Comprehensive pelvic floor physical therapy program for men with idiopathic chronic pelvic pain syndrome: a prospective study

Abstract

BackgroundMale chronic pelvic pain syndrome (CPPS) is a heterogeneous constellation of symptoms that causes significant impairment and is often challenging to treat. In this prospective study, we evaluated men with CPPS who underwent comprehensive pelvic floor physical therapy (PFPT) program. We used the previously validated Genitourinary Pain Index (GUPI) to measure outcomes.MethodsWe included 14 men who underwent physical therapy for idiopathic CPPS from October 2015 to October 2016. Men with clearly identifiable causes of pelvic pain, such as previous surgery, chronic infection, trauma, prostatitis and epididymitis were excluded. Treatment included: (I) manual therapy (internal and external) of pelvic floor and abdominal musculature to facilitate relaxation of muscles; (II) therapeutic exercises to promote range of motion, improve mobility/flexibility and strengthen weak muscles; (III) biofeedback to facilitate strengthening and relaxation of pelvic floor musculature; (IV) neuromodulation for pelvic floor muscle relaxation and pain relief. GUPI questionnaires were collected at initial evaluation and after the 10th visit. Higher scores reflect worse symptoms. Previous validation of the GUPI calculated a reduction of 7 points to robustly predict being a treatment responder (sensitivity 100%, specificity 76%) and a change in 4 points to predict modest response. Data are presented as medians (ranges).ResultsA total of 10 patients completed 10 visits, and the remaining four patients completed between 5 and 9 visits. The median National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) score at initial evaluation was 30.8 [16–39] and decreased to 22.2 [7–37] at the tenth visit. Five of the 10 patients (50%) in the study had a reduction of greater than 7 points indicating a robust treatment response, and two (20%) had a change of greater than 4 indicating moderate response. Three patients (30%) did not have any meaningful change in NIH-CPSI and the remaining four are in the process of completing 10 sessions. Duration of therapy appears to predict treatment response. Longer duration has better response.ConclusionsMale CPPS is difficult to treat and often requires a multimodal approach. Based on the results of our pilot study, pelvic floor rehabilitation may be an effective treatment option for select patients. A larger study with a control group is needed to validate the routine use of pelvic floor rehabilitation in men with CPPS and predict characteristics of men who would respond to therapy.

Effectiveness of external myofascial mobilisation in the management of male chronic pelvic pain of muscle spastic type: A retrospective study

“…Chronic pelvic pain syndrome remains a conundrum for physicians and patients because of the heterogeneity of the symptoms [ 26 ]. Monotherapy with medication or psychotherapy is often ineffective and can lead to frustration for both the patient and the practitioner [ 26 ]. For most practitioners, medical therapy directed at discrete symptoms is the first-line option.…”

“…We further analysed the treatment effectiveness through determining change in symptom severity. Patients' symptom severity was classified as mild (0-15), moderate (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) or severe (>29) based on their total score (Table 4). Before the implementation of treatment, most patients had severe (42%) or moderate symptoms (45%).…”

Curative efficacy of low frequency electrical stimulation in preventing urinary retention after cervical cancer operation

“…The second treatment is the use of endorphin procedures to relax abdominal and pelvic floor muscles with an analgesic effect [24]. In theory, the latter is suitable for muscle tension caused by pain and infection factors after delivery and general surgery [25], and its treatment program is as follows: electrical stimulation frequency is set at 1 Hz, pulse width is set at 270 μs, for 15–30 min each time, twice a day, for a duration of 3 days, then the catheter is removed. However, data of our hospital suggest that in the preventive treatment for urinary retention after cervical cancer operation, the second method seems to be more effective, and the possible reason may be as follows: even the chances of damage to pelvic floor tissues, blood vessels and nerves are greater in cervical cancer operation than in general gynecological surgery, and postoperative urinary retention caused by muscle tension are still dominant.…”

Urogenital Pain Including Pelvic Pain

“…Physical therapy, including Kegel exercise and myofascial treatments, accompanied with biofeedback, behavioral modifications, and acupuncture is an evidence based approach to treating chronic pelvic pain in men and women [16]. A multi-modal comprehensive physical therapy program uses manual therapy with myofascial release techniques of pelvic floor and abdominal musculature with a range of motion exercises that focuses on flexibility and strength of weak pelvic floor and abdominal muscles and biofeedback to improve relaxation and strength [26]. Within physical therapy modalities, myofascial release techniques targeted to weak or restricted pelvic floor muscles are more effective than general therapeutic massage [27].…”