Chronic Prostatitis or Chronic Pelvic Pain Syndrome?

A recent Johns Hopkins Health Alert reflects a current issue in the family practice and urology clinics. For decades, men who presented to their medical care provider with symptoms of perineal aching and malaise were diagnosed with prostatitis, or inflammation of the prostate gland, and then they were given antibiotics. It is not uncommon to meet men who have been on multiple courses of antibiotics over a period of years. Due to research that has emerged over the past decade, the prescribing of antibiotics has been questioned since most men do not actually have an infection.

Jeanette Potts, urologist, has written several articles and presented research about this issue. You can read an article about prostatitis by Dr. Potts by clicking here. The article describes the importance of classifying patients accurately into true infection versus chronic pain or neuromuscular dysfunction. The general population estimate for prevalence of prostatitis is 5-10%, and the estimated number of patients diagnosed with prostatitis who actually have an infection (bacterial prostatitis) is also 5-10%.

As pointed out in the Johns Hopkins alert, " ...the impact of CPPS on a man's quality of life is often devastating." In addition to pain and discomfort, patients may also suffer from urinary frequency that interferes with work and home activities. This NIH public access article describing the life impact of urologic pain syndromes also lists fatigue, sexual dysfunction, limited social roles and negative emotional changes as concerns for patients.

It can be challenging for physicians (and the patient) to modify the habit of prescribing antibiotics for prostate region pain. Increased awareness about the condition and about the change in focus (from prostate alone to consideration of the pelvic muscles and the neurologic systems as well) can help the pelvic rehab provider to share knowledge with both referral sources and patients. You can learn more information about the treatment of prostatitis in the Institute's Level 2A course as well as in the Male course.