Prostatitis

Technically this term refers to an inflammation of the prostate gland which causes pain in the pelvis and perhaps on passing urine, obstruction of the urethreal urine flow and voiding problems like frequency, urgency and hesitancy. The inflammation may be due to a bacterial infection in which case it responds well to a course on an appropriate antibiotic medication.

However, most cases labeled as prostatitis are non-bacterial where the man has no signs of a urinary tract infection (fever, positive pathology of a urine sample, smelly urine, etc.). As it turns out, many of these cases are not primarily related to the prostate, and the assumption by medical staff that it is prostatitis may result from substandard evaluation of the patient, a misunderstanding of the term or an assumption that it will sort itself out and the antibiotics won’t do any harm (1). All three of these errors on their own have the potential to cause harm and when applied together the damage and/or delay to access appropriate treatment can be significant for the health and quality of life of the man involved.

Yet since 1999, the expert panels on diagnostic criteria for this condition acknowledged that non-bacterial prostatitis would be more accurately described as ‘chronic pelvic pain syndrome’ (1). A later review further recommended that the use of antibiotics should be withheld until a second culture yielded the same bacterial profile (1).

Chronic pelvic pain in males (as for females) is a complex problem often involving physical, functional, psychological and co-morbiity issues. Everything from a possible history of sexual trauma, chronic bladder/bowel dysfunction, lower back or SIJ injuries, pelvic surgery or recurrent bladder or urinary tract infections.

As such, no one type of practitioner can reliably assess for all the related factors that may be causative or barriers to recovery. Let alone treat them all. So a multidisciplinary approach is considered best practice. Acknowledging there is no gold standard to treamentn Smith (3) reviews 16 treatment options and concludes that a multidisciplinary approach with multi-modal therapy appears to give the best outcome for patients. His list includes physiotherapy for myofascial trigger points.

Every man with a diagnosis of non-bacterial prostatitis is a man with chronic pelvic pain syndrome. The role of pelvic physiotherapists is to include or exclude mechanical, biomechanical and myofascial contributions to his condition and manage them in a reasonable and accountable time frame using objective outcome measures. This may occur while the patient is being treated by other practitioners who may be pursuing a pharmaceutical, nutritional or psychosocial approach.

Physiotherapy evaluation and treatment will include spinal segments from T12 to S4, lumbar and pelvic articulations, the hip joint, deep pelvic and anterior abdominal muscles, neural pathway restrictions and sensitisation, pelvic floor muscle function and myofascial trigger points at the least.

  1. Potts, J.M., 2015 Male pelvic pain syndrome: escaping the snare of prostatocentric thinking. Curr Bladder Dysfunt Rep 10:75-80.
  2. Barampwslo A, Mandeville A, Edwards S, Brook S, Cambitzi J, Cohen M. 2013. Male chronic pelvic pain syndrome and the role of interdisciplinary pain management. World J Urol 31:779-784
  3. Smith C, 2016. Male chronic pelvic pain: an update. Ind J of Urol 32:34-39

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