Dr Ashish Saini

What is chronic pelvic pain syndrome (CPPS)?


Chronic pelvic pain syndrome (CPPS) is also known as non-bacterial prostatitis and is one of the most common condition in urology impacting around 15% of all urologic outpatients. Usually, these patients have no urinary tract infection and have negative cultures of urine and prostatic fluid.

Chronic pelvic pain is a consistent pain observed in structures related to the pelvis of men. The ailment causes pain in the various anatomical structures around the prostate, including various muscle types, nerves and bony structures in the pelvis, abdomen, and spine. It is usually associated with negative cognitive, and emotional consequences as well as with symptoms suggestive of the lower urinary tract, and pelvic floor dysfunction.

Symptoms of CPPS

  • Urinary and erectile dysfunction
  • Pain focused in the prostate region as well as perineal, inguinal, scrotal and suprapubic pain.

Causes for chronic Pelvic pain

  • Ongoing acute mechanism like inflammation or infection involving somatic or visceral tissue
  • Chronic pain involving Central Nervous system
  • Emotional, behavioral and sexual responses

What happens in(ESWT) Extracorporeal Shock wave therapy procedure?


In most of the cases of (CPPS) chronic pelvic pain syndrome,the prostatic fluid often contains leukocytes. Before starting the Extracorporeal Shock wave therapy (ESWT),the Urologist expert performs Ultrasound to see whether it’s necessary to use a stand off or just the hand piece. If one is using stand off he should put a few drops of silicone oil and attach it to the hand piece.

Different mechanism of Extracorporeal shock wave therapy (ESWT)

There are different mechanisms through which Extracorporeal shock wave therapy ESWT Reduces pain

  • Interrupting the flow of nerve impulses by hyperstimulation of nociceptors
  • Healing tissue by revascularization processes
  • Reductions in muscle tone and spasticity

  • Chronic Pelvic Pain In Women


    Chronic pelvic pain in women is described as persistent, noncyclic pain understood to be in structures associated with the pelvis and existing for more than six months. Usually, no distinct evidence can be analyzed, and it can be imagined as a chronic regional pain syndrome or functional somatic pain syndrome.

    Chronic pelvic pain in a woman is typically correlated with other functional somatic pain syndromes like irritable bowel syndrome, nonspecific chronic fatigue syndrome and mental well-being ailments like post-traumatic stress disorder and depression. Diagnosis is based on the judgments from the history and physical examination. Pelvic ultrasonography is indicated to rule out any type of anatomic abnormalities. Urology expert like Dr AK Saini says that in absence of single etiology chronic pelvic pain in a woman can be conceptualized as a complex neuromuscular – psychosocial disorder consistent with a chronic regional pain syndrome.


    Clinical clues in Women with Chronic Pelvic Pain


    The History of the patient may reveal

  • Crampy Pain
  • Pain with urge to void
  • Postcoital bleeding
  • Post menopausal onset of pain

  • Physical examination

  • Enlarged or tender uterus
  • Vulvular/ vestibular pain
  • Pelvic floor muscle tenderness

  • Diagnostic testing

  • Mass on ultrasonography
  • Microscopic hematuria

  • Painful Bladder Syndrome / Interstitial Cystitis


    Interstitial cystitis also termed as painful bladder syndrome is a chronic condition inducing bladder pressure, bladder pain and on occasion’s pelvic pain. The pain varies from a mild ache to severe painful conditions.
    Once the bladder is full it expands and then indicates the brain that it's time to urinate. This communication occurs through the pelvic nerves. This creates the urge to urinate for most people.

    How IC/BPS can impact Your Life?

    IC can impact your social life, exercising activity, and sleep, and can induce a great deal of distress. Without therapy, Interstitial Cystitis symptoms can make it tougher to get through your daily courses activities. The condition may even impact your relationship with your spouse and family. It can also rob you of a good night's sleep and leave you tired and unhappy.

    Interstitial cystitis signs and symptoms include:

  • Pain in the pelvis or between the vagina and anus in women
  • Pain in between the scrotum and anus in men (perineum)
  • Chronic pelvic pain
  • A tenacious, urgent need to urinate
  • Constant urination, often of small amounts, throughout the day and night (up to 60 times a day)
  • Pain or distress while the bladder fills and easing after urinating.
  • Pain throughout coital intercourse.

  • Causes

    There are no specific causes of the occurrence of IC Interstitial Cystitis but experts and theories suggest that it may be due to

  • Defects in bladder tissue
  • Body’s immune system attacks the bladder
  • Changes in the nerves that damages the bladder