Skip to main content

Advertisement

SpringerLink
Log in

IBS and Chronic Prostatitis: Update on Chronic Pelvic Pain

  • Review
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The article aims to outline the pathogenesis, etiology, prevalence, and evaluation of chronic pelvic pain as it pertains to patients with two of the common causes: IBS and UCPPS.

Recent Findings

Because both diseases are diagnoses of exclusion, it is important to rule out other similar diagnoses. Biological markers are a new research frontier for identifying UCPP.

Summary

A careful and multimodal approach is then taken to address the patient’s goals and seek to optimize the QOL.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data Availability

No datasets were generated or analysed during the current study.

Abbreviations

UCPPS:

Urologic chronic pelvic pain syndrome

IBS:

Irritable bowel syndrome

CP/CPPS:

Chronic prostatitis/chronic pelvic pain syndrome

QOL:

Quality of life

NIH:

National Institute of Health

IPSS:

International Prostate Symptom Score

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Barsky AJ, Borus JF. Functional somatic syndromes. Ann Intern Med. 1999;130(11):910–21.

    Article  CAS  PubMed  Google Scholar 

  2. Wessely S, Nimnuan C, Sharpe M. Functional somatic syndromes: one or many? Lancet. 1999;354(9182):936–9.

    Article  CAS  PubMed  Google Scholar 

  3. Gallagher DM. Evaluation of colon dysfunction. Calif Med. 1961;95(3):156–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, Spiller R. Bowel disorders. Gastroenterology. 2016;

  5. Frangenheim H, Kkeindienst W. Chronic pelvic disease of unknown origin. J Reprod Med. 1974;13(1):23–6.

    CAS  PubMed  Google Scholar 

  6. Shoskes DA, Nickel JC, Dolinga R, Prots D. Clinical phenotyping of patients with chronic prostatitis/chronic pelvic pain syndrome and correlation with symptom severity. Urology. 2009;73(3):538–42. discussion 42-3

    Article  PubMed  Google Scholar 

  7. Krieger JN, Nyberg L Jr, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA. 1999;282(3):236–7.

    Article  CAS  PubMed  Google Scholar 

  8. Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012;10(7):712–21 e4.

    Article  PubMed  Google Scholar 

  9. Collins MM, Meigs JB, Barry MJ, Walker Corkery E, Giovannucci E, Kawachi I. Prevalence and correlates of prostatitis in the health professionals follow-up study cohort. J Urol. 2002;167(3):1363–6.

    Article  PubMed  Google Scholar 

  10. Collins MM, Stafford RS, O'Leary MP, Barry MJ. How common is prostatitis? A national survey of physician visits. J Urol. 1998;159(4):1224–8.

    Article  CAS  PubMed  Google Scholar 

  11. Clemens JQ, Meenan RT, O'Keeffe Rosetti MC, Kimes T, Calhoun EA. Prevalence of and risk factors for prostatitis: population based assessment using physician assigned diagnoses. J Urol. 2007;178(4 Pt 1):1333–7.

    Article  PubMed  Google Scholar 

  12. Habermacher GM, Chason JT, Schaeffer AJ. Prostatitis/chronic pelvic pain syndrome. Annu Rev Med. 2006;57:195–206.

    Article  CAS  PubMed  Google Scholar 

  13. Roberts RO, Lieber MM, Rhodes T, Girman CJ, Bostwick DG, Jacobsen SJ. Prevalence of a physician-assigned diagnosis of prostatitis: the Olmsted County Study of Urinary Symptoms and Health Status Among Men. Urology. 1998;51(4):578–84.

    Article  CAS  PubMed  Google Scholar 

  14. Suskind AM, Berry SH, Ewing BA, Elliott MN, Suttorp MJ, Clemens JQ. The prevalence and overlap of interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome in men: results of the RAND Interstitial Cystitis Epidemiology male study. J Urol. 2013;189(1):141–5. Population-based study estimated prevalence of chronic pelvic pain in men was 1.8%.

    Article  PubMed  Google Scholar 

  15. Dimitrakov J, Joffe HV, Soldin SJ, Bolus R, Buffington CA, Nickel JC. Adrenocortical hormone abnormalities in men with chronic prostatitis/chronic pelvic pain syndrome. Urology. 2008;71(2):261–6.

    Article  PubMed  Google Scholar 

  16. Clemens JQ, Brown SO, Kozloff L, Calhoun EA. Predictors of symptom severity in patients with chronic prostatitis and interstitial cystitis. J Urol. 2006;175(3 Pt 1):963–6. discussion 7

    Article  PubMed  Google Scholar 

  17. Lai HH, Thu JHL, Moh FV, Paradis A, Vetter J. Clustering of patients with interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome. J Urol. 2019;202(3):546–51.

