Chronic Urological Pelvic Pain

For decades, the approach to men suffering from chronic urological pelvic pain (UCPPS) was confined to a specific urological diagnosis, namely prostatitis. Men who experienced discomfort in their genitals, groin, perineum or pelvis were believed to be suffering from prostatitis and were treated, sometimes repeatedly, with long courses of antibiotics, although only 5-7% have been associated with positive bacterial cultures. Sadly, men who exhibited a high white blood cell counts in their semen or prostatic fluid were subjected to antibiotics, which were sometimes coupled with prostatic massages, and those who had no sign of inflammation in their semen were told they had prostadynia, and were usually dismissed or referred to a psychologist. And yet many of these patients also underwent many costly, invasive and unnecessary tests!

At least 50% of men with chronic pelvic pain, also have voiding or micturitional symptoms such as urinary hesitancy, frequency, urgency, intermittency (unintentional stopping and starting a urinary stream) and weak stream. These symptoms perpetuated the false belief that UCPPS was caused by an inflamed or enlarged prostate. It is not surprising that therapies targeting an allegedly abnormal prostate gland (antibiotics, alpha- blockers, anti-androgens) have led to very unsatisfying results in both clinical trials and clinical practice.

Because of the discomfort associated with this disorder as well as the distress, many men also experience changes in sexual functioning which include painful intercourse, decrease erectile function, ejaculatory dysfunction and sometimes painful orgasm or achiness following ejaculation. These symptoms do not respond to the traditional monotherapies listed above, and should therefore be considered an important component of UCPPS, rather than a more distressing independent diagnosis of Erectile or Sexual Dysfunction.

During a meeting of the International Prostatitis Collaborative Network in Bethesda, Maryland in 1998, Dr Jeannette Potts introduced her perception of prostatitis care and research, when she brazenly exhibited her drawing of a prostate gland behinad bars, exclaiming, "I was framed?" She went on to describe her non-prostatocentric approach to patients suffering from UCPPS.

Diagnosis and treatment of patients suffering with UCPPS requires time and patience. A thorough history which takes into account a man's physical, occupational, sexual, spiritual and social well-being is essential to understanding the multifaceted nature of this disorder.

Dr. Potts was the first to propose that prostatitis is a urological brand of a more global syndrome, in the same way that fibromyalgia or irritable bowel syndromes are frequently overlapping diagnoses which may represent only a part of a broader disease process. (Potts, et al. Prostatitis: Urology's Functional Somatic Syndrome, proceedings of the American Urological Association, 2001.) For this reason, Dr. Potts emphasizes the importance of the patient interview and review of symptoms.

In addition to a conventional medical and urological examination, Dr Potts performs a methodical assessment of the musculoskeletal system and the pelvic floor musculature, looking for imbalances and myofascial trigger points, which are a common source of referred pain, characteristic of UCPPS. Neuromuscular abnormalities such as these are also correlated with voiding symptoms as well as rectal pain and changes in defecation or bowel movements.

While there are occasions when medications such as antimicrobials, anti-inflammatories, neuro-modulating agents or muscle relaxants are prescribed, the mainstay of her therapy is self-care, under her guidance and specially trained pelvic floor physiotherapists. Integrative therapies are also individualized and may include acupuncture, cognitive therapy, biofeedback and guided imagery.