Chronic Pelvic Pain Syndrome

Chronic pelvic pain syndrome (CPPS) includes nonbacterial prostatitis (NBP) and prostatodynia(PDY). It is a clinical syndrome with pelvic pain and discomfort as the main symptoms, accompanied by various urination symptoms and sexual dysfunction, but infection can not confirm.

This disease may be caused by an unknown pathogenic microorganism or a noninfectious disease, or it may be caused by pelvic tension myalgia unrelated to the prostate itself. This type of prostatitis can be divided into two subtypes: inflammatory CPPS (type Ⅲa) and noninflammatory CPPS (type Ⅲb).

Causes

1. Pathogen infection

2. Voiding dysfunction

3. Psychological factors

4. Neuroendocrine factors

5. Abnormal immune response

6. Pelvic diseases

7. Lower urinary tract epithelial dysfunction

8. Theory of oxidative stress

Symptom

1. Pain and discomfort in the perineum, suprapubic area, penis, scrotum, groin, lower back, and urethra, especially the tip of the penis and glans.

2. Various symptoms of urinary tract stimulation or urinary obstruction in different degrees, such as urgency, frequency, pain, hesitation, interruption of urination, weak urine flow and post-micturition dribble and other urination disorders.

3. Patients can also have pain and discomfort after ejaculation. There were no abnormal findings in a routine physical examination and nervous system examination of chronic pelvic pain syndrome, but it finds that the anal sphincter was tight, tenderness in the prostate gland, and the tissue around the prostate was tense. Mild and moderate bladder neck obstruction and different degrees of bladder trabecula formation can be shown in the Cystoscopy.

Diagnosis

The diagnosis of CPPS is exclusive. CPPS is a common reaction to different types of damage caused by various causes. In addition to pain, patients are also often accompanied by other sensory, functional, behavioral, and psychological changes. During the diagnosis process, the clinical manifestations of each patient should be carefully recorded.

1. Medical history

The time when pelvic pain occurs, whether it is a continuous pain, intermittent pain or periodic pain;

The inducement of pain, the relationship between pain and emotional change should also be paid attention to;

Relationship between pain and body position change;

The location of the pain is limited to a specific organ or involves multiple organs in the pelvis.

If necessary, relevant quantitative tables can be used for quantification and evaluation, such as pain level (assessed by cognitive and emotional variables), international erectile function index (IIEF), intravaginal ejaculation latency (IELT), depression score, quality of life score (QOL), etc.

It is important to understand anxiety, depression, and sexual problems for pain assessment and treatment planning whether patients have suffered sexual, physical, or emotional abuse or not, and the social-psychological state when pain occurs.

2. Physical examination

Whether the pelvic pain has a clear location, if there is any organic change in the pain site, such as the size, texture, mass, tenderness of testis, epididymis, prostate, etc. Examine the trigger point of myofascial pain and the muscle pain that may span (referred pain). The function of pelvic floor muscles can be known by digital rectal examination.

3. Laboratory examination

Including urine routine analysis and urine sediment examination, EPS routine examination, four-cup (or two-cup) bacteriological examination, etc.

4. Special inspection

Including cystourethroscopy, external genitalia ultrasound, transrectal prostate ultrasound, CT, and MRI imaging if necessary. EMG is an optional CPP assistant examination.

The purpose of diagnosis is to exclude the specific diseases of pelvic pain, such as infection, tumor, etc. Once the obvious pathogenic factors are eliminated, there is no need to repeatedly or excessively concentrate on further identifying the pathogenic factors.

Treatment

1. Western medicine treatment

Antibiotic

Anti-inflammatory treatment

α receptor blockers and five α reductase inhibitors

Botanical preparation

Analgesic treatment

Psychotherapy

Biofeedback therapy (often combined with electrical stimulation)

Hyperthermia

Prostate massage

Prostate injection/transurethral prostate perfusion

Extracorporeal shock wave therapy via the perineum

2.Traditional Chinese medicine treatment

This treatment option can effectively improve the patients' pain and discomfort, micturition problems, and quality of life. The reason why CPPS is difficult to treat is also determined by the structure of the gland, and the outer capsule blocks the entry of drugs.

The commonly used medicines can not penetrate into the prostate tissue, and the concentration of ingredients reaching the gland body is low, which can not reach the bactericidal concentration. Moreover, the side effect is large, which is easy to produce drug resistance.

Traditional Chinese herbal medicine contains many ingredients, which can not only eliminate inflammation, avoid flora disorder and side effects, but also improve the immune status of patients. For example, the common herbal medicine Diuretic and Anti-inflammatory Pill with a high cure rate can play a good role in the treatment of CPPS.

The peach kernel and red peony in the formula can play the role of promoting blood circulation and blood stasis, relieving pain and swelling and unblock the blocked prostate gland tube. And the application of cowherb seed, plantain, Dianthus Superbus and houttuynia cordata can effectively remove the cause of disease, reduce frequent urination and other symptoms.

In addition, taking herbal medicine with other traditional Chinese medicine treatments, such as herbal sitz bath, acupuncture, can also improve the blood circulation, promote metabolism, enhance the dissolution of leukocyte releasing protein.

The warm stimulation can also reduce the excitability of nerves, inflammatory edema, relieve the pressure of nerve endings so as to relax the muscles, ligaments, and other tissues of patients so as to reduce swelling and relieve pain Effect.

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