Chronic prostatitis is pelvic or perineal pain without evidence of urinary tract infection lasting longer than three months. The National Institutes of Health (NIH) classifies prostatitis into four syndromes. This article discusses the four prostatitis syndromes listed in the medical research and by the NIH.
Prostatitis affects half of all men
Prostatitis is a common condition affecting almost half of all men during their lifetimes. Prostatitis accounts for over two million outpatient visits every year. One percent of all primary care visits in the United States is for prostatitis.
Prostatitis – the “wastebasket of clinical ignorance”
Prostatitis has been called the “wastebasket of clinical ignorance.”
Stamey, Thomas Alexander, 1989, “Pathogenesis and Treatment of Urinary Tract Infections,” Lippincott, Williams and Wilkins
Historical confusion – the many names of Prostatitis
Prostatitis is referred to by several different names, some are proper and some describe slightly different conditions such as:
levator ani syndrome,
unspecified anorectal pain,
bladder pain syndrome,
chronic pelvic pain syndrome,
Physicians tend to manage patients with prostatitis based on a patchwork of what they learned during residency, experience, the last paper on the subject they read, and perhaps a touch of evidence.
Chronic pelvic pain (CPP) occurs in women and men. The American College of Obstetricians and Gynecologists’ (ACOG) definition applies to women. The European Association of Urologists (EAU) revised their guidelines beginning in 2009 to include women and men in their definition of chronic pelvic pain. Chronic pelvic pain is a bladder pain syndrome that occurs in women and men. Urological pain syndromes in men include Chronic Prostatitis / Chronic Pelvic Pain Syndrome (CPPS).
Chronic pelvic pain has two different definitions:
Historically, chronic pelvic pain (CPP), was defined by the American College of Obstetricians and Gynecologists (ACOG) and applied to women.
In 2009, the European Association of Urology (EAU) published EAU Guidelines on Chronic Pelvic Pain. Their stated objective was “to revise guidelines for the diagnosis, therapy, and follow-up of CPP patients.”
The European Association of Urologists (EAU) guidelines distinguish between gynecological, gastrointestinal and musculoskeletal pain syndromes in women and men.
In the revised guidelines published by the European Association of Urology (EAU) on Chronic Pelvic Pain, they included chapters on chronic prostate pain and bladder pain syndromes, urethral pain, scrotal pain, pelvic pain in gynecologic practice and others.
ACOG’s Definition of Chronic Pelvic Pain (CPP)
The American College of Obstetricians and Gynecologists (ACOG) definition of chronic pelvic pain.
“Pain lasting for six or more months that localizes to the anatomic pelvis, anterior abdominal wall at or below the umbilicus, the lumbosacral back, or the buttocks and is of sufficient severity to cause functional disability or lead to medical care. Chronic pain can come and go or it can be constant.” (1)
American College of Obstetricians and Gynecologists, 2011
Chronic Pelvic Pain Continues after a Hysterectomy
“Approximately 12 percent of hysterectomies are performed for pelvic pain and 30 percent of patients who seek treatment at pain clinics have already had a hysterectomy.” (2)
Novak’s Textbook of Gynecology, 12th Ed, 1996
EAU’s Definition of Chronic Pelvic Pain (CPP)
The European Association of Urology (EAU) includes both women and men in its definition of chronic pelvic pain and defines chronic pelvic pain as follows (Ref. 2013):
“Chronic or persistent pain perceived in structures related to the pelvis of either men or women. The pain must be continuous or recurrent for at least six months.” (3)
European Association of Urology, 2013
Urological Pain Syndromes-Women / Men
When the pain is localized to a single organ, some specialists may wish to consider using an end organ term such as “Bladder Pain Syndrome.” Urological pain syndromes include bladder pain syndrome, which is often termed as interstitial cystitis.
Urological Pain Syndromes in Men
Urological pain syndromes in men include Prostate Pain Syndrome, which is often termed Chronic Prostatitis / Chronic Pelvic Pain Syndrome according to the National Institute of Health (NIH) classification of chronic prostatitis.
