What Is Chronic Prostatitis? Treating Chronic Pelvic Pain in Men
Chronic pelvic pain syndrome (CPPS) is a type of a common condition affecting men called prostatitis. According to Prostate Cancer UK, CPPS is the most common form of prostatitis, affecting up to 95 per cent of men with prostatitis (i). Other names for CPPS you may hear are prostate pain syndrome, chronic non-bacterial prostatitis and chronic abacterial prostatitis.
Prostatitis can affect men at any age, though it tends to be more common in those in their 30s, 40s and 50s. It’s the name for a set of symptoms caused by inflammation of the prostate gland, a small gland about the size of a chestnut that lies between the penis and the bladder. The prostate’s job is to produce secretions that mix with sperm to create some of the fluid in semen, which it releases into the urethra (the tube running through the middle of the prostate that allows urine to flow out of the body) during ejaculation.
There’s not always an obvious reason why prostatitis develops, though it can sometimes be caused by an infection. What we do know, however, is that it isn’t cancer, and according to Prostate Cancer UK there’s no evidence at the moment to suggest men with prostatitis are more likely to get prostate cancer (i).
What are the symptoms?
The symptoms of prostatitis vary widely and depend on the type of prostatitis you have. With CPPS the main symptom is pain, which can be worse on some days than others and affect one or more of the following:
Perineum (the area between the rectum – back passage – and testicles)
Penis (especially the tip)
CPPS can also cause pain or a burning sensation during ejaculation, as well as sexual problems such as erectile dysfunction and premature ejaculation. It can cause urinary symptoms too, including pain during urination, needing to urinate more frequently (and often more urgently), a weak urinary stream and the feeling that you haven’t emptied your bladder fully after urination. You may experience more general symptoms with CPPS too, including tiredness, other aches and pains, bloating and diarrhoea.
Since CPPS is a chronic condition, it also means the symptoms persist – to be diagnosed, you need to have been having symptoms for at least three months.
Meanwhile, other types of prostatitis include:
Acute bacterial prostatitis (this isn’t common and is caused by a bacterial infection, with symptoms – including a high temperature – developing quickly)
Chronic bacterial prostatitis (also caused by a bacterial infection, but unlike acute bacteria prostatitis the symptoms can last much longer, though they tend to be much milder and can come and go, causing flare-ups)
Asymptomatic inflammatory prostatitis (this doesn’t have any symptoms and is usually diagnosed after being discovered by chance – after having tests for another condition, for instance)
Both acute and chronic bacterial prostatitis share several symptoms with CPPS, such as urinary symptoms and pain. However, whether you have CPPS or another form of prostatitis, the symptoms can have a significant impact on your quality of life.
What causes CPPS?
Since CPPS isn’t caused by a bacterial infection experts don’t yet fully understand what causes it. According to Prostate Cancer UK it may simply be that some men are more likely to get CPPS than others (iii) – though the charity suggests several things may trigger it, including:
Urine getting into the prostate
A history of infections affecting the prostate
Problems with the pelvic floor muscles (the muscles that support your bladder and bowel that help control urination), including previous damage to these muscles
Stress, anxiety and depression (the charity claims some research shows a connection between high levels of stress and anxiety and CPPS, and that feeling stressed or depressed may cause physical symptoms that trigger the condition or make it worse (ii))
Other health problems such as chronic fatigue syndrome and irritable bowel syndrome (some men with CPPS also have symptoms of these conditions)
If you think you may have CPPS, your doctor can diagnose it as well as rule out any other condition your symptoms may be caused by (though bear in mind that you’ll normally only be diagnosed with CPPS if you’ve experienced symptoms for three months or longer). You may be given one or more tests, including an examination of your prostate gland (called a digital rectal examination). You’ll also usually have to give a urine sample to check for the signs of an infection and possibly also a blood test.
On the other hand, if you experience sudden and severe prostatitis symptoms, see a health professional as soon as possible as you may have acute prostatitis, which needs urgent treatment.
How is it treated?
There are several treatments for CPPS that help control the symptoms, and you may need one or more of them depending on what symptoms you’re experiencing. Some of the main treatments include:
Pain relief medication
If your pain is mild, you may find that taking over-the-counter painkillers such as paracetamol helps. Anti-inflammatory painkillers such as ibuprofen may also help you to manage the pain of CPPS, however they aren’t suitable for everyone so ask your GP or a pharmacist if they are safe for you before you try them.
Other drugs that may help with more severe and long-term pain include certain types of antidepressants and anti-epilepsy drugs. These – and some other drugs used to relieve CPPS pain – are available on prescription from your doctor.
Meanwhile, if you don’t get any or much relief from pain-relief medication you can ask your GP to refer you to a specialist NHS pain clinic, where you may be shown a variety of treatments to help control and relieve your pain.
Medicines for urinary symptoms
Certain drugs may help improve some of the urinary symptoms associated with CPPS, including alpha-blockers, which may improve a weak or slow urine flow, and drugs called 5-alpha-reductase inhibitors, which may improve some urinary symptoms by shrinking the prostate gland. These are both more commonly used to treat an enlarged prostate gland, which isn’t the same as prostatitis, though they have been found to help with CPPS symptoms in some men.
Despite the fact that CPPS isn’t thought to be caused by a bacterial infection, certain types of antibiotics are often used to treat it – though their effectiveness is thought to be limited. It is possible that some antibiotics act to reduce inflammation, which may be useful for CPPS, or that they might treat ‘hidden’ bacteria that don’t show up on urine tests.
