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Chronic Pelvic Pain In Older Men - Pain in Pelvic Area for Senior Men

By Chris Iliades, MD

By the time men reach the age of 80, most of them will have experienced a chronic painful condition that rarely gets diagnosed or treated properly. The symptoms may include pain somewhere in the pelvic area, difficulty urinating and erectile dysfunction. In the past, most of these men were diagnosed with chronic prostatitis, given several courses of antibiotics and told that the problem was all in their head when the treatment didn't work.

"This condition goes by many names and that is part of the problem," says Daniel Shoskes, MD, a urology specialist at the Cleveland Clinic in Ohio. "The condition has been called prostatitis, chronic prostatitis, prostatodynia and chronic pelvic pain syndrome. We now know that this syndrome is a collection of symptoms that are caused by several different conditions."

Recognizing The Symptoms Of Chronic Pelvic Pain in Men

"The pain may be felt in the pelvic or the lower abdominal area. Pain can be worse after urinating or ejaculating. Some men may describe the pain as a sensation similar to sitting on a golf ball," says Dr. Shoskes.

Here are some other common symptoms:

  • Burning pain when urinating or ejaculating
  • Incontinence, trouble starting or dribbling when urinating
  • Low back pain
  • Pain in the testicles
  • Pain in the groin area
  • Pain when having a bowel movement
  • Pain in the pelvic floor (the area between the testicles and the anus)

Causes of Chronic Pelvic Pain in Men

In some cases the pain and other symptoms are caused by a bacterial infection. In these cases, a culture may show bacteria in the urine or the semen and a diagnosis of acute or chronic bacterial prostatitis can be made. These infections will usually respond to antibiotics.

"In about 85 percent of these cases the pain is not caused by infection. These cases fall under the condition of chronic pelvic pain syndrome for which there may be several different causes." —Daniel Shoskes, MD

Dr. Shoskes has developed a way to identify the different causes of chronic pelvic pain syndrome. This breakdown allows doctors to diagnose the condition correctly and to pick the best treatment. "Just like a headache may have many different causes, so does pelvic pain syndrome. If you used only one treatment for a migraine, a tension headache or a sinus infection, you would not be very successful," he explains Shoskes.

Dr. Shoskes' classification for chronic pelvic pain was recently featured in the journal Urology, and many urologists and primary care doctors are now using his system for diagnosing and treating the condition.

Dr. Shoskes' Six Categories for Chronic Pelvic Pain in Men

Dr. Shoskes has come up with the acronym UPOINT to break down the causes of pelvic pain. The pain may be due to one or more of these causes and may require one or more types of treatment. By treating each specific cause, Dr. Shoskes has been able to show a high rate of treatment success for a condition that once was characterized by treatment failure.

The results of a prospective study Shoskes conducted showed that 84 percent of his patients treated with diagnostic help from the UPOINT tool show significant improvement of their symptoms within six months.

Here are the UPOINT categories:

  • Urinary symptoms: These symptoms may respond to medications that improve urination.
  • Psychosocial: These symptoms may be caused by stress and may respond to mental health therapies.
  • Organs specific: These symptoms indicate an abnormality of the bladder or the prostate that may respond to a specific therapy. For instance, Dr. Shoskes recommends an herbal anti-inflammatory for an enlarged prostate.
  • Infection: These symptoms are caused by infection and usually respond to an appropriate antibiotic.
  • Neurologic/systemic: These symptoms may include pain outside the prostate area and may be part of a general neurological condition such as fibromyalgia or irritable bowel syndrome. In these cases medications that treat systemic neurologic symptoms may help.
  • Tenderness: Spasms of the muscles in the pelvic floor are very common in chronic pelvic pain and may contribute in up to 50 percent of pelvic pain cases. These spasms may respond to physical therapy.

Tips for Seniors and Caregivers

Chronic pelvic pain syndrome in men is finally getting the attention it deserves. The National Institutes of Health recently announced a $37.5 million commitment to fund research into the causes of pelvic pain disorders in men. Dr. Shoskes has established a website to help other doctors use the UPOINT system at http://www.upointmd.com. Here are more of his tips:

  • If you or someone you care for is having symptoms of pelvic pain, erectile dysfunction or urinary problems, talk to your doctor about it.
  • Make sure your doctor rules out other causes of urinary symptoms such as an enlarged prostate, urinary stones or urinary cancer.
  • If your doctor prescribes antibiotics and they do not relieve the symptoms, especially if cultures are negative, consider other causes of chronic pelvic pain.
  • If your doctor is not familiar with chronic pelvic pain syndrome, ask for a referral to a urologist who has experience treating this condition.