Urological Pelvic Pain in Men is NOT Prostatitis

Male pelvic pain continues to be erroneously approached as an urological condition and even worse, as an infectious or inflammatory malady of the prostate gland.

Although growing numbers of studies demonstrate a changing focus away from the prostate, a comprehensive approach for this condition in men is rare.

Unfortunately, part of the problem is the Prostatitis Classification System which lists pelvic pain as type 3 prostatitis despite the fact that this condition has never been proven to be caused by an infection, not even a malady of the prostate gland!

Even if lower urinary tract symptoms and/or sexual complaints are associated with pelvic pain, “prostatitis” is unlikely.

The broad differential diagnosis of male pelvic pain requires a comprehensive approach. After excluding serious or acute pathological conditions of the colon, rectum, neurological system or urinary tract, the physician must consider dynamic or functional conditions such as pelvic muscle dysfunction, Myofascial trigger points, pudendal neuralgia and functional somatic syndromes, also described as central sensitization syndromes. Patients may have one or more of these conditions, and often, I have found that patients do indeed have overlapping syndromes. Anxiety and stress play both a predisposing and/or perpetuating role in pelvic pain as well.

A medical doctor specializing in male pelvic pain must formulate the correct diagnosis- it is not enough to just call this a Pelvic Pain Syndrome- What is the underlying cause?

I have long believed that patient empowerment is the cornerstone to treating this condition. It is essential to make the correct diagnosis, but more importantly, the patient should bear witness to the medical formulation of that diagnosis. Only then, can he regain confidence and begin taking steps towards his recovery.

Studies fail to show a correlation with infection or prostate disease

As early as 1963, an investigator observed that antibiotics afforded no better response than placebo among men with symptoms of prostatitis.¹ This has been corroborated by many, many investigators since then. It has been well known in the medical community, for decades! That this condition is not an infection; however, antibiotics were and still are “first line” therapy.

CAUTION! Physical Therapy has become the new Cipro (antibiotic)!

Fortunately, more doctors are avoiding the use of antibiotics for this condition. Unfortunately, physical therapy is being prescribed in a similar fashion- without an examination or a confirmed diagnosis that would justify physical therapy. It is true that more than half of men who have prostatitis-like symptoms or pelvic pain have underlying conditions amenable to physical therapy; however, many also have serious urological, colorectal, and neurological conditions which are misdiagnosed and patients suffer from delayed diagnosis and treatment.  Physical therapists are very good at physical therapy, but they are not medical doctors.

A physician specializing in male pelvic pain considers a broad differential diagnosis which may require specialized interviews, clinical exams, urodynamic procedures, endoscopy and in depth psychosocial evaluation.

Pharmacological agents, prescribed by a medical doctor may be required as adjuvant therapy even when Physical Therapy is indicated. When we prescribe physical therapy, we reassess all of our patients after 6-8 sessions. It is essential to closely monitor all patients at the beginning of any type of treatment, in order to refine, modify or correct the approach initially taken.

¹ Gonder MJ Prostatitis Lancet 1963; 83:305-306