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Treatment Options

Pelvic pain treatment options.

Treatment Options

Doctor and Urologist Diagnosis

Initially you will be seen by your doctor or referred to an urologist who, following a number of tests, will diagnose your condition. It is important that all patients undertake this process and do not self-diagnose the condition based on information provided in this website.

Non Bacterial CPPS is the occurrence of Chronic Pelvic pain where no symptoms of bacteria exist. Pain can be experienced in the pelvis, lower abdomen, lower back and genitals. You may also experience pre-ejaculatory pain and lower urinary tract symptoms, which include the urge and frequency to urinate as well as difficulty in undertaking and completing this.

Your GP or referred urologist will undertake initial tests to ascertain whether there is a bacterial infection. Following this they would undertake a physical examination of the kidneys, suprapubic region, external genitalia, pelvic floor for tenderness and prostate. There would be further tests to exclude other conditions before you are diagnosed with Non-Bacterial Chronic Pelvic Pain Syndrome. At the first stages you will be prescribed antibiotics, anti-inflammatory medicine and neuromodulators to control the pain.  You may be referred for a prostate massage.

Prostate Massage

A prostate massage is normally carried out by a highly experienced Pelvic Pain Physiotherapist. This is a specialist skill and there are a limited amount of practitioners in the UK who are qualified in this area. The practitioner will use their finger to massage the outer prostate.  This will help to reduce the pain and empty fluid out from the pelvic ducts. 

Whilst this may give temporary relief it only provides a short-term solution. Most men have very tight pelvic floor muscles that are treated through pelvic floor therapy, posture work and biofeedback.

Acupuncture

Acupuncture treats the whole of the body through the central nervous system. It seeks to create a biochemical change by releasing chemicals in the brain, spinal cord and muscles. Some patients find relief using acupuncture but it is not widely used for CPPS patients and the effects are often temporary.

Chiropractic

Chiropractors use traditional skills to manipulate the body and apply different forces. They specifically make adjustments where there is spinal dysfunction, that effects the nervous system down to the pelvic floor. They can help to stabilise the pelvic floor. In conjunction with focused shockwave therapy chiropractic treatment can be beneficial.

Transrectal Thermotherapy

Transrectal thermotherapy involves placing a probe into the man’s rectum and targeting heat at a temperature of between 41-45°C towards the prostate gland. Although no definitive clinical evidence exists, it is thought that the heat will increase blood flow and better delivery of medication to the prostate as well as reduce toxins, increase zinc levels and reduce pain levels through changes to the sensory nerves.

Extracorporeal Focused Shockwave Therapy

Extracorporeal focused therapy is the gold standard treatment. This technology is widely used in erectile dysfunction treatment and was first accepted in the NHS some 40 years ago to treat kidney stones.

Clinical trials and in clinic experience show that this is the most effective management treatment available today. The focused shockwave targets the inflamed prostate, inducing it to reduce in size, relieving pressure and pain both on the bladder and the pelvic floor muscles, reducing the urge to urinate and allowing for a more balanced and less frequent flow.

The efficacy of this treatment is enhanced when combined with therapy to further reduce retained pain with Athermal Radio Frequency and Micro current.

Athermal Radio Frequency and Micro Current

This treatment is used to ease retained and current pain as well as inflammation. It is particularly effective when combined with Extracorporeal shockwave therapy to reduce soft tissue pain. The technology resets retained pain which becomes ‘locked’ within the body and reduces inflammation by decreasing the temperature of the affected area to  a normal heat. It also has a therapeutic impact across the whole body, enabling patients to experience a better sense of wellness after their first visit.

Chronic Pelvic Pain Syndrome Surgery

Not all surgical options are now available in the UK and you should speak with your Urologists regarding the options. Surgery is the most extreme of the Chronic Pelvic Pain Syndrome options.  Prior to Focused shockwave therapy it was the only option left for many men.

Transurethral Resection (TURP)

Transurethral resection of the prostate is a procedure that is undertaken to open up the ejaculatory ducts, cut away part of the prostate and remove prostate stones that are thought to be causing obstruction to the prostate ducts. A small instrument is passed through your urethra (the narrow tube that carries your urine and sperm). This form of surgery does carry significant risks including retrograde ejaculation, infertility and a decrease in orgasm, urine leakage and ED. This is not popular in the UK and there is little evidence to suggest that this relieves ongoing symptoms.

 

Laser Prostatectomy

Laser prostatectomy, which uses a laser to destroy the enlarged prostate tissue that leads to LUTS, is a minimally invasive procedure currently used as an alternative to TURP. This review of 20 studies involving 1898 subjects found laser techniques to be useful and relatively safe alternatives to TURP.