Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatment

Table of ContentsView All

View All

Table of Contents

Symptoms

Causes

Diagnosis

Treatment

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) affects approximately 2 to 10% of adult males and causes chronicpelvic painand urinary and sexual problems.The cause of this condition is not known, and diagnosis of CP/CPPS can be challenging because many other health conditions have similar symptoms.If you have any of the symptoms of CP/CPPS, it is important to seek help because the condition does not go away on its own and treatment can provide relief.This article will discuss the symptoms and possible causes of CP/CPPS. It will also go through the diagnosis process and potentially similar medical conditions. Common treatments for CP/CPPS are also discussed.Korrawin / Getty ImagesSymptoms of Chronic Prostatitis/Chronic Pelvic Pain SyndromeThe symptoms of CP/CPPS syndrome include the following:Pain in the perineum, pelvis, or rectumPain in the lower back, bladder/lower abdomen, testicles, and penisPain with ejaculationDifficult painful urination and/or weak urine streamUrgency to urinate or increased urinary frequencyErectile dysfunctionAnxiety and depressionWith CP/CPPS, a person usually experiences episodes or flares over many months.CausesIt’s unclear what causes CP/CPPS in males. While a bacterial infection of the prostate used to be the suspected culprit, research has found no evidence of bacteria in prostate tissue in affected individuals, and most experts now believe that CP/CPPS is a non-infectious syndrome.Experts are considering the following as possible causes for the condition:Inflammation from traumaAutoimmune process—when your immune system mistakenly attacks your own healthy cellsInfrequent ejaculationAbnormal reaction to normal prostate bacterial floraIncrease prostate tissue pressureStress, which can tighten the pelvic musclesMore specifically, many experts believe that one of the conditions above may trigger a phenomenon calledcentral sensitization. This may lead to persistent neuropathic pain, similar to what is seen in other chronic pain conditions like fibromyalgia andirritable bowel syndrome.Diagnosis and Related Health ConditionsThe diagnosis of CP/CPPS can be tricky because many other health conditions mimic its symptoms.Some of the other conditions your healthcare provider may consider include:Acute bacterial prostatitisUrinary tract infectionSexually transmitted infections (STIs)Colorectal, prostate, bladder, or testicular cancerAninguinalherniaBenign prostatic hyperplasiaPelvic floor dysfunctionBladder stonesNeurogenic bladderPudendal neuralgiaCP/CPPS is a diagnosis of exclusion, meaning other health problems need to be ruled out first. Your healthcare provider will need to do a thoroughmedical history and physical examinationto determine the cause of your symptoms.In addition to a history and physical examination,laboratory testsare also performed, such as aurinalysisand urine culture. Depending on the risks and symptoms, aprostate-specific antigen (PSA) blood test, urine cytology, urethral discharge culture, and a complete blood count (CBC) may be done as well.Variousimaging testsmay also be warranted based on individual symptoms and laboratory results. For example, if you have blood in your urine, acystoscopyto exclude bladder cancer will likely be performed. Likewise, testicular pain warrants a scrotal ultrasound, and lower abdominal pain often warrants acomputed tomography (CT)scan of the abdomen and pelvis.Treatments for Chronic Prostatitis/Chronic Pelvic Pain SyndromeThe treatment of CP/CPPS usually begins with a combination of three medications: an antibiotic, an alpha-blocker likeFlomax (tamsulosin), and a pain medication such as Tylenol (acetaminophen) or a nonsteroidal anti-inflammatory (NSAID).Sometimes, a medication to treat nerve pain like Lyrica (pregabalin) is also prescribed.Non-medication therapies are also often used for managing the symptoms of CP/CPPS.According to a Cochrane Review, these therapies may help ease the symptoms of CP/CPPS:AcupunctureA physical activity programAdditionally, research suggests that cognitive-behavioral therapy (CBT) can help relieve the symptoms of CP/CPPS, especially pain, urinary problems, and depression. CBT has also been found to improve a person’s overall quality of life.Lastly, pelvic physical therapy to achieve myofascial trigger point release may be useful for those who experience pelvic pain related to pelvic floor muscle spasms.SummaryPeople with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) can experience chronic pelvic pain and urinary and sexual problems. The cause is unknown, and diagnosis can be tricky because CP/CPPS symptoms can also appear in other health conditions. There are treatments available, including medications, acupuncture, and physical activity.CP/CPPS is a complex disease and getting it diagnosed can be a lengthy process. Once diagnosed, most people benefit from a multifaceted treatment program that includes both medication and non-medication treatments.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) affects approximately 2 to 10% of adult males and causes chronicpelvic painand urinary and sexual problems.The cause of this condition is not known, and diagnosis of CP/CPPS can be challenging because many other health conditions have similar symptoms.