Do you suffer from back pain? Check out these tips from the medical literature to minimize your risk of back pain while sitting, bending, lifting, or during prolonged periods of standing.
Prevalence of Low Back Pain
Lower back pain is becoming a growing problem in industrialized countries accounting for up to $50 billion spent per year in the United States alone (2000). Ninety percent of the budget is spent on 10 percent of patients who have persistent chronic pain lasting longer than three months (1).
Chronic back pain, often with associated leg pain, is the most common medical complaint in developed countries, (Bigos, et al. 1994). Headache is its only peer (Lawrence, 1977). A complaint of back pain is the most common reason for early Social Security disability in the USA. The disability issues are so important that several countries and many organizations have convened to examine the problem, (Anderson, 1996). (2)
Tips to Minimize Risk of Back Pain – While Standing:
Posture techniques that help avoid lower back pain while standing:
Maintain good abdominal tone; keep abdomen flattened while standing.
When prolonged standing is necessary, place one foot on a step for a few minutes.
Wear cushion-soled shoes for prolonged standing.
While Bending, Lifting, or Carrying:
Posture techniques that help avoid back pain while bending, lifting or carrying:
Bend at the knees, not at the waist.
Lift with the thighs (keep heavy objects centered close to abdomen).
Flex knees while bending.
When carrying heavy objects, turn with the feet, not by twisting the trunk.
While Sitting and Lying:
Posture techniques that help avoid back pain while sitting and lying:
Sit on a straight-backed, firm, supportive chair.
Sit only for short periods.
Sleep on your back with your knees bent, or on your side on a firm mattress.
Avoid prolonged standing, prolonged sitting, and improper lifting (1).
Classifications of Low Back Pain with or Without Sciatica
“Transient– Self-limited; duration is hours to days; comes to medical attention when an episode of pain occurs.
“Acute– Self-limited, but protracted; duration is days to weeks; often seen by physicians; treatment is symptomatic; most recover spontaneously; evaluation and treatment required for severe symptoms.
“Persistent– Lasts more than 3-6 months; does not relent with time; high correlation with degeneration of the spine (spondylitis disease); surgical intervention occurs mostly in this group.
“Chronic Pain Syndrome– Lasts more than 6 months; worsens with time; associated with major co-morbidities (other conditions that also cause the same problem). ” (2)
Classifications of Low Back Pain
“Acute low back pain– generally defined as pain which lasts from a few days to a few months. Back pain with or without leg radiation is common (sciatica).
“Persistent low back pain– Progressively leads to the chronic state, defined by preoccupation with pain, depression, anxiety, and disability.” (2)
Management of chronic back / leg pain:
Restore strength: Along the spine first.
Restore general conditioning.
Teach posture and body mechanics. (2)
Kelley’s Textbook of Internal Medicine, Fourth Edition, 2000, “Approach to the Patient with Back Pain,” written by Glen S. O’Sullivan, U.S.A.
Textbook of Pain, 4th Edition, 1999, “Chronic Back Pain,” written by Donlin M. Long, U.S.A.
Musculoskeletal disorders (MSDs) are also known as Cumulative Trauma Disorders (CTDs) and Repetitive Motion Disorders (RMDs) and overuse syndromes as well as repetitive strain injuries (RSIs). Learn more now about some of the most common MSDs seen in office workers which can be called by any of the names mentioned in this article.
MSDs are common in office workers
The U.S. Department of Labor Occupational Safety and Health Administration defines musculoskeletal disorders (MSDs) as “injuries and disorders of the soft tissues (muscles, tendons, ligaments, joints and cartilage) and nervous system. They can affect nearly all tissues, including the nerves and tendon sheaths, and most frequently involve the arms and back.”
Up to 85 percent of the population will suffer from musculoskeletal pain.
Musculoskeletal disorders (MSDs) are known by many names, such as cumulative trauma disorders (CTDs).
MSDs are also called repetitive motion disorders (RMDs), overuse syndromes, repetitive strain injuries, and “office syndrome.”
