Testing for Chronic Pelvic Pain Syndrome (CPPS)

Medically reviewed by Dr. Paul Song M.D

Article at a Glance

Testing for chronic pelvic pain syndrome (CPPS) can be difficult. It involves looking at the patient’s symptoms and also looking beyond the prostate and into whole body health. This non-bacterial category of prostatitis is the most common, affecting 90 to 95% of prostatitis patients, but it is the most difficult category of prostatitis to diagnose and treat because many problems that cause CPPS originate outside of the prostate itself. In fact, an estimated 50% of CPPS cases are the result of tension in the pelvic floor muscles, which can be caused by stress and emotional health problems. The chronic prostatitis causes that involve tension include pelvic floor disorders, neuromuscular tension, and chronic tension disorders. Inflammation from other places in the body usually accompanies chronic tension in the pelvic floor and that is a major contributor to CPPS.

Testing for Chronic Pelvic Pain Syndrome

The two most effective and comprehensive ways of testing for chronic pelvic pain syndrome are NPAT and UPOINT. These holistic methods evaluate and narrow down the patient’s symptoms so the doctor can recommend a personalized multimodal treatment program specifically tailored to the patient’s needs.

The NPAT Treatment Program for CPPS is a treatment program developed by the leading naturopathic urologist, Dr. Geo Espinosa, N.D. This program recognizes how chronic pelvic pain is grounded in a man’s lifestyle, diet, nutrition, and other factors that originate outside the prostate and may contribute to chronic tension. NPAT stands for:

• Natural treatments (ALCAT, elimination diets, and wheat-free diets),
• Phytotherapy (pollen and quercetin together with probiotics),
• Alternative Treatments (acupuncture, prostate massage, pelvic rehabilitation and therapy), and
• Total body (exercise, chronic stress management, lifestyle)

This holistic, naturopathic program helps health providers create an individualized treatment program that incorporates natural and alternative remedies for prostatitis. The NPAT Program specifically focuses on eliminating pelvic tension because many chronic prostatitis cases generally stem from problems that take place outside of the prostate and elsewhere in the body. The NPAT Program takes into consideration a patient’s mental health, stress level, diet, possible allergies, and other aspects of health to diagnose and treat CPPS.

Doctors can use the new UPOINT System to make more effective treatment decisions for their CPPS patients. The name stands for the following domains:

• Urinary,
• Psychosocial,
• Organ specific,
• Infection,
• Neurologic/systemic, and
• Tenderness

The system was developed by a urologist to help doctors and patients customize their CPPS treatment program. A patient is classified as “yes” or “no” for each of the six domains in UPOINT. Once the doctor can see the problem areas and where the symptoms lie, he or she can provide treatments that have proven to effective for those problems. This helps patients avoid unnecessary and ineffective treatment.

In addition to giving the National Institutes of Health Chronic Prostatitis Symptoms Index (NIH-CPSI), a doctor may also run the following tests for ruling out the specific domains when using the UPOINT system:

Urinary: Measure post-void residual by ultrasound

Psychosocial: Determine if patient has clinical depression or feelings of helplessness and hopelessness, also called catastrophizing

Organ Specific: Test for pain improvement after emptying of the bladder and prostate tenderness (through massaging and feeling the prostate for tenderness)

Infection: Cultures for urine, mycoplasma and ureaplasma, expressed prostatic secretions, or urine after post-prostate massage

Neurologic/Systemic: Ask about pain outside of pelvic region and presence of other pain syndromes

Tenderness: Palpation of abdominal and pelvic skeletal muscles via rectum to check for muscle spasm and trigger points

Doctors can use both NPAT and UPOINT when testing for chronic pelvic pain syndrome to narrow down a patient’s symptoms and their causes. Following these guidelines, doctors can work one on one with patients to develop an individualized treatment plan that utilizes multiple treatments proven to work for the specific symptoms. These methods also help patients avoid following unnecessary and potentially harmful treatments that do not work for CPPS, such as antibiotics. Research on CPPS treatments has found that employing a multimodal treatment program (including both natural and alternative treatments for prostatitis) is the best course of therapy. A multi-treatment approach helps men find the path to recovery and pain relief.