Chronic pelvic pain syndrome

Clinic

• Chronic Prostatitis/ Chronic pelvic pain syndrome (CP/CPPS), previously known as chronic nonbacterial prostatitis
• It is long-term pelvic pain and lower urinary tract symptoms (LUTS) without evidence of a bacterial infection.
• It affects about 2–6% of men. Together with IC/BPS, it makes up urologic chronic pelvic pain syndrome (UCPPS).
• The cause is unknown.

Signs / Symptoms

• Chronic pelvic or perineal pain without evidence of urinary tract infection
• Pain may radiate to the back and rectum, making sitting uncomfortable.
• Pain can be present in the perineum, testicles, tip of penis, pubic or bladder area.
• Dysuria, arthralgia, myalgia, unexplained fatigue, abdominal pain, constant burning pain in the penis, and frequency may all be present.
• Frequent urination and increased urgency may suggest interstitial cystitis
• Post-ejaculatory pain, mediated by nerves and muscles, is a hallmark of the condition, and serves to distinguish CP/CPPS patients from men with BPH or normal men.
• Some patients report low libido, sexual dysfunction and erectile difficulties

Causations

Pelvic floor dysfunction theory

• CP/CPPS maybe a psychoneuromuscular (psychological, neurological, and muscular) disorder.
• Anxiety or stress results in chronic, unconscious contraction of the pelvic floor muscles, leading to the formation of trigger points and pain.
• The pain results in further anxiety and thus worsening of the condition.

HPA axis theory

Stress-driven hypothalamic–pituitary–adrenal axis dysfunction and adrenocortical hormone abnormalities or peripheral nerves inflammation maybe the etiology of CP/CPPS

Bacterial infection

The bacterial infection theory was shown to be unimportant in a 2003 study which found that people with and without the condition had equal counts of similar bacteria colonizing their prostates.

Overlap with IC/PBS

• Interstitial Cystitis, Painful Bladder Syndrome and CP/CPPS could be under the umbrella term Urologic Chronic Pelvic Pain Syndromes (UCPPS)
• UCPPS is a term adopted by the network to encompass both IC/BPS and CP/CPPS, which are proposed as related based on their similar symptom profiles
• There is a potential relationships between UCPPS and other chronic conditions that are sometimes seen in IC/PBS and CP/CPPS patients, such as Irritable bowel syndrome, fibromyalgia, and Chronic fatigue syndrome.

Miasm

• It has not only unknown etiologies but also it has very loose border with other similar disease.
• I think, nothing except miasms could explain the extent of Sign / Symptoms and also the undefined borders of CP/CPPS with
  • CFS
  • Fibromyalgia
  • IBS
  • Prostatitis
  • Interstitial cystitis

The best miasm would be HSV-1 and HSV-2