significant patient adherence and their efficacy is at best circumstantial.
Although there are no established treatments that consistently relieve symptoms, treatment options are improving. However, there have been few randomised controlled trials (RCTs) focusing on chronic prostatitis/CPPS, so more research is needed.
As a result, primary and in many cases secondary care doctors are usually reluctant to treat patients suffering from CPPS, which results in significant patient dissatisfaction.

International Andrology Treatment Protocol for Chronic Pelvic Pain Syndrome

As a specialist men’s health clinic, CPPS is one of the most common health issues that we encounter. Based on our significant clinical experience we have devised a treatment protocol that has proved to be the most effective in alleviating pain (compared to the existing treatment options) for men suffering from CPPS. The treatment protocol is based on our understanding of the condition, scientific evidence, and extensive clinical practice. Whereas it is unlikely that every man will benefit from this treatment protocol, our results to date are very encouraging and as such we recommend this treatment to the majority of our patients suffering from CPPS.

Our CPPS treatment protocol is a simple combination therapy of:

• Daily dosing of tadalafil (Cialis);
• A course of Extracorporeal Shockwave Treatment in the perineum area.

Whereas both of the above treatment modalities are usually prescribed to patients suffering from erectile dysfunction, they have also proved to be highly effective in treating CPPS in men.

Equally,  important is the fact that both treatments are very safe with almost no or minimal side-effects, with the exception of one, improved erections!

The results of our patients to date are very encouraging and in our opinion, this treatment protocol completely changes the landscape of CPPS management.

To find out more about this treatment, please contact our Patient Co-ordination team on 0203 131 4122 or read our Frequently Asked Questions below.

CPPS treatment Frequently Asked Questions

What evidence is there that the treatment works?

Although further research is still needed, there is significant evidence that both daily dosings of tadalafil and shockwave therapy can help with CPPS. See below for a list of medical papers discussing the treatment options:

http://onlinelibrary.wiley.com/doi/10.1111/bju.12681/full

https://www.ncbi.nlm.nih.gov/labs/articles/22340476/

https://www.ncbi.nlm.nih.gov/labs/articles/19372000/

https://www.ncbi.nlm.nih.gov/pubmed/18510660

http://www.jurology.com/article/S0022-5347(08)60098-1/abstrac

http://www.aamj.eg.net/journals/pdf/2485.pdf

How long after I start the treatment will I see improvements?

Many patients will start feeling improvements within a week of starting treatment (as a result of the daily intake of Cialis). The therapeutic effect of the shock-wave treatment is usually felt 4 weeks from the start of the treatment – this means that the combined effect will be maximised around 1 month from the start of your treatment.

For how long do I need to do the treatment?

The shockwave treatment is comprised of four 20 minute sessions (1 or 2 sessions per week) and needs to be performed only once. Unfortunately, Cialis needs to be taken on an on-going daily basis, since our practical experience suggests that cessation of the medication usually results to a re-emergence of the symptoms.

What are the side-effects?

Both daily intake of Cialis and shockwave treatment have been researched very extensively and they exhibit almost no serious side-effects.

Millions of men worldwide have been taking daily Cialis to treat erectile dysfunction and although they might experience some minor side effects (muted muscle pain or blocked nose), it is a medication which is very well tolerated. In fact, one might argue that Tadalafil (and other PDE-5 inhibitors such as Viagra) are wonder drugs since they have shown to have a beneficial effect on a number of conditions:

• Erectile dysfunction
• LUTS and BPH
• Can reduce cardiovascular disease

Similarly, shockwave therapy has shown to have almost no side-effects, with the exception of improved erections (if it is applied on the penis).

What is the cost of the treatment?

The first step to receiving the treatment necessitates that you have a consultation with one of our experienced uro-andrologists who will evaluate your condition and determine whether you are likely to benefit from this treatment. The first consultation cost is £250.

Beyond that, and assuming you are a good candidate, you would need to pay for your medication (you can purchase these at any pharmacy) and for the shockwave sessions, at £500 per session.

I am suffering from Chronic Pelvic Pain, what should I do next?

If you believe you are suffering from Chronic Pelvic Pain and it causes you significant concern we advise you to see a specialist urologist/andrologist.

Our doctors have vast experience treating this condition and our clinic is an international referral centre for patients looking for treatment. We would be happy to review your case and treat you in our clinic.