You may be referred to a specialist for counselling or stress management if your doctor or urologist believes your symptoms may be linked with the way you feel. Some counsellors may also teach you techniques that could help you manage chronic pain, such as techniques used in cognitive behavioural therapy (CBT).
If your CPPS symptoms might be caused by a problem with your pelvic floor muscles, your GP may decide to refer you to a physiotherapist to learn exercises that can help strengthen them, which can help you control your bladder. A physiotherapist may also massage parts of your pelvic floor muscles that are particularly tender, and show you breathing and relaxation techniques that may help with pain relief.
Having all or part of your prostate gland surgically removed isn’t an option for many men with CPPS, as not only can it cause unwanted side effects, but it may make your symptoms worse.
How to help yourself
CPPS is a long-term condition that can have a considerable impact on your day-to-day life, making everyday tasks and activities difficult and uncomfortable. Your GP or specialist can help control your symptoms, but there are a few things you can do yourself that may make life a little easier.
Making time to relax on a regular basis can help if stress or anxiety tends to make your symptoms worse. There are lots of ways to relax – just do whatever makes you feel calm, whether that’s going for a walk in the fresh air, taking a warm bath (this may also help relieve perineal pain), listening to music or using a meditation app on your smartphone.
Having a healthy lifestyle may also help you feel more in control of your symptoms. Staying active, for instance, may help with pain control – though remember to check with your doctor before starting to exercise if you haven’t been very active lately. It is, however, a good idea to avoid any exercise that puts pressure on the perineum, as it could aggravate your symptoms – cycling, for instance (according to Prostate Cancer UK if you want to keep cycling, try using a different saddle, such as one made from gel).
Good nutrition will help support your health in general, so try to have a healthy diet with at least five portions of fruit and vegetables every day. And if you find that certain foods make your symptoms worse – spicy foods, for instance – try to make a point of avoiding them whenever possible. Aim to drink plenty of fluids but limit drinks that contain caffeine such as tea, coffee and cola, as well as alcohol and fizzy drinks, all of which may irritate your bladder.
Some of the other things you could try include the following:
If you have to sit for long periods as part of your working day, you may find it difficult when your symptoms are flaring up. So, try to make yourself comfortable – take a soft cushion to sit on and aim to avoid sitting for too long (try setting a reminder on your smartphone or computer to stand up and stretch your legs every hour or 30 minutes).
Try complementary therapies
Some natural therapies may be useful for relieving stress and pain. According to Prostate Cancer UK, acupuncture may be useful for pain relief, or you could try a natural treatment that helps you to relax, such as massage. Biofeedback therapy – which aims to teach you how to control bodily functions that normally work involuntary – has also been found helpful for CPPS symptoms (iv) (find a biofeedback practitioner by visiting findatherapy.org).
Natural therapies aren’t widely available on the NHS, so if you decide to look for a private therapist try to find one who’s fully qualified and a member of a professional organisation.
Natural supplements for prostate support
Taking certain natural supplements may help relieve the symptoms of CPPS and maintain prostate health in general. If you’re thinking of taking any of the following nutritional or herbal supplements, remember to tell your doctor or specialist about it before doing so, since according to Prostate Cancer UK some natural remedies may interfere with some treatments for prostatitis.
A plant that originates from North America, saw palmetto has been used traditionally by Native Americans for various health conditions, including urinary problems in men. These days it’s often recommended by nutritional therapists for prostate enlargement (benign prostatic hyperplasia or BPH) as well as CPPS, with one open-controlled study suggesting it may be helpful for prostatitis (v).
Found in foods such as red wine, grapefruit, onions, apples, black tea, beans and green leafy vegetables, quercetin is a substance that’s classed as a flavonoid antioxidant. Widely marketed as a remedy for allergy relief, quercetin has also been found to be useful for CPPS symptoms. For instance, one small-scale double-blind placebo-controlled trial found that taking a quercetin supplement improved CPPS symptoms such as pain, while taking a placebo had no effect (vi).
Inflammation plays a significant role in CPPS, which is why anti-inflammatory painkillers are often recommended for CPPS symptoms. Natural alternatives to anti-inflammatory drugs include turmeric, the culinary spice that gives curry dishes their distinctive colour and flavour. The active ingredient in turmeric that’s responsible for its anti-inflammatory effect is curcumin. While there are no direct studies to confirm curcumin’s effectiveness in relieving prostatitis symptoms, there is evidence curcumin may have anti-inflammatory properties and that it may be helpful for pain management (vii).
Magnesium is important for a large number of functions in the body, including prostate gland function. It’s found in a very high concentration in the prostate and is released into seminal fluid. Men with chronic prostatitis may also have significantly lowered magnesium blood levels (viii). To boost your magnesium intake you can eat more foods such as nuts, seeds, oily fish, soya beans, whole grains, dark green leafy vegetables, bananas and yoghurt. If you’re considering taking a supplement to make sure you’re getting the magnesium you need, look for a form that has a high absorption rate, such as magnesium citrate.
Living with CPPS can have a significant effect on your quality of life, but this guide should help to make it a little easier. For more information on a number of common health conditions, feel free to visit our health library.
Available online: https://prostatecanceruk.org/media/2497207/prostatitis-ifm.pdf
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Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.