Chronic pelvic pain syndrome (CPPS)
How is it treated?
Treatment varies from man to man – just like CPPS does. The treatments will help to control your symptoms and might even get rid of your CPPS completely. But CPPS could return weeks, months or even years later. You may have to try a few things until you find something that works well for you. You’ll probably try more than one of the following:
- exercises and physical activity
- treatment for pain
- other treatments.
Each person will respond to treatments differently. If one doesn’t work, you should be able to try something else. Your treatment may be managed by your GP or by a urologist at the hospital. You may also see a specialist nurse, or a sexual health specialist.
There is some evidence that certain medicines can help improve prostatitis symptoms. Your GP or urologist may prescribe one or a combination of the following medicines.
- Alpha-blockers. There is some evidence that alpha-blockers, such as tamsulosin (Flomaxtra®, Diffundox®, Flomax Relief®, Pinexel®, Stronazon®), help improve urinary symptoms for some men, particularly a weak or slow flow, and pain. If they aren’t helping after four to six weeks, you will usually stop taking them.
- Antibiotics. Even though CPPS isn’t usually caused by a bacterial infection, there is a little evidence that antibiotics might help control symptoms in some men. This might be because they treat an infection that hasn’t been found by the tests. Or it might be because they help reduce inflammation.
- 5-alpha-reductase inhibitors. Although there is no strong evidence that 5-alpha-reductase inhibitors, such as finasteride (generic finasteride or Proscar®), are effective, some men find they improve urinary symptoms. This could be because they shrink the prostate. They can take up to six months to work.
- Non-steroidal anti-inflammatory drugs (NSAIDs). There is no strong evidence that NSAIDs, such as ibuprofen, are effective, but some men find they reduce symptoms such as pain. You can get some NSAIDs from pharmacies, but it’s important to talk to your GP first. This is because they can have side effects, such as stomach irritation and stomach ulcers.
- Pain-relieving medicines. These may help with any discomfort or pain. It may be enough to take over-the-counter pain relief such as paracetamol. Your doctor or a pharmacist can recommend ones that are suitable for you.
- Other medicines to relieve pain. Medicines used for other conditions can also be used to treat prostatitis pain. You might be offered anti-depressants (such as amitriptyline) to treat long-term prostatitis pain – some men with prostatitis find these helpful.
All medicines carry a risk of side effects. Ask your doctor for more information about the different treatments, and whether they might be suitable for you.
Names of medicines
Medicines often have two different names – a scientific or generic name and a brand name. For example, the alpha-blocker tablet tamsulosin is the scientific or generic name for the drug. Flomaxtra® and Diffundox® are examples of different brand names. The brand name is given to the drug by the company that makes it. Ask your doctor or nurse if you have any questions about your medicines, or speak to our Specialist Nurses.
Studies suggest there is a link between CPPS and how you’re feeling, so your doctor might refer you to a counsellor or psychologist. They are trained to listen and can help you understand your feelings and find ways to deal with them. Some men find this helpful.
In particular, cognitive behavioural therapy (CBT) can help men find ways to deal with prostatitis. CBT focuses on your thoughts, beliefs and attitudes and how these can affect what you do and how you feel. It involves talking with a therapist who will help you come up with practical ways to change any patterns of behaviour or ways of thinking that may be causing you problems.
You can refer yourself for counselling on the NHS, or you could see a private counsellor. To find out more, visit the NHS website or contact the British Association for Counselling & Psychotherapy.
Exercises and physical activity
If your doctor thinks your CPPS may be caused by problems with your pelvic floor muscles, they may refer you to a physiotherapist. A physiotherapist helps people to reduce pain through exercises or physical activity. The physiotherapist might show you breathing and relaxation techniques, or massage tender areas of your pelvic floor muscles (known as trigger points).
They might also teach you how to do pelvic floor muscle exercises. The pelvic floor muscles support the bladder and bowel, and help control when you urinate. Doing pelvic floor muscle exercises and stretches can help strengthen the muscles, which may help with urinary symptoms.
Some research has shown that doing regular physical activity can help to prevent CPPS symptoms. Your GP may also be able to refer you to a local exercise programme, or you could join a community walking group. Remember to pace yourself and only do what is comfortable for you. Find out more about local walking groups.
Treatment for pain
If pain-relieving medicines aren’t helping, your doctor may refer you to a pain clinic. Pain clinics have teams of health professionals who specialise in treating pain and can carry out further assessments and offer a variety of treatments.
Some men have found the following treatments helpful.
- Prostate massage. The doctor massages your prostate through the wall of the back passage (rectum). They will slide their finger gently into your back passage, using gloves and gel to make it more comfortable. If your prostate is tender or painful this might be done under general anaesthetic in hospital so you will be asleep and won’t feel anything. There is no strong scientific evidence for using prostate massage.
- Anti-depressants. If your prostatitis affects your mood and you become very low, depressed or anxious, your doctor might suggest you try taking anti-depressant tablets or refer you to a counsellor. Joining a support group and talking to other people with prostatitis can also help your mood.
- Treatments for sexual problems. If your prostatitis is causing sexual problems such as difficulty getting or keeping an erection, speak to your doctor or nurse. There is support available and things to try that can work well. For example, your doctor can prescribe medicines such as sildenafil (generic sildenafil or Viagra®) or tadalafil (generic tadalafil or Cialis®).
- Surgery. Very occasionally, surgery may be an option. It usually involves removing all or part of the prostate. It isn’t done very often because there’s a chance it may make symptoms worse and cause a number of side effects.