Pelvic pain in men

Many men experience pain in the pelvis at some point in their life.  Associated complains may include difficult, painful, or frequent urination; pain in the area of the bladder, groin, anus, and abdomen; inability to obtain an erection or pain during ejaculation; and fever and chills. It may be gradual (for chronic cases) or sudden (for acute cases). Prostatitis is the most common diagnosis in men younger than 50. While the prostate may be a source of pelvic pain, it is likely that in many cases that pain does not start entirely due to the prostate.

A number of terms have been used to describe the syndrome now commonly called pelvic pain syndrome. These include prostatodynia (painful prostate) and bacterial prostatitis. There are many classifications in the medical world and many attempts are made to standardize an approach to such symptoms. The incidence is approximately 2 to 10% of all adult men and high in the population group of approximately 30 %.

Possible causes of pelvic pain: Bladder disorders, nerve conditions, hernia, prostatitis (CPPS), and STDs. There is very little data on the statistics due to underreporting of this condition.

Chronic pelvic pain syndrome includes pain in the perineum, lower abdomen, testicles, penis, and with ejaculation, difficulty in passing urine and leads to sexual dysfunction.  All these problems with daily simple activities cause depression and decrease in quality of life.

You may notice bowel disorders, IBS, chronic fatigue syndrome (CFS) and fibromyalgia. To identify the possible causes by a detailed clinical history and examination, the laboratory tests are aimed to identify correctable causes to give rapid relief. Further evaluations are often required in a few chronic conditions. Urine analysis with targeted radiological tests reveal the cause of the problems. Imaging are required at times to identify the disease process along with a diagnostic cystoscopy.

Treatment:

Pain often responds to antibiotics even though the cultures may be negative because diagnosing the condition is very challenging. Doxazosin can also reduce muscle spasm, and is sometimes useful in CPPS.

Anti-inflammatory medication helps in controlling the pain and to reduce the edema (Swelling) in the local region to help in the healing of the region. Pelvic pain is waxing and waning in nature, hence the choice of medicines vary depending on the condition at presentation. It is very important to address the sexual dysfunction which is often present with this disease with PDE5 inhibitors. There are a number of medicines that are used to control nerve pain and few patients with chronic pelvic pain benefit from these.

Also, sacral nerve stimulation helps in relief, it is an invasive therapy and is useful if the sacral nerve is the problem which is uncommon. Physiotherapy for the pelvic muscles is useful. Sometimes, the pain around the genitals causes the muscles of the pelvic floor to become tense and sore which leads to further pain. Acupuncture or transcutaneous electrical nerve stimulation (TENS) is helpful as well. It’s important to stress the importance of relaxation, medication and cognitive behavioural therapy to help cope from the pain.

The take-home message is to generate awareness about the disease and to seek appropriate medical help for the pelvic pain for achieving long term disease-free life.

– Bivek Kumar,
Urologist, Andrologist and Uro- Surgeon,
Apollo Spectra, Bangalore