If you have any of the symptoms of CP/CPPS, it is important to seek help because the condition does not go away on its own and treatment can provide relief.

This article will discuss the symptoms and possible causes of CP/CPPS. It will also go through the diagnosis process and potentially similar medical conditions. Common treatments for CP/CPPS are also discussed.

Korrawin / Getty Images

Male doctor and testicular cancer patient are discussing about testicular cancer test report. Testicular cancer and prostate cancer concept.

Symptoms of Chronic Prostatitis/Chronic Pelvic Pain Syndrome

The symptoms of CP/CPPS syndrome include the following:

With CP/CPPS, a person usually experiences episodes or flares over many months.

It’s unclear what causes CP/CPPS in males. While a bacterial infection of the prostate used to be the suspected culprit, research has found no evidence of bacteria in prostate tissue in affected individuals, and most experts now believe that CP/CPPS is a non-infectious syndrome.

Experts are considering the following as possible causes for the condition:

More specifically, many experts believe that one of the conditions above may trigger a phenomenon calledcentral sensitization. This may lead to persistent neuropathic pain, similar to what is seen in other chronic pain conditions like fibromyalgia andirritable bowel syndrome.

The diagnosis of CP/CPPS can be tricky because many other health conditions mimic its symptoms.

Some of the other conditions your healthcare provider may consider include:

CP/CPPS is a diagnosis of exclusion, meaning other health problems need to be ruled out first. Your healthcare provider will need to do a thoroughmedical history and physical examinationto determine the cause of your symptoms.

In addition to a history and physical examination,laboratory testsare also performed, such as aurinalysisand urine culture. Depending on the risks and symptoms, aprostate-specific antigen (PSA) blood test, urine cytology, urethral discharge culture, and a complete blood count (CBC) may be done as well.

Variousimaging testsmay also be warranted based on individual symptoms and laboratory results. For example, if you have blood in your urine, acystoscopyto exclude bladder cancer will likely be performed. Likewise, testicular pain warrants a scrotal ultrasound, and lower abdominal pain often warrants acomputed tomography (CT)scan of the abdomen and pelvis.

Treatments for Chronic Prostatitis/Chronic Pelvic Pain Syndrome

The treatment of CP/CPPS usually begins with a combination of three medications: an antibiotic, an alpha-blocker likeFlomax (tamsulosin), and a pain medication such as Tylenol (acetaminophen) or a nonsteroidal anti-inflammatory (NSAID).Sometimes, a medication to treat nerve pain like Lyrica (pregabalin) is also prescribed.

Non-medication therapies are also often used for managing the symptoms of CP/CPPS.

According to a Cochrane Review, these therapies may help ease the symptoms of CP/CPPS:

Additionally, research suggests that cognitive-behavioral therapy (CBT) can help relieve the symptoms of CP/CPPS, especially pain, urinary problems, and depression. CBT has also been found to improve a person’s overall quality of life.

Lastly, pelvic physical therapy to achieve myofascial trigger point release may be useful for those who experience pelvic pain related to pelvic floor muscle spasms.

Summary

People with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) can experience chronic pelvic pain and urinary and sexual problems. The cause is unknown, and diagnosis can be tricky because CP/CPPS symptoms can also appear in other health conditions. There are treatments available, including medications, acupuncture, and physical activity.

