The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is using the umbrella term Urologic Chronic Pelvic Pain Syndromes (UCPPS) to replace pain syndromes associated with the bladder:
- Bladder pain syndrome/Intersistital Cystitis (BPS/IC)
- Pain arising from the prostate gland (chronic prostatitis/chronic pelvic pain syndrome, CP/CPPS).
Although the term, Urologic Chronic Pelvic Pain Syndrome is used for research purposes only at this stage, it appears to be a much more descriptive diagnosis since the shift is occurring in research and practice from a bacterial cause of chronic prostatitis to a complex pain problem. Any medical term with the word “itis” in it is suggestive of an underlying inflammatory cause.
Many studies have shown that men with chronic pelvic pain have very little inflammation (as measured by white blood cells, or pus cells, in their prostatic fluid); however, other studies looking for subtle markers of inflammation (cytokines) find inflammation in the majority of sufferers. The question at hand is,” does this type of inflammation have a more neurogenic basis”? Neurogenic inflammation in tissues can be caused by an AIGS (Abnormal Impulse Generating Site). In an AIGS, impulses can go along the nerve in both directions, resulting in neurogenic swelling and bogginess at the nerve endings, long after the tissues have healed. This could be one of the issues that sensitizes the pudendal nerve and contributes to the pain and dysfunction in urological chronic pelvic pain.
It is estimated on the Chronic Prostatits website (www.chronicprostatitis.com) that “pelvic floor muscle spasm may be the main cause of symptoms in over 90% of CPPS patients. Everyone with CP/CPPS should have a pelvic floor examination as part of a complete urological work-up by someone expert in trigger point/myofascial evaluation”. Since muscular problems are the domain of physiotherapists, seek out help from a Pelvic Floor Physiotherapists, who has specialized training in this area.
Dr. Daniel Shoskes has developed a classification system, called the UPOINT system. This system helps the health practitioner and patient to focus their treatment energy and time on the right domain(s), or areas of the patient’s presentation in urological chronic pelvic pain. These pain syndromes have been classified as follows (the symptoms increase in severity with the number of areas involved):
U- urinary symptoms such as frequency and urgency are predominant
P- psychosocial factors such as stress and anxiety are present
O- organ specific findings such as Hunner’s ulcers are seen in the bladder
I- infection/inflammation is present in the bladder or prostate
N- neurological findings are predominant
T- tender muscles
Listen to what your doctors and therapists are telling you, and make sure that you deal with all of the areas involved in your presentation, including the psychosocial aspects (this is very important). If you address all the areas of involvement, you are more likely to get full resolution, and heal from your pain completely.