Whatever the name, you’ll feel the pain.
“A rose by any other name would smell as sweet.”
William Shakespeare, Romeo and Juliet
Poor ergonomic posture can cause MSDs
When workers sit or stand in a posture that is not ergonomically correct, they can experience musculoskeletal pain.
Because musculoskeletal pain and musculoskeletal disorders (MSDs) are a major source of suffering, health care, and utilization of compensation, there is a definite need for prevention (2).
OSHA – MSDs have a variety of names
Ergonomics: The Study of Work, OSHA 3125, page 2, states “Occupational safety and health professionals have called these disorders a variety of names, including cumulative trauma disorders, repeated trauma, repetitive stress injuries, and occupational overexertion syndrome.”
Cumulative Trauma Disorders (CTDs) defined by PEOSH:
“Cumulative trauma disorders (CTDs) are injuries of the musculoskeletal and nervous systems that may be caused by repetitive tasks, forceful exertions, vibrations, mechanical compression (pressing against hard surfaces) or sustained or awkward positions. Cumulative trauma disorders are also called repetitive motion disorders (RMDs), overuse syndromes, regional musculoskeletal disorders, repetitive motion injuries, or repetitive strain injuries.”
Public Employees Occupational Safety and Health Program, New Jersey Department of Health and Senior Services, “PEOSH Cumulative Trauma Disorders in Office Workers” December 1, 1997
Musculoskeletal Disorders in office workers:
Carpal Tunnel Syndrome – a compression of the median nerve in the wrist that may be caused by swelling and irritation of tendons and tendon sheaths.
Tendinitis – An inflammation (swelling) or irritation of a tendon. It develops when the tendon is repeatedly tensed from overuse or unaccustomed use of the hand, wrist, arm, or shoulder.
Tenosynovitis – An inflammation (swelling) or irritation of a tendon sheath associated with extreme flexion and extension of the wrist.
Low Back Disorders – These include pulled or strained muscles, ligaments, tendons, or ruptured disks. They may be caused by cumulative effects of faulty body mechanics, poor posture, and/or improper lifting techniques.
Synovitis – An inflammation (swelling) or irritation of a synovial lining (joint lining).
DeQuervain’s Disease – A type of synovitis that involves the base of the thumb.
Bursitis – An inflammation (swelling) or irritation of the connective tissue surrounding a joint, usually of the shoulder.
Epicondylitis – Elbow pain associated with extreme rotation of the forearm and bending of the wrist. The condition is also called tennis elbow or golfer’s elbow.
Thoracic Outlet Syndrome – a compression of nerves and blood vessels between the first rib, clavicle (collar bone), and accompanying muscles as they leave the thorax (chest) and enter the shoulder.”
Cervical Radiculopathy – A compression of the nerve roots in the neck.
Ulnar Nerve Entrapment – A compression of the ulnar nerve in the wrist.
Symptoms of MSDs or CTDs
The following symptoms may involve the back, shoulders, elbows, wrists, or fingers. If symptoms last for at least one week or if they occur on many occasions a doctor should be consulted.
Decreased joint motion,
Cracking or popping of joints
MSDs can be caused by work and non-work activities
These disorders can result from work and other than work activities that involve repetitive motions or sustained awkward postures, such as sports or hobbies.
“These painful and sometimes crippling disorders develop gradually over periods of weeks, months, or years. . .Work and non-work activities may together contribute to cumulative trauma disorders. These disorders can also be aggravated by medical conditions such as diabetes, rheumatoid arthritis, gout, multiple myeloma, thyroid disorders, amyloid disease and pregnancy.”
“PEOSH Cumulative Trauma Disorders in Office Workers” December 1, 1997
Public Employees Occupational Safety & Health, State of NJ, 1997.
Textbook of Pain, 1998, “Prevention of Disability due to Chronic Musculoskeletal Pain,” written by Steven James Litton
U.S. Department of Labor Occupational Safety and Health Administration, OSHA 3125 2000 (Revised), “Ergonomics: The Study of Work”