CP/CPPS is a complex disease and getting it diagnosed can be a lengthy process. Once diagnosed, most people benefit from a multifaceted treatment program that includes both medication and non-medication treatments.

10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Graziani A, Grande G, Martin M, et al.Chronic prostatitis/chronic pain pelvic syndrome and male infertility.Life (Basel). 2023;13(8):1700. doi:10.3390/life13081700Harvard Medical School Harvard Health Publishing.Chronic nonbacterial prostatitis (chronic pelvic pain syndrome).Kwon JK, Chang IH.Pain, catastrophizing, and depression in chronic prostatitis/chronic pelvic pain syndrome.Int Neurourol J. 2013;17(2):48-. doi:10.5213/inj.2013.17.2.48Bowen DK, Dielubanza E, Schaeffer AJ.Chronic bacterial prostatitis and chronic pelvic pain syndrome.BMJ Clin Evid. 2015;2015:1802.Saint Luke’s.Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).Chen L, Zhang M, Liang C.Chronic prostatitis and pelvic pain syndrome: another autoimmune disease?.Arch Immunol Ther Exp (Warsz). 2021;69(1):24. doi:10.1007/s00005-021-00628-3Arora HC, Eng C, Shoskes DA.Gut microbiome and chronic prostatitis/chronic pelvic pain syndrome.Ann. Transl. Med. 2017;5:30-30. doi:10.21037/atm.2016.12.32Rees J, Abrahams M, Doble A, Cooper A.Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline.BJU Int.2015;116(4):509-525. doi:10.1111/bju.13101Franco JV, Turk T, Jung JH, et al.Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome.Cochrane Database Syst Rev. 2018;26;1:CD012551. doi:10.1002/14651858.CD012551.pub2Herati AS, Moldwin RM.Alternative therapies in the management of chronic prostatitis/chronic pelvic pain syndrome.World J Urol. 2013; 31(4):761-766. doi:10.1007/s00345-013-1097-0Additional ReadingPontari MA, Krieger JN, Litwin MS, et al.Pregabalin for the treatment of men with chronic prostatitis/chronic pelvic pain syndrome: a randomized controlled trial.Archives of Internal Medicine. 2010;170(17):1586-1593. doi:10.1001/archinternmed.2010.319

10 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Graziani A, Grande G, Martin M, et al.Chronic prostatitis/chronic pain pelvic syndrome and male infertility.Life (Basel). 2023;13(8):1700. doi:10.3390/life13081700Harvard Medical School Harvard Health Publishing.Chronic nonbacterial prostatitis (chronic pelvic pain syndrome).Kwon JK, Chang IH.Pain, catastrophizing, and depression in chronic prostatitis/chronic pelvic pain syndrome.Int Neurourol J. 2013;17(2):48-. doi:10.5213/inj.2013.17.2.48Bowen DK, Dielubanza E, Schaeffer AJ.Chronic bacterial prostatitis and chronic pelvic pain syndrome.BMJ Clin Evid. 2015;2015:1802.Saint Luke’s.Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).Chen L, Zhang M, Liang C.Chronic prostatitis and pelvic pain syndrome: another autoimmune disease?.Arch Immunol Ther Exp (Warsz). 2021;69(1):24. doi:10.1007/s00005-021-00628-3Arora HC, Eng C, Shoskes DA.Gut microbiome and chronic prostatitis/chronic pelvic pain syndrome.Ann. Transl. Med. 2017;5:30-30. doi:10.21037/atm.2016.12.32Rees J, Abrahams M, Doble A, Cooper A.Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline.BJU Int.2015;116(4):509-525. doi:10.1111/bju.13101Franco JV, Turk T, Jung JH, et al.Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome.Cochrane Database Syst Rev. 2018;26;1:CD012551. doi:10.1002/14651858.CD012551.pub2Herati AS, Moldwin RM.Alternative therapies in the management of chronic prostatitis/chronic pelvic pain syndrome.World J Urol. 2013; 31(4):761-766. doi:10.1007/s00345-013-1097-0Additional ReadingPontari MA, Krieger JN, Litwin MS, et al.Pregabalin for the treatment of men with chronic prostatitis/chronic pelvic pain syndrome: a randomized controlled trial.Archives of Internal Medicine. 2010;170(17):1586-1593. doi:10.1001/archinternmed.2010.319

