Chronic Pelvic Pain in Men Clinical Presentation

  • Author: Richard A Watson, MD; Chief Editor: Edward David Kim, MD, FACS   more...
 
Updated: Nov 16, 2011
 

History

Symptoms parallel those experienced by persons with chronic bacterial and nonbacterial prostatitis. The typical patient is a young to middle-aged man with variable symptoms of chronic, irritative, and/or obstructive voiding accompanied by moderate to severe pain in the pelvis, lower back, perineum, and/or genitalia.

Erectile dysfunction is the symptom that initially brings many men to seek medical attention; however, the patient often waits until the end of the interview to mention the problem or he may avoid mentioning it at all unless the physician specifically inquires.

To facilitate history taking and to establish a more uniform standard, an NIH collaborative panel proposed the Chronic Prostatitis Symptom Index (NIH-CPSI). This index is calculated using a series of 9 questions that contain 21 items used to assess patient history in a standardized and quantifiable format. These questions are provided below.

Pain symptom questions are as follows:

  • In the past week, have you experienced any pain (1) between your rectum and testicles, (2) in the testicles, (3) in the tip of the penis, or (4) below your waist
  • In the past week, have you experienced pain or burning upon urination or pain or discomfort during or after sexual intercourse
  • How often have you had pain in any of the above areas over the last week
  • Over the last week, which number (1-10) best describes your average pain or discomfort on the days that you had it

Urinary symptoms questions are as follows:

  • Over the last week, how often have you had the sensation of not emptying your bladder completely after you finished urinating
  • Over the last week, how often have you had to urinate again less than 2 hours after you finished urinating

Questions regarding the impact of symptoms are as follows:

  • Over the last week, how much have your symptoms kept you from doing the kinds of things you would usually do
  • Over the last week, how much did you think about your symptoms

The following quality-of-life life question is also included in the index:

  • If you were to spend the rest of your life with your symptoms just the way they have been during the last week, how would you feel about that
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Physical Examination

No physical examination finding in chronic pelvic pain syndrome (CPPS) is pathognomonic. Examination of the genitalia reveals normal results. Digital rectal examination may reveal a tight anal sphincter. When the anal sphincter tone is hyperactive, a verifiable spastic neuropathy must be excluded. The hyperactivity may otherwise indicate a spasmodic hyperirritability of the pelvic floor musculature, which may be amenable to medical and biofeedback therapies.

The prostate and adjacent tissues may be moderately to severely tender, and the gland itself may be slightly congested or boggy. However, the presence of a small, relatively firm gland does not exclude the possibility of CPPS type III. Extreme tenderness upon gentle palpation of the prostate should raise suspicion for acute bacterial prostatitis or even a prostatic abscess.

The value of this examination is to exclude other diagnoses, such as prostate cancer, chronic urethritis/meatitis, and granulomatous prostatitis.

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Contributor Information and Disclosures
Author

Richard A Watson, MD  Professor of Surgery (Urology), Department of Surgery, Division of Urology, UMDNJ New Jersey Medical School, Hackensack University Medical Center

Richard A Watson, MD is a member of the following medical societies: Academy of Medicine of New Jersey, American Urological Association, Association of Military Surgeons of the US, and Society of University Urologists

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS  Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, Sexual Medicine Society of North America, and Tennessee Medical Association

Disclosure: Lilly Consulting fee Advisor; Astellas Consulting fee Speaking and teaching; Watson Consulting fee Speaking and teaching; Allergan Consulting fee Speaking and teaching

Additional Contributors

Robert J Irwin, Jr, MD Chair, Harris L Willits Professor, Department of Surgery, Division of Urology, University Hospital, University of Medicine and Dentistry of New Jersey

Robert J Irwin, Jr, MD is a member of the following medical societies: Phi Beta Kappa

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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