Chronic Pelvic Pain Syndromes
Also see Gynae guidelines - Chronic Pelvic Pain
These may be bladder/urethral/prostatic (“prostatitis”)/scrotal/testicular/post vasectomy/penile/Vaginal/vulval/urethral/anorectal. Usually no sinister underlying cause or pathology.
Non malignant pain perceived in structures related to the pelvis of either men or women. There are often associated negative cognitive, behavioural, sexual or emotional consequences.
Pain is usually associated with symptoms suggesting lower urinary tract, sexual, bowel or gynaecological dysfunction in the absence of proven infection or other obvious pathology
Diagnosis is based on the history and exclusion of other conditions
Management prior to referral:
Rule out pathology with simple investigations. Do not assume you will find pathology.
- History and examination to assess nature/duration of pain, associated urinary/ gynae symptoms/ psychological issues/ sexual history and sexual dysfunction symptoms / irritable bowel symptoms (present in up to 30% men with chronic pelvic pain)
- May be associated with IUCDs, consider trial of removal
- Urine dipstick/MSU
- Urine cytology
- STI screen (first pass urine men for chlamydia/gonorrhoea +/- swab for trichomoniasis; Chlamydia/HVS women)
- Cystoscopy if haematuria ( hyperlink)
Frequency volume chart/Flow rates if associated lower urinary tract symptoms
- Education: condition chronic and about controlling symptoms rather than cure, however most chronic prostatitis/male pelvic pain syndrome will improve within 6 months
- Diet: avoid spicy/acidic foods, caffeine, alcohol, chocolate
- Psychological/behavioural treatment
- Antibiotics: if suspect underlying infection. Always send MSU/STI screen prior to treatment. If improved after 2 weeks continue for 6 weeks. If no improvement discontinue.
Repeated use of Antibiotics in absence of proven infection should be avoided
- Analgesics: particularly NSAIDS
- Alpha blockers: not licensed but can be helpful in up to 60% of both men and women. Trial for at least 6 weeks if LUTS
- 5-alpha reductase inhibitors in men. Take for at least 3 months.
- Anticholinergics if frequency/urgency
- Neuropathic pain modulators eg. amitriptyline, gabapentin etc
- Stool softener if defaecation painful
Indications for referral:
Diagnosis of pathology: refer to appropriate specialty
Unsuccessful pain management: refer pain team
CKS Chronic prostatitis, September 2019:
EUA Guidelines on Chronic Pelvic Pain 2021
British Association of Urological Surgeons, September 2015: https://www.baus.org.uk/professionals/baus_business/publications/85/chronic_pelvic_pain_guidelines/
Mr Christopher Blake, Consultant Urologist, RCHT
Dr Bridgitte Wesson, GP & Kernow RMS GP Guideline lead Urology
Reviewed: March 2022
Next review due : March 2023