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Graziani A, Grande G, Martin M, et al.Chronic prostatitis/chronic pain pelvic syndrome and male infertility.Life (Basel). 2023;13(8):1700. doi:10.3390/life13081700Harvard Medical School Harvard Health Publishing.Chronic nonbacterial prostatitis (chronic pelvic pain syndrome).Kwon JK, Chang IH.Pain, catastrophizing, and depression in chronic prostatitis/chronic pelvic pain syndrome.Int Neurourol J. 2013;17(2):48-. doi:10.5213/inj.2013.17.2.48Bowen DK, Dielubanza E, Schaeffer AJ.Chronic bacterial prostatitis and chronic pelvic pain syndrome.BMJ Clin Evid. 2015;2015:1802.Saint Luke’s.Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).Chen L, Zhang M, Liang C.Chronic prostatitis and pelvic pain syndrome: another autoimmune disease?.Arch Immunol Ther Exp (Warsz). 2021;69(1):24. doi:10.1007/s00005-021-00628-3Arora HC, Eng C, Shoskes DA.Gut microbiome and chronic prostatitis/chronic pelvic pain syndrome.Ann. Transl. Med. 2017;5:30-30. doi:10.21037/atm.2016.12.32Rees J, Abrahams M, Doble A, Cooper A.Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline.BJU Int.2015;116(4):509-525. doi:10.1111/bju.13101Franco JV, Turk T, Jung JH, et al.Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome.Cochrane Database Syst Rev. 2018;26;1:CD012551. doi:10.1002/14651858.CD012551.pub2Herati AS, Moldwin RM.Alternative therapies in the management of chronic prostatitis/chronic pelvic pain syndrome.World J Urol. 2013; 31(4):761-766. doi:10.1007/s00345-013-1097-0

Graziani A, Grande G, Martin M, et al.Chronic prostatitis/chronic pain pelvic syndrome and male infertility.Life (Basel). 2023;13(8):1700. doi:10.3390/life13081700

Harvard Medical School Harvard Health Publishing.Chronic nonbacterial prostatitis (chronic pelvic pain syndrome).

Kwon JK, Chang IH.Pain, catastrophizing, and depression in chronic prostatitis/chronic pelvic pain syndrome.Int Neurourol J. 2013;17(2):48-. doi:10.5213/inj.2013.17.2.48

Bowen DK, Dielubanza E, Schaeffer AJ.Chronic bacterial prostatitis and chronic pelvic pain syndrome.BMJ Clin Evid. 2015;2015:1802.

Saint Luke’s.Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

Chen L, Zhang M, Liang C.Chronic prostatitis and pelvic pain syndrome: another autoimmune disease?.Arch Immunol Ther Exp (Warsz). 2021;69(1):24. doi:10.1007/s00005-021-00628-3

Arora HC, Eng C, Shoskes DA.Gut microbiome and chronic prostatitis/chronic pelvic pain syndrome.Ann. Transl. Med. 2017;5:30-30. doi:10.21037/atm.2016.12.32

Rees J, Abrahams M, Doble A, Cooper A.Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline.BJU Int.2015;116(4):509-525. doi:10.1111/bju.13101

Franco JV, Turk T, Jung JH, et al.Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome.Cochrane Database Syst Rev. 2018;26;1:CD012551. doi:10.1002/14651858.CD012551.pub2

Herati AS, Moldwin RM.Alternative therapies in the management of chronic prostatitis/chronic pelvic pain syndrome.World J Urol. 2013; 31(4):761-766. doi:10.1007/s00345-013-1097-0

Pontari MA, Krieger JN, Litwin MS, et al.Pregabalin for the treatment of men with chronic prostatitis/chronic pelvic pain syndrome: a randomized controlled trial.Archives of Internal Medicine. 2010;170(17):1586-1593. doi:10.1001/archinternmed.2010.319

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