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Chronic Pelvic Pain Syndrome (CPPS)
- CPPS (1/3): definition and etiology
- CPPS (2/3): signs and symptoms, diagnostic work-up
- CPPS (3/3): Treatment
The chronic pelvic pain syndrome (CPPS) is characterized by
- chronic or recurrent pain for at least six months, which is perceived in structures of the pelvis
- the CPPS affects women as well as men
- without evidence of pelvic organ disease (diagnosis of exclusion)
- CPPS is associated with symptoms of the lower urinary tract and rectum and often has negative consequences regarding sexuality and psychological well-being.
- If pain is felt in a single organ or area (e.g. urinary bladder, prostate, testis, perineum, vulva, or after vasectomy), more specific terms should be used: bladder pain syndrome, prostate pain syndrome, testicular pain syndrome, pelvic floor pain syndrome, vulvar pain syndrome, or postvasectomy testicular pain syndrome.
Obsolete terms: in the absence of symptoms and signs of bacterial infection of the prostate, the term chronic prostatitis should not be used for CPPS. The syllable "-itis" in the disease term leads both the patient and the therapist astray. For the definition of chronic prostatitis, see bacterial prostatitis. Furthermore, terms like prostatodynia or vulvodynia are discouraged. EAU guidelines: (Engeler u.a., 2020).
Epidemiology of Chronic prostatitis
Recurrent pain in the prostate area, but also testis or penis, is common and a frequent urological diagnosis. 5% of men aged 20–50 years, age peak between 20–49 years and above the 70th years of age.
Etiology (Causes) of the Chronic Pelvic Pain Syndrome
The etiology of CPPS is heterogeneous, as implied by the definitions. A multifactorial genesis of pain with triggering as well as disease-sustaining factors is likely.
Visceral pain is typical for CPPS: sudden and severe onset, diffuse and difficult to localize, accompanying vegetative reactions, radiation of pain to skin and muscle regions, and hyperalgesia.
are often (recurrent) infections, injuries or dysfunctions, which repeatedly cause a pain stimulus. In a small proportion of patients, this pain can become independent of the triggering cause due to neuromodulatory processes.
Neuroplasticity of the CNS:
as the disease progresses, recurrent stimuli lead to central sensitization: increased sensitivity of pain receptors, pain pathways and CNS areas. This lowers the stimulus threshold for pain perception (allodynia) and also causes the perception of pain in other areas, making diagnosis and therapy more difficult.
the low threshold for pain perception leads to pain and dysfunction of the pelvic floor (tendinopathy, myogeloses or myofascial trigger points). Activation of the pelvic floor leads to pain during micturition or ejaculation, and avoidance behavior due to negative experiences develops.
is the increased perception of visceral afferents (storage, emptying, organ pain) by central sensitization. Visceral hyperalgesia is not only present in chronic pain due to above mentioned neuroplastic processes in the CNS. Even after acute cystitis, an overactive bladder can develop via this mechanism lasting several weeks.
anxiety disorders, depression and personality disorders are more frequent in patients with CPPS than in controls. There are several explanations for this: on the one hand, mental illness may negatively influence pain perception, and on the other hand, chronic pain leads to mental illness:
Stressful experiences in the past (such as death, separation, or abuse) increase the stress level of the organism: increasing muscle tension, leads to exhaustion and makes one more receptive to pain stimuli. The resulting worry and anxiety lead to further stress and a vicious cycle.
Chronic pain leads to exhaustibility and restrictions in daily life with a higher risk of social and professional retreat, and in the course reactive depression.
|Bacterial prostatitis||Index||Prostatitis symptoms|
Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
- Fall, M.; Baranowski, A. P.; Elneil, S.; Engeler, D.; Hughes, J.; Messelink, E. J.; Oberpenning, F.; de C Williams, A. C. u.a.
- EAU guidelines on chronic pelvic pain.
Eur Urol, 2010, 57, 35-48
- Krieger u.a. 1999 KRIEGER, J. N. ; NYBERG, Jr. ; NICKEL, J. C.:
- NIH consensus definition and classification of prostatitis.
282 (1999), Nr. 3, S. 236–7
- Nickel 2003 NICKEL, J. C.:
- Recommendations for the evaluation of patients with prostatitis.
In: World J Urol
21 (2003), Nr. 2, S. 75–81
- Schaeffer u.a. 2002 SCHAEFFER, A. J. ; DATTA, N. S. ; FOWLER, Jr. ; KRIEGER, J. N. ; LITWIN, M. S. ; NADLER, R. B. ; NICKEL, J. C. ; PONTARI, M. A. ; SHOSKES, D. A. ; ZEITLIN, S. I. ; HART, C.:
- Overview summary statement. Diagnosis and management of chronic
prostatitis/chronic pelvic pain syndrome (CP/CPPS).
60 (2002), Nr. 6 Suppl, S. 1–4
Deutsche Version: Chronische Prostatitis und chronisches Beckenschmerzsyndrom