Resources to Help You Manage Pain with Confidence

What Is Chronic Pelvic Pain Syndrome (CPPS)?

Chronic Pelvic Pain Syndrome (CPPS) is a persistent and often complex condition affecting the pelvic region. It is more common in men but can affect people of all genders. CPPS is not just a physical issue—it involves an intricate interplay between the body, mind, and environment, and each person’s experience is unique.

What Does It Feel Like?

CPPS symptoms can vary widely but often include:

• Pain or discomfort in the pelvis, lower back, abdomen, or genitals.

• Urinary issues, such as urgency, frequency, or burning sensations.

• Pain during or after sexual activity, such as discomfort with ejaculation.

• A sense of tightness, heaviness, or persistent tension in the pelvic region.

These symptoms can fluctuate over time and may be influenced by stress, activity levels, posture, or emotional states【5, 6, 9】.

What Causes CPPS?

The development of CPPS is multifactorial, with contributions from physical, emotional, and behavioral systems. Factors include:

• Trauma:

  • Physical trauma: Injuries, infections, surgeries, or procedures affecting the pelvic region, as well as physical trauma like circumcision【1】.

  • Past trauma: Sexual abuse, rape, or other significant physical or emotional harm can leave a lasting imprint on the nervous system【10】.

  • Life experiences: Adverse childhood experiences (e.g., loss of a parent, unstable home environment) or adult challenges (e.g., bullying, harassment, grief, financial stress) can have profound effects【3】.

• Infection and inflammation: Acute or past infections can initiate immune responses, leading to inflammation that irritates pelvic nerves and tissues【1, 7】.

• Changes in the muscular system: The pelvic muscles often act predictively, preparing for or reacting to perceived threats. In CPPS, the normal activation patterns of these muscles may shift, resulting in chronic over-activation. This not only contributes to a sense of tension but can also release pro-inflammatory chemicals and metabolites, further sensitising the nervous system【4, 7】.

• Nerve sensitivity: The nerves supplying the pelvis can lower their activation threshold in response to persistent pain, inflammation, or emotional stress, creating a feedback loop that sustains discomfort【4, 7】.

• Stress and emotional responses: Chronic stress, anxiety, or patterns of guarding and avoidance can further heighten pain and reinforce cycles of tension【3, 10】.

How Can CPPS Be Treated?

Recovery from CPPS requires a whole-person approach, addressing both the physical and psychological contributors to pain. Treatment strategies may include:

• Education and understanding: Learning how pain and sensitivity develop in the body can reduce fear and foster empowerment in your recovery【2, 3】.

• Manual therapy and movement: Techniques to promote relaxation/letting-go, improve mobility, and retrain normal activation patterns in the pelvic muscles and surrounding areas【1, 7】.

• Nervous system regulation: Relaxation practices, such as mindfulness, breathing exercises, and body awareness techniques, can help calm the nervous system and reduce sensitivity【5, 8】.

• Addressing trauma: Exploring and processing past or current traumatic experiences with appropriate support can help reduce their impact on your body and pain experience【3, 10】.

• Retraining the muscular system: Targeted approaches to restore balanced function in the pelvic muscles can reduce tension and minimise the release of sensitising chemicals【4, 7】.

• Lifestyle adjustments: Changes to posture, activity levels, nutrition, and stress management can help reduce symptom flare-ups and support recovery【5, 6】.

• Psychological support: Therapy or counselling can provide valuable tools for managing the emotional toll of CPPS and addressing past or ongoing stressors【3, 10】.

Hope for Recovery

Living with CPPS can feel overwhelming, but recovery is possible. Whether your pain has been influenced by physical trauma, emotional stress, or life’s challenges, understanding the connections between these factors can empower you to take steps toward healing. With the right support and an approach tailored to your unique experience, you can work toward regaining control, confidence, and ease in your life.

References

1. Cyr, M.-P., Nahon, I., Worman, R., Cowley, D., & Hodges, P. W. (2024). Classification systems for chronic pelvic pain in males: A systematic review. BJU International.

2. Wood, N. (2015). How to talk to someone with an “untreatable” lifelong condition. BMJ, 351, h5037.

3. Farrar, S. (2020). Towards an Understanding of Men’s Experiences of Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS). ClinPsychD Thesis, University of East London.

4. Kutch, J. J., et al. (2017). Brain signature and functional impact of centralized pain: A MAPP Network Study. Pain, 158(10), 1979–1991.

5. Xu, T., et al. (2019). Changes in whole body pain intensity and widespreadness during urologic chronic pelvic pain syndrome flares. Neurourology and Urodynamics, 38(8), 2333–2350.

6. Sutcliffe, S., et al. (2015). Changes in Symptoms During Urologic Chronic Pelvic Pain Syndrome Flares. Neurourology and Urodynamics, 34(2), 188–195.

7. Clemens, J. Q., et al. (2019). Urologic chronic pelvic pain syndrome: Insights from the MAPP Research Network. Nature Reviews Urology, 16(3), 187–200.

8. Quallich, S. A., et al. (2022). Flares and their impact among male urologic chronic pelvic pain syndrome patients: An in-depth qualitative analysis. Neurourology and Urodynamics.

9. Sutcliffe, S., et al. (2014). Urologic Chronic Pelvic Pain Syndrome Symptom Flares: Characterization of the Full Spectrum of Flares. BJU International, 114(6), 916–925.

10. Jonsson, K., & Hedelin, H. (2008). Chronic abacterial prostatitis: Living with a troublesome disease affecting many aspects of life. Scandinavian Journal of Urology and Nephrology, 42(6), 545–550

Written February 2025