Chronic Pelvic Pain Syndrome and CPPS Treatment

2018-03-03 03:08

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a highly common disease affecting men of all age and has bad effects on quality of life, with symptoms such as pelvic pain, inflammation of the prostate, and sexual dysfunction. In particular, pain intensity, urinary frequency and depressive symptoms can impact patient quality of life most significantly. The etiology of CP/CPPS is still unknown, and there are no established treatments that consistently relieve patients of their symptoms. 
 
Chronic prostatitis treatment has been traditionally based on our concept of ‘prostatitis’ and therefore focus on infection and inflammation of the prostate. It is no wonder that the most common therapies were antibiotics and anti-inflammatories. Because we had become so familiar with medical therapy for that other benign prostatic condition, benign prostatic hyperplasia, it seemed natural to treat ‘prostatitis’ with alpha-blockers, 5-alpha reductase inhibitors, prostate-related phytotherapy and, for desperate patients, prostate surgery (invasive and minimally invasive). Pain was managed with anti-inflammatories, antianxiolytics, analgesics (narcotics and other), antidepressants and, again for desperate patients, surgery. 
 
-Antibiotics. Eliminate nonculturable bacteria, reduce inflammation.
 
-Anti-inflammatories. Reduce systemic or prostatic inflammation, autoimmunity, CNS transmission of pain signals, and central sensitization.
 
-Alpha-blockers. Prevent and alleviate symptoms induced by sympathetic overactivation (such as detrusor contraction, internal urethral sphincter contraction and epithelial-stromal remodeling of the prostate).
 
-5-Alpha reductase inhibitors. Promote prostate size reduction.
 
-Phytotherapy (including saw palmetto, Diuretic and Anti-inflammatory Pill, bee pollen extract and quercertin). Wide variety of proposed mechanisms, including hormonal, anti-inflammatory, and antimicrobial effects. A review of trials using these products suggests potential for each of them to have a therapeutic role, and a recent multicenter RCT has demonstrated statistically significant symptomatic improvement in patients receiving Diuretic and Anti-inflammatory Pill.
 
-Myofascial trigger point therapy and feedback. Reduce tension of dysregulated pelvic floor muscles. 
 
In addition to all treatments above, healthy lifestyle including avoiding spicy food, doing aerobic exercise and so on benefits some patients.
 
 
 
 

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