    Article  PubMed  Google Scholar 

  18. Gasperi M, Krieger JN, Forsberg C, Goldberg J, Buchwald D, Afari N. Chronic prostatitis and comorbid non-urological overlapping pain conditions: a co-twin control study. J Psychosom Res. 2017;102:29–33.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Levy RL, Jones KR, Whitehead WE, Feld SI, Talley NJ, Corey LA. Irritable bowel syndrome in twins: heredity and social learning both contribute to etiology. Gastroenterology. 2001;121(4):799–804.

    Article  CAS  PubMed  Google Scholar 

  20. Vehof J, Zavos HMS, Lachance G, Hammond CJ, Williams FMK. Shared genetic factors underlie chronic pain syndromes. Pain. 2014;155(8):1562–8.

    Article  PubMed  Google Scholar 

  21. Shoskes DA, Keslar KS, Gotwald P, Berglund R, Vij S. Neuroinflammatory gene expression in chronic prostatitis/chronic pelvic pain syndrome patients: insights into etiology and phenotype biology. Transl Androl Urol. 2021;10(8):3340–7.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Camilleri M, Busciglio I, Carlson P, McKinzie S, Burton D, Baxter K, et al. Candidate genes and sensory functions in health and irritable bowel syndrome. Am J Physiol Gastrointest Liver Physiol. 2008;295(2):G219–25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Shoskes DA, Nickel JC, Rackley RR, Pontari MA. Clinical phenotyping in chronic prostatitis/chronic pelvic pain syndrome and interstitial cystitis: a management strategy for urologic chronic pelvic pain syndromes. Prostate Cancer Prostatic Dis. 2009;12(2):177–83.

    Article  CAS  PubMed  Google Scholar 

  24. Nickel JC, Shoskes DA. Phenotypic approach to the management of the chronic prostatitis/chronic pelvic pain syndrome. BJU Int. 2010;106(9):1252–63.

    Article  PubMed  Google Scholar 

  25. Nijs J, Meeus M, Van Oosterwijck J, Ickmans K, Moorkens G, Hans G, De Clerck LS. In the mind or in the brain? Scientific evidence for central sensitisation in chronic fatigue syndrome. Eur J Clin Invest. 2012;42(2):203–12.

    Article  PubMed  Google Scholar 

  26. Christianson JA, Liang R, Ustinova EE, Davis BM, Fraser MO, Pezzone MA. Convergence of bladder and colon sensory innervation occurs at the primary afferent level. Pain. 2007;128(3):235–43.

    Article  PubMed  Google Scholar 

  27. Bullones Rodriguez MA, Afari N, Buchwald DS, National Institute of D, Digestive, Kidney Diseases Working Group on Urological Chronic Pelvic P. Evidence for overlap between urological and nonurological unexplained clinical conditions. J Urol. 2013;189(1 Suppl):S66–74.

    PubMed  PubMed Central  Google Scholar 

  28. Russo J, Katon W, Sullivan M, Clark M, Buchwald D. Severity of somatization and its relationship to psychiatric disorders and personality. Psychosomatics. 1994;35(6):546–56.

    Article  CAS  PubMed  Google Scholar 

  29. Halvorson HA, Schlett CD, Riddle MS. Postinfectious irritable bowel syndrome--a meta-analysis. Am J Gastroenterol. 2006;101(8):1894–9. quiz 942

    Article  PubMed  Google Scholar 

  30. Pontari M, Giusto L. New developments in the diagnosis and treatment of chronic prostatitis/chronic pelvic pain syndrome. Curr Opin Urol. 2013;23(6):565–9.

    Article  PubMed  Google Scholar 

  31. Tanaka Y, Yamashita R, Kawashima J, Mori H, Kurokawa K, Fukuda S, et al. Omics profiles of fecal and oral microbiota change in irritable bowel syndrome patients with diarrhea and symptom exacerbation. J Gastroenterol. 2022;57(10):748–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Pontari MA. Etiology of chronic prostatitis/chronic pelvic pain syndrome: psychoimmunoneurendocrine dysfunction (PINE syndrome) or just a really bad infection? World J Urol. 2013;31(4):725–32.

    Article  CAS  PubMed  Google Scholar 

  33. Litwin MS, McNaughton-Collins M, Fowler FJ Jr, Nickel JC, Calhoun EA, Pontari MA, et al. The National Institutes of Health chronic prostatitis symptom index: development and validation of a new outcome measure. Chronic Prostatitis Collaborative Research Network. J Urol. 1999;162(2):369–75.

