Chronic Pelvic Pain Syndrome (CPPS)

Medically reviewed by Dr. Paul Song M.D

• Chronic pelvic pain syndrome (CPPS) is the most common form of prostatitis.
• CPPS is responsible for 2 million urology appointments every year in the US.
• CPPS is often caused by other problems in the body outside of the prostate itself.
• The best treatment programs involve a combination of natural and alternative therapies.

Chronic pelvic pain syndrome (CPPS) is the most common form of prostatitis, making up about 90 to 95% of all cases of prostatitis. This form is also referred to as chronic nonbacterial prostatitis or just chronic prostatitis (CP). This form of prostatitis involves more areas of the pelvis and areas outside of the prostate itself.

The official definition of CPPS describes it as pain in a man’s pelvic region that lasts longer than three months, but there are many other symptoms than just pain. Chronic pelvic pain syndrome is not just the most common form of prostatitis; it is the most commonly diagnosed urological problem for men over 50 and the third most commonly diagnosed urological problem among younger men, according to Medscape. An estimated 40% of all urological visits—2 million every year—are for CPPS.

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Having CPPS can profoundly affect a man’s mental state and quality of life. Because it is so frustratingly difficult to treat, it is emotionally hard to deal with. If does not help when doctors tell patients that chronic pelvic pain is not life threatening. A common response to that statement is, “It may not threaten my life, but it threatens my ability to live my life and hurts my overall quality of life. I know that it may not kill me but it does affect my life.” And that is understandable. With long-term symptoms such as chronic pelvic discomfort, pain when ejaculating, and urinary issues, the ongoing health issues can be very difficult to deal with.

This disease frustrates and confuses both patients and doctors. Without a generally accepted medical cause for CPPS, it makes it hard for doctors to diagnose and treat it. There is another interesting fact about CPPS—even though it is not a bacterial form of prostatitis, bacteria may still play a role in some cases of this disease. Bacteria seem to have an ability to remain undetected or have a different effect on the prostate in men who have CPPS. Because of this aspect, most urologists prescribe antibiotics for CPPS as an initial treatment just in case there are bacteria hiding that they have not detected during diagnosis. On the other hand, modern naturopathic doctors try to avoid prescribing antibiotics believing them to do more harm than good for the CPPS patient if bacteria are not identified.

So let’s recap. When dealing with different cases of CPPS, you may find cases with inflammation or no inflammation; and you may find cases with bacterial causes or nonbacterial causes. No wonder it is so hard to diagnose and treat. Beyond those two big factors, there are a number of other possible chronic prostatitis causes—trauma, autoimmune disorders, food intolerance, pelvic floor disorders, chronic stress, other infections and many others. That is why it is important to work with a doctor who can look at the whole person and treat it holistically and with a variety of treatments.

The above factors may be a bit vague, but here are some more specific criteria. To be diagnosed as CPPS, the symptoms must be present for at least three months and the symptoms may also come and go (which you may remember is similar to chronic bacterial prostatitis). One of the most distinguishing features of CPPS is that it is accompanied by unexplained chronic pelvic pain. This pain can vary in consistency and how much it affects a man’s life. Some men are fortunate enough to have their pain and symptoms improve over time even without receiving treatment; other men need more ongoing treatment such as medications for urinary symptoms and pain or they seek relief in more natural and alternative options like prostatic massage, phytotherapy, ice packs, cognitive training, exercise, and other natural therapies.

Am I at Risk for Chronic Pelvic Pain Syndrome?

Being that the majority of prostatitis sufferers have CPPS, and half of men have some prostatitis symptoms at some point in their lives, you should be aware of CPPS symptoms and seek treatment right away if you do experience pelvic pain. Younger men are more at risk for this type of prostatitis as the median age of CPPS patients is 43. Early and aggressive treatment is important for men who want to father children because the disease can lead to infertility in untreated long-term.

All men who live with ongoing CPPS can benefit from making lifestyle changes. These modifications include dietary changes, adopting stress management techniques, and embarking on a journey to explore potential causes in their lives like chronic tension or a pelvic floor disorder. Men should keep an open mind about researching natural and alternative treatments that have been proven effective for prostatitis.