Pelvic tenderness is not limited to the prostate in CPPS

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BMC Urol. 2007 Oct 2;7(1):17 [Epub ahead of print]

Pelvic tenderness is not limited to the prostate in chronic prostatitis/chronic pelvic pain syndrome (CPPS) type IIIA and IIIB: comparison of men with and without CP/CPPS.


Berger RE, Ciol MA, Rothman I, Turner JA.

BACKGROUND: We wished to determine if there were differences in pelvic and non-pelvic tenderness between men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) Type III and men without pelvic pain.

METHODS: We performed the Manual Tender Point Survey (MTPS) as described by the American College of Rheumatology on 62 men with CP/CPPS Type IIIA and IIIB and 98 men without pelvic pain. We also assessed tenderness of 10 external pelvic tender points (EPTP) and of 7 internal pelvic tender points (IPTP). All study participants completed the National Institutes of Health Chronic Prostatitis Symptom Inventory (NIH CPSI).

RESULTS: We found that men with CPPS were significantly more tender in the MTPS, the EPTPS and the IPTPS. CPSI scores correlated with EPTP scale but not with IPTP scale or prostate tenderness. Prostatic tenderness was present in 75% of men with CPPS and in 50% of men without CPPS. Expressed prostatic fluid leukocytosis was not associated with prostatic tenderness.

CONCLUSION: Men with CP/CPPS have more tenderness compared to men without CPPS. Tenderness in men with CPPS is distributed throughout the pelvis and not specific to the prostate.

PMID: 17908331 [PubMed - as supplied by publisher]

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This rather good study is available in full online. I like this quote, for instance:

The finding of increased tenderness in MTPS tender points in men with CP/CPPS is in accord with findings of diffusely increased tenderness in women with interstitial cystitis, a syndrome possibly related to CP/CPPS. We hypothesize that central and/or peripheral pain sensitization in the pelvis may account for the diffuse symptoms and tenderness found in pelvic pain syndromes. The diffuse tenderness on pelvic examination in our present study may be a manifestation of mechanical sensitization to pressure with the development of allodynia and hyperesthesia mediated via the CNS. If prostatic inflammation was the source of prostatic pain and the non-prostate pelvic tenderness was secondary to muscle guarding, we would have expected to find a relationship of prostatic secretion inflammation to prostatic and muscle tenderness. Since we found no such associations, we hypothesize that prostatic and other pelvic tenderness may both be related to an another more dominant process such as central or peripheral neural sensitization and that inflammation in prostatic secretion may be incidental.