Chronic prostatitis/chronic pelvic pain syndrome

Chronic nonbacterial prostatitis, also known as chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), is long term pelvic pain and symptoms with urination without evidence of a bacterial infection. It affects about 2 to 6% of men. Chronic nonbacterial prostatitis, also known as chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), is long term pelvic pain and symptoms with urination without evidence of a bacterial infection. It affects about 2 to 6% of men. The cause is unknown. Diagnosis involves ruling out other potential causes of the symptoms such as bacterial prostatitis, benign prostatic hypertrophy, overactive bladder, and cancer. CP/CPPS and interstitial cystitis are sometimes referred to jointly as 'UCPPS' (urologic chronic pelvic pain syndrome). Recommended treatments include multimodal therapy, physiotherapy, and a trial of alpha blocker medication or antibiotics in certain newly diagnosed cases. Tentative evidence supports some non medication based treatments. Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is characterized by pelvic or perineal pain without evidence of urinary tract infection, lasting longer than 3 months, as the key symptom. Symptoms may wax and wane. Pain can range from mild to debilitating. Pain 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. Dysuria, arthralgia, myalgia, 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, mediated by nerves and muscles, is a hallmark of the condition, and serves to distinguish CP/CPPS patients from men with BPH or normal men. Some patients report low libido, sexual dysfunction and erectile difficulties. The cause is unknown. However, there are several theories of causation. One theory is that CP/CPPS is a psychoneuromuscular (psychological, neurological, and muscular) disorder. The theory proposes that anxiety or stress results in chronic, unconscious contraction of the pelvic floor muscles, leading to the formation of trigger points and pain. The pain results in further anxiety and thus worsening of the condition. Another proposal is that it may result from an interplay between psychological factors and dysfunction in the immune, neurological, and endocrine systems. A 2016 review suggested 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. Theories behind the disease include stress-driven hypothalamic-pituitary-adrenal axis dysfunction and adrenocortical hormone (endocrine) abnormalities, and neurogenic inflammation.