Chronic Pelvic Pain CPPS Symptoms

Medically reviewed by Dr. Paul Song M.D

Article at a Glance

Chronic pelvic pain syndrome (CPPS) is also called chronic non-bacterial prostatitis. Chronic pelvic pain syndrome is by far the most common type of prostatitis affecting men. It is important for men to recognize chronic pelvic pain (CPPS) symptoms and signs so they can seek treatment as soon as possible. It may not be as serious as acute bacterial prostatitis, but can become a debilitating condition and the sooner you get to work on finding the causes of the symptoms and treating CPPS, the better.

Chronic Pelvic Pain Syndrome (CPPS) Symptoms

There are three main groups of CPPS symptoms:

1. pain
2. urinary tract problems
3. sexual problems

Of these three categories, the most dominant symptom is pain. The pain is most commonly experienced in the perineum—the area between the anus and the base of the penis. To fulfill criteria for being diagnosed as CPPS, the pain must be present for at least three months. The pain and other chronic prostatitis symptoms may come and go rather than be persistent and may also be accompanied by unexplained fatigue.

The pain symptoms associated with CPPS include:

• Lower back pain
• Pelvic pain or pain above the pubic bone
• Rectal pain
• Perineum pain (area between the anus and the scrotum)
• Genital pain
• Feeling like you are sitting on a tennis ball or a peach pit
• Sitting for long periods triggers or exacerbates pain and symptoms
• Pain or discomfort in the penis tip or shaft
• Testicle ache or pain
• Pain in and around the tailbone
• Groin pain that can be in either side (or both sides)
• Discomfort (or relief) after having a bowel movement
• Depression
• Self-esteem problems
• Social withdrawal
• Problems with intimate relations
• Anxiety

Men with CPPS commonly experience sexual function problems. These sex-related symptoms can include the following:

• Pain or discomfort during intercourse
• Painful ejaculation or pain after ejaculating
• Ejaculatory dysfunction
• Erectile dysfunction
• Blood in semen
• Reduced libido
• Anxiety about having sex

It can be devastating to men whose sex lives are affected by CPPS. If sex is less enjoyable it tends to reduce sexual frequency. Even though some men feel pain during or after ejaculation, other men can actually feel better after they ejaculate. Some men worry about the safety of having sex with prostatitis. The good news is that sex is generally safe (unless the prostatitis is related to a sexually transmitted disease which should be treated and ruled out for both partners).

Urinary tract problems are also a hallmark of CPPS. Men with CPPS may experience the following symptoms:

• Painful urination
• Burning sensation during urination
• Feeling like you cannot completely empty your bladder
• Frequent need to urinate frequently (more often than every two hours)
• A strong urge to urinate immediately
• Weak urinary flow
• Frequent nighttime urination
• Dribbling or urinary incontinence
• The need to urinate keeps you from doing ordinary daily activities or from things you want to do
• Hesitancy before or during urination

If you are experiencing any of these urinary symptoms, contact your healthcare provider as soon as possible so you can determine if you have CPPS. A prompt diagnosis and treatment of CPPS is critical, as this form of prostatitis is a challenge to treat and requires specific treatment modalities combining alternative and natural therapies. Left untreated, it can develop into a frustrating long-term condition.

Chronic pelvic pain syndrome may be the most common type of prostatitis, but it is the hardest kind of prostatitis to diagnose and treat. So many men are misdiagnosed with other similar conditions to prostatitis, such as an enlarged prostate (BPH). Doctors don’t know exactly what causes prostatitis symptoms and CPPS, but there are a number of theories. These include an abnormal buildup of pressure in the urinary tract, irritation resulting from an autoimmune or chemical process, food intolerance, trauma, or pain generated in the nerves and muscles within the pelvis such as a pelvic floor spasm resulting from a chronic tension disorder. An estimated 50% of CPPS cases stem from tension or dysfunction in the pelvic floor.

Diagnosing CPPS is challenging because there is no single test of culture for it. Tests don’t usually find bacteria, so antibiotics do not work for CPPS. Doctors use a few systems, such as UPOINT and the National Institute of Health’s Chronic Prostatitis Symptoms Index (CPSI), to determine how severe the symptoms are and which treatments will work best for a patient’s specific symptoms. One of the key things a doctor can check for is pelvic muscle tension when performing a digital rectal exam. Pelvic tension is often a major cause of prostatitis symptoms.

So here’s some good news and bad news about treating CPPS. The bad news is that there is no quick-fix pill you can take. The good news is that there are a number of treatments. You may find the best relief in complementary and alternative prostatitis treatments. These natural and drug-free treatments include quercetin and pollen supplements, acupuncture, stress management, trigger point therapy, prostate massage, and even yoga. There are many other natural therapies that can help CPPS sufferers, so do not give up hope. You just have to keep an open mind and keep trying to find the right combination that works for your symptoms.

One of the solutions may be in looking at diet to determine if there is a food allergy or intolerance or even a trigger. Men who have dietary causes of their CPPS symptoms can learn to avoid foods that trigger their symptoms. Looking at diet and lifestyle is part of examining your whole-body health so you can find out how to approach CPPS. The most successful treatment plans include several different therapies and lifestyle changes that lead to finding relief from your prostatitis symptoms.