    Article  CAS  PubMed  Google Scholar 

  34. Masterson JM, Castaneda PR, Kim J. Pathophysiology and Clinical biomarkers in interstitial cystitis. Urol Clin North Am. 2023;50(1):39–52.

    Article  PubMed  Google Scholar 

  35. Bryk DJ, Shoskes DA. Using the UPOINT system to manage men with chronic pelvic pain syndrome. Arab. J Urol. 2021;19(3):387–93. UPOINT system approach allowed significant benefit based on phenotype.

    Google Scholar 

  36. Clemens JQ, Erickson DR, Varela NP, Lai HH. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol. 2022;208(1):34–42.

    Article  PubMed  Google Scholar 

  37. Patcharatrakul T, Gonlachanvit S. Outcome of biofeedback therapy in dyssynergic defecation patients with and without irritable bowel syndrome. J Clin Gastroenterol. 2011;45(7):593–8.

    Article  PubMed  Google Scholar 

  38. Fitzgerald MP, Anderson RU, Potts J, Payne CK, Peters KM, Clemens JQ, et al. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. J Urol. 2013;189(1 Suppl):S75–85. Randomized trial showed value of myofascial physical therapy.

    PubMed  PubMed Central  Google Scholar 

  39. Shahabi L, Naliboff BD, Shapiro D. Self-regulation evaluation of therapeutic yoga and walking for patients with irritable bowel syndrome: a pilot study. Psychol Health Med. 2016;21(2):176–88.

    Article  PubMed  Google Scholar 

  40. Camilleri M. Diagnosis and treatment of irritable bowel syndrome: a review. JAMA. 2021;325(9):865–77.

    Article  CAS  PubMed  Google Scholar 

  41. Shorter B, Ackerman M, Varvara M, Moldwin RM. Statistical validation of the shorter-moldwin food sensitivity questionnaire for patients with interstitial cystitis/bladder pain syndrome. J Urol. 2014;191(6):1793–801.

    Article  PubMed  Google Scholar 

  42. Dionne J, Ford AC, Yuan Y, Chey WD, Lacy BE, Saito YA, et al. A systematic review and meta-analysis evaluating the efficacy of a gluten-free diet and a low FODMAPs diet in treating symptoms of irritable bowel syndrome. Am J Gastroenterol. 2018;113(9):1290–300.

    Article  CAS  PubMed  Google Scholar 

  43. Alammar N, Wang L, Saberi B, Nanavati J, Holtmann G, Shinohara RT, Mullin GE. The impact of peppermint oil on the irritable bowel syndrome: a meta-analysis of the pooled clinical data. BMC Complement Altern Med. 2019;19(1):21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Rothrock NE, Lutgendorf SK, Kreder KJ, Ratliff T, Zimmerman B. Stress and symptoms in patients with interstitial cystitis: a life stress model. Urology. 2001;57(3):422–7.

    Article  CAS  PubMed  Google Scholar 

  45. Black CJ, Thakur ER, Houghton LA, Quigley EMM, Moayyedi P, Ford AC. Efficacy of psychological therapies for irritable bowel syndrome: systematic review and network meta-analysis. Gut. 2020;69(8):1441–51.

    Article  PubMed  Google Scholar 

  46. Drossman DA, Tack J, Ford AC, Szigethy E, Tornblom H, Van Oudenhove L. Neuromodulators for functional gastrointestinal disorders (disorders of gut-brain interaction): a Rome Foundation Working Team Report. Gastroenterology. 2018;154(4):1140–71 e1.

    Article  PubMed  Google Scholar 

  47. van Ophoven A, Hertle L. Long-term results of amitriptyline treatment for interstitial cystitis. J Urol. 2005;174(5):1837–40.

    Article  PubMed  Google Scholar 

  48. Qin Z, Zhang C, Guo J, Kwong JSW, Li X, Pang R, et al. Oral pharmacological treatments for chronic prostatitis/chronic pelvic pain syndrome: a systematic review and network meta-analysis of randomised controlled trials. EClinicalMed. 2022;48:101457. Network meta-analysis shows little evidence for efficacy of oral pharmacological treatments like antibiotics and alpha blockers in UCPPS.

  49. Thakkinstian A, Attia J, Anothaisintawee T, Nickel JC. alpha-blockers, antibiotics and anti-inflammatories have a role in the management of chronic prostatitis/chronic pelvic pain syndrome. BJU Int. 2012;110(7):1014–22.

