Prostatitis causes chronic pelvic pain

New research is shedding light on one of the bigger conundrums in men's health -chronic pain in the pelvis.

Different studies have found it affects anywhere from 2.2 to 9.7 per cent of adult men. It shows up as an ache in the bladder, testicles and penis -places that most of us would rather associate with pleasure than pain.

Finding the cause is often a medical mystery worthy of TV's Dr. House. Noted urologist Dr. Curtis Nickel of Queen's University writes the most common culprit is an inflammation of the prostate gland, adding that at least 90 per cent of all cases of chronic prostatitis are attributable to a bacterial chronic prostatitis/chronic pelvic pain syndrome.

Women don't have prostates, but they can get similar symptoms from a bladder condition called interstitial cystitis.

Although these conditions are frequently treated with antibiotics, doctors are often unable to find the specific bacteria responsible. Perhaps some weird bug is eluding them, or maybe there are no bacteria at all, and the antibiotic is doing something else. Perchance there are psychological factors at play here.

Nickel has been working on an entirely different treatment approach, using an alpha blocker called silodosin. Alpha blockers do a number of things, including relaxing muscles, and are already used to treat men with enlarged prostate glands, as well as for high blood pressure.

In a just-published study, Nickel and his colleagues found that 56 per cent of the adult men receiving silodosin reported moderate or marked improvement in their chronic prostatitis pain, compared to 29 per cent who received placebo.

The high response rate to the placebo is probably a tipoff that this is a complex problem involving both the mind and the body. After all, why would almost a third of the men have reduced pain after receiving sugar pills?

This leads us to an entirely different approach to chronic pelvic pain, made famous in a book called A Headache in the Pelvis by David Wise and Dr. Rodney Anderson. The book is in its sixth edition, and you can find many of its key ideas on the website pelvicpainhelp.com.

Wise and Anderson explain that chronic pelvic pain may arise from the human instinct to protect the genitals, rectum and contents of the pelvis from injury or pain by contracting the pelvic muscles. This leads some people to continuously tighten their pelvic floor muscles, as if they were always trying to stop the flow of urine.

Why is this bad? They use the analogy of keeping your fist clenched for 30 seconds, then 30 minutes, then a whole day.

Eventually, this action is going to lead to pain, which will probably continue even after you relax the muscles. It would take some time, some pampering, and most importantly, no chronic retightening of the fist before your hand felt normal again, they write.

It's actually much easier to deal with a chronic fist clencher than someone who is tensing up their pelvic muscles. After all, we don't usually need to put our fists into a ball.

The pelvic muscles are pressed into service for everyday activities such as walking, lifting and holding in urine. Therefore, they write, it's a delicate juggling act to deal with the need for rest and healing of this vital part of the body on the one hand and the demand on the pelvic muscles to do the work required to function in life.

The book advocates a long-term non-drug approach that puts the work squarely on the person suffering from the pain.

It requires adherence to a program called paradoxical relaxation: a series of exercises to desensitize the trigger points of the pelvic muscles.

The book also delves into the psychological aspects of this condition.

Miller's approach reinforced the idea to his patients that there was a relationship between how they managed the stress in their life and their symptoms.

Obviously, chronic pelvic pain calls out for a trip to the urologist who may indeed treat it successfully with drugs.

Still, it's nice to know that there are other approaches that are helping people with this vexing condition.

Tom Keenan is an award-winning science writer, professional speaker and professor at the University of Calgary.