CHRONIC PELVIC PAIN SYNDROME MALE
Introduction:
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and interstitial cystitis/bladder pain syndrome collectively referred to as urologic CPPS (UCPPS) is defined by the absence of identifiable bacterial infection as a cause for the chronic pain and urinary symptoms.
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) accounts for 90% of prostatitis cases in outpatient clinics and is characterized by chronic pelvic pain symptoms lasting at least 3 months during the past 6 months, in the
absence of a urinary tract bacterial infection but in the presence of urinary symptoms and sexual dysfunction.
A 2016 review paper found that although the peripheral nervous system is responsible for starting the condition, the central nervous system (CNS) is responsible for continuing the pain even without continuing input from the peripheral nerves.
SYMPTOMS
Pelvic or perineal pain without evidence of urinary tract infection, lasting longer than 3 months.
Symptoms may wax and wane.
Pain can range from mild to debilitating, may radiate to the back and rectum, making sitting uncomfortable.
Pain can be present in the perineum, testicles, tip of penis, pubic or bladder area.
Unexplained fatigue, abdominal pain, constant burning pain in the penis, and frequency may all be present. Frequent urination and increased urgency may suggest interstitial cystitis (inflammation centred in bladder rather than prostate).
Post-ejaculatory pain.
TREATMENT
Neurologic/systemic
Neurologic treatments include the use of neuropathic pain drugs such as pregabalin, gabapentin, and amitriptyline.
Nerve Blocks
Superior Hypogastric Plexus Block /PRF
Neuromodulation
Limited data exists on the application of neuromodulation for men with CPPS.
Tenderness of skeletal muscle
CHRONIC PELVIC PAIN SYNDROME INFEMALE
Overview
Chronic pelvic pain is pain in the area below your bellybutton and between your hips that lasts six months or longer.
Chronic pelvic pain can have multiple causes. It can be a symptom of another disease, or it can be a condition in its own right.
If your chronic pelvic pain appears to be caused by another medical problem, treating that problem may be enough to eliminate your pain.
However, in many cases it's not possible to identify a single cause for chronic pelvic pain. In that case, the goal of treatment is to reduce your pain and other symptoms and improve your quality of life.
SYMPTOMS :
Severe and steady pain
Poorly localised
Pain that comes and goes (intermittent)
Dull aching
Sharp pains or cramping
Pressure or heaviness deep within your pelvis
In addition, you may experience:
Pain during intercourse
Pain while having a bowel movement or urinating
Pain when you sit for long periods of time
Your discomfort may intensify after standing for long periods and may be relieved when you lie down. The pain may be mild and annoying, or it may be so severe that you miss work, can't sleep and can't exercise.
Causes
Endometriosis. This is a condition in which tissue from the lining of your uterus grows outside your uterus. These deposits of tissue respond to your menstrual cycle, just as your uterine lining does — thickening, breaking down and bleeding each month as your hormone levels rise and fall. Because it's happening outside your uterus, the blood and tissue can't exit your body through your vagina. Instead, they remain in your abdomen, where they may lead to painful cysts and fibrous bands of scar tissue (adhesions).
Musculoskeletal problems. Conditions affecting your bones, joints and connective tissues (musculoskeletal system) — such as fibromyalgia, pelvic floor muscle tension, inflammation of the pubic joint (pubic symphysis) or hernia — can lead to recurring pelvic pain.
Chronic pelvic inflammatory disease. This can occur if a long-term infection, often sexually transmitted, causes scarring that involves your pelvic organs.
Ovarian remnant. After surgical removal of the uterus, ovaries and fallopian tubes, a small piece of ovary may accidentally be left inside and later develop painful cysts.
Fibroids. These noncancerous uterine growths may cause pressure or a feeling of heaviness in your lower abdomen. They rarely cause sharp pain unless they become deprived of a blood supply and begin to die (degenerate).
Irritable bowel syndrome. Symptoms associated with irritable bowel syndrome — bloating, constipation or diarrhea — can be a source of pelvic pain and pressure.
Painful bladder syndrome (interstitial cystitis). This condition is associated with recurring pain in your bladder and a frequent need to urinate. You may experience pelvic pain as your bladder fills, which may improve temporarily after you empty your bladder.
Pelvic congestion syndrome. Some doctors believe enlarged, varicose-type veins around your uterus and ovaries may result in pelvic pain. However, other doctors are much less certain that pelvic congestion syndrome is a cause of pelvic pain because most women with enlarged veins in the pelvis have no associated pain.
Psychological factors. Depression, chronic stress or a history of sexual or physical abuse may increase your risk of chronic pelvic pain. Emotional distress makes pain worse, and living with chronic pain contributes to emotional distress. These two factors often become a vicious cycle.
Diagnosis
In some cases, a clear explanation may never be found.
With patience and open communication, however, you and your doctor can develop a treatment plan that helps you live a full life with minimal discomfort.
Treatment
The goal of treatment is to reduce symptoms and improve quality of life.
If your doctor can pinpoint a specific cause, treatment will focus on that cause. However, if a cause can't be identified, treatment will focus on managing your pain and other symptoms. For many women, the optimal approach involves a combination of treatments.
Medications
Pain relievers. Over-the-counter pain remedies, such as, ibuprofen or acetaminophen , may provide partial relief from your pelvic pain.
Hormone treatments.
Antibiotics.
Antidepressants.
Other therapies
Your doctor may recommend specific therapies or procedures as a part of your treatment for chronic pelvic pain. These may include:
Physical therapy.
Stretching exercises, massage and other relaxation techniques may improve your chronic pelvic pain.
(TENS). TENS delivers electrical impulses to nearby nerve pathways.
Neurostimulation (spinal cord stimulation). This treatment involves implanting a device that blocks nerve pathways so that the pain signal can't reach the brain. It may be helpful, depending on the cause of your pelvic pain.
Trigger point injections.
Psychotherapy. If your pain could be intertwined with depression, sexual abuse, a personality disorder, a troubled marriage or a family crisis, you may find it helpful to talk with a psychologist or psychiatrist. There are different types of psychotherapy, such as cognitive behavioral therapy and biofeedback.
Surgery
To correct an underlying problem that causes chronic pelvic pain.
Laparoscopic surgery. If you have endometriosis, doctors can remove the adhesions or endometrial tissue using laparoscopic surgery.
Hysterectomy. In rare complicated cases, your doctors ma y recommend removal of your uterus (hysterectomy), fallopian tubes (salpingectomy) or ovaries (oophorectomy).