    Article  CAS  PubMed  Google Scholar 

  50. Pontari MA, Krieger JN, Litwin MS, White PC, Anderson RU, McNaughton-Collins M, et al. Pregabalin for the treatment of men with chronic prostatitis/chronic pelvic pain syndrome: a randomized controlled trial. Arch Intern Med. 2010;170(17):1586–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Doiron RC, Nickel JC. Management of chronic prostatitis/chronic pelvic pain syndrome. Can Urol Assoc J. 2018;12(6 Suppl 3):S161–S3.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Lindeke-Myers A, Hanif AM, Jain N. Pentosan polysulfate maculopathy. Surv Ophthalmol. 2022;67(1):83–96.

    Article  PubMed  Google Scholar 

  53. Chey WD, Drossman DA, Johanson JF, Scott C, Panas RM, Ueno R. Safety and patient outcomes with lubiprostone for up to 52 weeks in patients with irritable bowel syndrome with constipation. Aliment Pharmacol Ther. 2012;35(5):587–99.

    Article  CAS  PubMed  Google Scholar 

  54. Johnston JM, Kurtz CB, Macdougall JE, Lavins BJ, Currie MG, Fitch DA, et al. Linaclotide improves abdominal pain and bowel habits in a phase IIb study of patients with irritable bowel syndrome with constipation. Gastroenterology. 2010;139(6):1877–86 e2.

    Article  CAS  PubMed  Google Scholar 

  55. Pimentel M, Lembo A, Chey WD, Zakko S, Ringel Y, Yu J, et al. Rifaximin therapy for patients with irritable bowel syndrome without constipation. N Engl J Med. 2011;364(1):22–32.

    Article  CAS  PubMed  Google Scholar 

  56. Cash BD, Lacy BE, Schoenfeld PS, Dove LS, Covington PS. Safety of Eluxadoline in patients with irritable bowel syndrome with diarrhea. Am J Gastroenterol. 2017;112(2):365–74.

    Article  CAS  PubMed  Google Scholar 

  57. Camilleri M, Ford AC. Pharmacotherapy for irritable bowel syndrome. J Clin Med. 2017;6(11)

  58. Kirk PS, Santiago-Lastra Y, Qin Y, Stoffel JT, Clemens JQ, Cameron AP. The effects of cystoscopy and hydrodistention on symptoms and bladder capacity in interstitial cystitis/bladder pain syndrome. Neurourol Urodyn. 2018;37(6):2002–7.

    Article  PubMed  Google Scholar 

  59. Miller JL, Rothman I, Bavendam TG, Berger RE. Prostatodynia and interstitial cystitis: one and the same? Urology. 1995;45(4):587–90.

    Article  CAS  PubMed  Google Scholar 

  60. Beamer MR, Pinkhasov A, Kravchick S. Preoperative modified spermatic cord block predicts success in candidates for microscopic spermatic cord denervation. Urology. 2021;156:31–6.

    Article  PubMed  Google Scholar 

  61. Egeo G, Fofi L, Barbanti P. Botulinum neurotoxin for the treatment of neuropathic pain. Front Neurol. 2020;11:716.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Parsons BA, Goonewardene S, Dabestani S, Pacheco-Figueiredo L, Yuan Y, Zumstein V, et al. The benefits and harms of botulinum toxin-A in the treatment of chronic pelvic pain syndromes: a systematic review by the European Association of Urology Chronic Pelvic Pain Panel. Eur Urol Focus. 2022;8(1):320–38.

    Article  PubMed  Google Scholar 

  63. Nickel JC. Medical marijuana for urologic chronic pelvic pain. Can Urol Assoc J. 2018;12(6 Suppl 3):S181–S3.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

No funding was received for this article.

Author information

Authors and Affiliations

  1. Phelps Hospital, Northwell Health, 755 N Broadway Ste 510, NY, Sleepy Hollow, 10591, USA

    Ehab Eltahawy

  2. College of Medicine, University Of Arkansas for Medical Sciences, Little Rock, USA

    Nada Lelovic

  3. Department of Urology, University of Michigan, Ann Arbor, USA

    Susanne Quallich

  4. Department of Urology, University of Arkansas for Medical Sciences, Little Rock, USA

    Bruno Machado

Authors
  1. Ehab Eltahawy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nada Lelovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Susanne Quallich
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bruno Machado
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

EA wrote the section on treatment NL,

BM wrote the section on etiology and pathogenesis

SQ wrote the section on evaluation and cases

All authors reviewed the manuscript.

Corresponding author

Correspondence to Ehab Eltahawy.

Ethics declarations

Competing interests

The authors declare no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Eltahawy, E., Lelovic, N., Quallich, S. et al. IBS and Chronic Prostatitis: Update on Chronic Pelvic Pain. Curr Bladder Dysfunct Rep (2024). https://doi.org/10.1007/s11884-024-00740-y

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11884-024-00740-y

Keywords

Search

Navigation