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Chronic Non-Bacterial Prostatitis & Pelvic Health Physiotherapy

Prostatitis

Prostatitis is a common condition that can impact a man’s pelvic health. It is the most common urinary tract problem for men younger than age 50 and the third most common urinary tract problem for men older than age 50.1 For subsets of Prostatitis have been identified:


1- Chronic Non-Bacterial Prostatitis*

2- Acute Bacterial Prostatitis

3- Chronic Bacterial Prostatitis

4- Asymptomatic Inflammatory Prostatitis



Acute and Chronic Bacterial Prostatitis

These subtypes of Prostatitis are caused by a bacterial infection. This infection may be caused by bacteria that travels up the urethra and into the prostate. Treatment includes speaking to your Family Doctor to determine the best course of action. This may include a course of antibiotics, or a referral to a specialist, such as a Urologist.


Chronic Non-Bacterial Prostatitis

Chronic Non-Bacterial Prostatitis, also known as Chronic Pelvic Pain Syndrome, (CP/CPPS), described a subset of prostatitis that involves pain in and around the prostate, without being a bacterial infection. It impacts 10-15% of men. The main symptoms of CP/CPPS can include pain or discomfort lasting 3 or more months in one or more of the following areas:


· between the scrotum and anus

· the central lower abdomen

· the penis

· the scrotum

· the lower back

Other common symptoms include:

· Pain in the urethra during or after urination.

· Pain in the penis during or after urination.

· Urinary frequency—urination eight or more times a day. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination.

· Urinary urgency

· A weak or an interrupted urine stream.

· Pain during or after ejaculation

· Pelvic and lower abdominal pain


How can Pelvic Physiotherapy Help?

Recent studies have shown that Prostatitis may be due to or associated with pelvic floor muscle dysfunction, specifically pelvic floor hypertonicity. In fact, appropriate Pelvic Floor Muscle Training seems to be efficacious in patients with chronic prostatitis/chronic pelvic pain syndrome.


Manual therapy techniques applied to the pelvic floor and performed by a physical therapist specially trained in these techniques, along with progressive muscle relaxation, flexibility exercises, and aerobic exercises, appears to be beneficial to patients in reducing pain, improving bladder symptoms, and improving sexual function.




What does an appointment look like?


A Pelvic Health Physiotherapist specializes in the assessment, management, and treatment of pelvic floor dysfunction and associated conditions. The initial assessment will include completing a detailed health questionnaire, which will enable your Physiotherapist to better understand your symptoms and health concerns. The physical exam will involve the assessment of the muscles, ligaments, tendons and connective tissue of the pelvis, hips, sacroiliac joints, low back, abdomen, and thorax. With your consent, an internal examination of your pelvis and pelvic floor muscles may be performed. An internal examination enables your Pelvic Health Physiotherapist to examine anatomical changes, symmetry to a contraction, muscle tone, and painful areas⁴. However, if an alternative is required, many external techniques can be performed to determine the root cause of your symptoms.


What does Treatment look like?


Treatment is always tailored and specific to each individual. Your Physiotherapist will evaluate your health history, the physical exam findings, and your functional goals to determine the best course of treatment. Options may include:

· Education regarding your symptoms, condition, assessment findings, and treatment plan

· Bladder retraining

· Constipation management and bowel retraining

· Targeted manual therapy of the myofascial system

· Visceral mobilizations

· Pelvic floor muscle downregulation and relaxation

· Pelvic floor muscle strengthening and training

· Motor control training and strengthening of the deep core musculature

· Motor control training and strengthening of the abdominal wall, hips ,and thorax

· Postural education and retraining

· Diastasis Recti Abdominis retraining

· Functional retraining of the neuro-muscular system to achieve movement and activity goals

· Neuromuscular Stimulation of the Pelvic Floor

· Liaising with your other healthcare professionals to achieve holistic and comprehensive treatment outcomes



If you are unsure of whether Pelvic Floor Physiotherapy will help with your symptoms and condition, we highly encourage you to contact us for a 15 minute Free Phone Consultation. One of our specialised Pelvic Floor Physiotherapists will discuss your concerns with you, and help you determine whether this is the best course of treatment for you.




References

1. van Reijn-Baggen DA, Han-Geurts IJM, Voorham-van der Zalm PJ, Pelger RCM, Hagenaars-van Miert CHAC, Laan ETM. Pelvic Floor Physical Therapy for Pelvic Floor Hypertonicity: A Systematic Review of Treatment Efficacy. Sex Med Rev. 2021 Jun 11:S2050-0521(21)00012-3. doi: 10.1016/j.sxmr.2021.03.002. Epub ahead of print. PMID: 34127429.


2. Cornel EB, van Haarst EP, Schaarsberg RW, Geels J. The effect of biofeedback physical therapy in men with Chronic Pelvic Pain Syndrome Type III. Eur Urol. 2005 May;47(5):607-11. doi: 10.1016/j.eururo.2004.12.014. Epub 2005 Jan 22. PMID: 15826751.

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