What is chronic non-bacterial prostatitis?
The name is misleading. Only a small fraction of men with prostatitis symptoms have a bacterial infection; the rest have CP/CPPS, in which the prostate is usually not inflamed at all. What the examination does find, in most men, is a pelvic floor that is tight and tender, with trigger points that reproduce the perineal, penile, testicular, rectal and suprapubic pain and the urinary symptoms that bring them to the doctor.
Modern urology treats CP/CPPS by phenotype using the UPOINT system, and the “T” for pelvic floor tenderness is treated with pelvic floor physiotherapy. Combining trigger point release with relaxation training, sometimes called the Wise-Anderson protocol, has the longest track record. Stress, prolonged sitting, cycling, holding urine and constipation all feed the muscle tension, so habits are part of the treatment too.
Common signs and symptoms
- Pain or pressure in the perineum, the area between the scrotum and anus
- Pain in the penis, testicles, lower abdomen, groin or low back
- Pain or burning with urination, urgency, frequency, or a weak or hesitant stream
- Pain during or after ejaculation
- Symptoms that flare with sitting, stress, cold or long drives
- Fatigue, low mood and anxiety from months of unexplained pain
What causes it?
- Chronic pelvic floor tension and trigger points, often started by stress, an infection or an injury that has since resolved
- A sensitised nervous system that keeps signalling pain after the trigger is gone
- Habits: prolonged sitting, cycling, holding urine, straining with constipation
- Pudendal nerve irritation
- Previous infections or procedures that left the muscles guarding
- Overlap with bladder pain syndrome and irritable bowel syndrome
How pelvic floor physiotherapy helps
Pelvic floor physiotherapy for CP/CPPS finds the muscles that reproduce your pain and releases them, then teaches you to keep them relaxed with breathing, stretching and habit changes. It works alongside your urologist’s care and is the treatment for the muscle component that antibiotics were never going to fix.
A treatment plan typically includes:
- A history and external assessment of the pelvic floor, abdomen, hips and lower back
- Manual trigger point release, externally and, with your consent, internally
- Paradoxical relaxation and diaphragmatic breathing to lower resting pelvic floor tone
- Stretching and mobility for hips, adductors and the lower back
- Bladder and bowel habits, sitting and cycling modifications
- Coordination with your urologist within a UPOINT-style plan, and referral for stress or sleep support where that helps
What the research says
The studies below are peer-reviewed and linked to their permanent records so you can read them yourself.
In this series of 138 men with chronic pelvic pain who had failed conventional treatment, combining pelvic floor trigger point release with paradoxical relaxation training led most to report moderate or marked improvement in pain and urinary symptoms.
Anderson RU, Wise D, Sawyer T, Chan C. Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. Journal of Urology, 2005. View study
The UPOINT classification treats CP/CPPS by phenotype; its “Tenderness” domain identifies men with pelvic floor muscle tenderness and directs them to pelvic floor physical therapy.
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 and Prostatic Diseases, 2009. View study
This Cochrane review of non-drug treatments for CP/CPPS found that several approaches, including acupuncture, shockwave therapy and lifestyle changes, may reduce symptoms, while calling for larger, better trials of physical therapies.
Franco JVA, Turk T, Jung JH, et al.. Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Cochrane Database of Systematic Reviews, 2018. View study
Treatment at Corelife Wellness in Oakville
Corelife Wellness is a dedicated pelvic health clinic at 3075 Hospital Gate, Unit 312, Oakville, next to Oakville Trafalgar Memorial Hospital. Care starts with a free 15-minute consultation by phone, video or in person, followed by a full assessment with our Registered Physiotherapist. Every pelvis is unique, so your plan is built from that exam rather than a template. No referral is needed, and physiotherapy is often eligible under extended health benefits.
How assessment and treatment work, and how to book, are on our main page: Pelvic floor physiotherapy in Oakville.
Helpful reading from our team
When to see a doctor first
Pelvic floor physiotherapy is safe and you do not need a referral, but some symptoms need a medical assessment before or alongside treatment:
- Fever, chills or feeling acutely unwell with urinary symptoms (possible acute bacterial prostatitis)
- Being unable to pass urine
- Blood in urine or semen
- A lump or change in a testicle, or unexplained weight loss
