Chronic pelvic pain is generally defined by chronic pain in the region of the pelvis (Lai, 2015).
It is a common symptom that can be caused by several different structural and functional dysfunctions/disorders that affect the anorectal area, urinary bladder, reproductive system, and pelvic floor muscles. Unlike pelvic pain caused by structural diseases like endometriosis, pelvic pain linked with functional disorders cannot be explained by an organic or other specified pathological reason (Clemens, 2008).
Functional disorders that can cause pelvic pain are classified into three general categories:
Chronic nonbacterial prostatitis is sometimes described as a “headache in the pelvis” with pain symptoms affecting urinary and sexual function. It’s a tricky condition because as “nonbacterial” suggests, the pain and inflammation is not tied to a known bacterial infection, which can confuse both the patient as well as their healthcare providers. Yet, the pain is real and their negative affects on quality of life are real as well. The pain caused by nonbacterial prostatitis can be disabling, preventing participation in valued activities and causing isolation and depression.
Possible causes of nonbacterial prostatitis include:
Chronic inflammation has been deeply explored as the cause of CP/CPPS during the past twenty years. In a literature review by Bresser et al. (2017), evidence over the years points to the possibility that dysregulated inflammation and autoimmunity directed against prostate antigens may be a factor in the development of chronic prostatitis and chronic pelvic pain.
Further study of how histamine release and inflammation contribute to chronic pelvic pain, may help find more effective therapies for those with chronic pelvic pain.
Treatment for nonbacterial prostatitis is difficult as there is has been limited research regarding interventions. However, here is a roundup of the treatments that have shown to have some benefit, including pelvic floor physical therapy.
Pelvic floor physical therapy has been shown to help manage the symptoms of chronic pelvic pain by helping manage pain through the following modalities:
Breser ML, Salazar FC, Rivero VE, Motrich RD. Immunological Mechanisms Underlying Chronic Pelvic Pain and Prostate Inflammation in Chronic Pelvic Pain Syndrome. Front Immunol. 2017;8:898. Published 2017 Jul 31. doi:10.3389/fimmu.2017.00898
Lai H, Gereau RWT, Luo Y, O’Donnell M, Rudick CN, Pontari M, et al. Animal models of urologic chronic pelvic pain syndromes: findings from the multidisciplinary approach to the study of chronic pelvic pain research network. Urology (2015) 85:1454–65.10.1016/j.urology.2015.03.007
Clemens JQ. Male and female pelvic pain disorders – is it all in their heads? J Urol (2008) 179:813–4.10.1016/j.juro.2007.12.001 [PubMed]
Anderson RU, Wise D, Sawyer T, Chan C. (2005). Integration of Myofascial Trigger Point Release and Paradoxical Relaxation Training Treatment of Chronic Pelvic Pain in Men. Journal of Urology;174:155–60. PMID: 15947608.
FitzGerald MP, Anderson RU, Potts J, et al. (2009). Randomized Multicenter Feasibility Trial of Myofascial Physical Therapy for the Treatment of Urological Chronic Pelvic Pain Syndromes. Journal of Urology;182:570–80. PMID: 19535099.
O’Leary, M. (2011). Treating prostatitis: Any cause for optimism?. Harvard Medical School Health Publications: Prostate Knowledge. Accessed at: https://www.harvardprostateknowledge.org/treating-prostatitis-any-cause-for-optimism