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Men:
Do What it Takes to Fight Groin Pain?
Eric
Sabo, October 17, 2005.
What's
in a name? Sometimes referred to as prostatitis, chronic pelvic pain syndrome is
really a condition onto itself. Men who have either problem may suffer from
groin pain, urination difficulties and even erectile problems. But instead of
bacterial infections that are clearly linked to prostatitis, the causes of
pelvic pain syndrome are unknown. And there is no simple antibiotic that can
ease symptoms.
What
can be done? Dr. Anthony Schaefer, urologist at the Feinberg School of Medicine
at Northwestern University in Chicago, explains how men can combat this
mysterious and frustrating syndrome.
What
is chronic pelvic pain syndrome?
It's a pain syndrome, and although prostatitis is a name that is used by lay
people, we tend to call it chronic pelvic pain syndrome to be more accurate. The
name reflects the fact that we don't know exactly where the pain is coming from,
and in some cases it could be from the prostate, but not necessarily. The
prostate may or may not be involved.
What
are the main symptoms?
Chronic pelvic pain syndrome causes pain in the pelvic region with or without
urinary symptoms, such as an urgency or frequency in the need to go to the
bathroom.
How
common is chronic pelvic pain syndrome?
The estimates vary depending where you are, but anywhere from two to six percent
of men in different parts of the world have chronic pelvic pain.
Do
we know what causes chronic pelvic pain?
In general, there are more white blood cells on average in a patient's prostatic
fluid, but it's not a clear-cut point. I think one of the more interesting
observations is that cytokines, which help control inflammation and can actually
attract white blood cells to organs, are found in greater amounts in the
prostatic fluid of some men with this condition. That suggests that maybe the
prostate is a component of the syndrome.
These
cytokines are similar to ones that would draw white blood cells to the joints
and cause arthritis. So there may be logical explanations of why some men to
have these pelvic pain symptoms.
How
do you diagnose chronic pelvic pain syndrome?
The diagnosis is self-made. There is a questionnaire we use to quantify the
symptoms. By definition, a syndrome is not a disease. It's not like a tissue
diagnosis or a blood test.
Is
there any way to treat it?
There's no effective therapy at this point. In the controlled studies that we've
done, most notably the one where we gave patients an antimicrobial or an alpha
blocker [antibiotics like Cipro or high blood pressure medications like
Cardura], the patients did not show any improvement. Now, the negative aspect of
the study was that we chose men for the study who had already been exposed to
those drugs, and they had pretty severe symptoms. So, it's possible that those
drugs may benefit some men who have the earlier onset of the condition.
Hence,
if you talk to a patient, he may say, "Gee, I had a mild case of
prostatitis and I took some Cipro or something, and I feel much better."
That person probably is telling the truth, and he may have had prostatic
infection or inflammation that responded because he was treated early. New
studies are being launched that are going to look at men with an earlier onset
of symptoms to see if antimicrobials or alpha blockers may benefit them.
Pain
medicines are being tested as well. If you can't eradicate the problem, but you
can at least get rid of the pain, then you've done the patient a service.
Does
this syndrome clear up over time?
It can, but evidence shows that it tends to persist.
How
difficult is it to live with?
The discomfort and impact of chronic pelvic pain syndrome is as great as it is
for things like arthritis and cardiovascular disease. It has a significant
negative impact, and it often exceeds the negative impact that you see with
chronic, well-defined conditions.
Can
it affect a man's sex life?
Sexual symptoms are sometimes associated with this condition. For example, there
can be ejaculatory pain. In some cases, chronic pelvic pain syndrome can be a
clue that there may be ejaculatory duct obstruction, which, for example, could
be a treatable cause of chronic pelvic pain syndrome. But those are unusual
cases. I have patients who feel better after ejaculation and those who feel
worse.
So,
ejaculating more can help?
Well, what you need to know is that, in a nutshell, no one knows what to do.
There are a lot of theories, and a lot of people have supported different ideas.
But I think the safe thing to say is, if it works for you and it's safe, it's
all right to do it. So, anything from ejaculating more or less, to drinking wine
or not drinking is pretty much dependent upon the patient's response.
How
do you manage patients with chronic pelvic pain?
We first rule out things we can identify and treat, like infection or
obstruction. Then, if those things are all negative and you have the syndrome,
you're left to try to treat experimentally. Based on the patient's history, you
may elect to try some things.
I
think if you go about it in an open way and tell the patient, "We're going
to try a reasonable course for this drug." And if he does get better, even
if it's a placebo effect, you could still argue that it's worthwhile because
he's better. But I'm not in favor of long-term medications that can have side
effects without showing any measurable improvement.
Are
there any lifestyle measures that can help?
Riding a bike can cause perineal nerve discomfort, so that's something that can
be changed. I try to figure out what's bothering the patient and make
suggestions as to correct it. But it's just common sense. Eliminate the
causative problems.
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