Many men spend months, and sometimes years, going from doctor to doctor with the same complaint: persistent discomfort in the lower abdomen or groin area. They undergo dozens of tests, have ultrasounds, yet the results come back “clean.” Doctors shrug their shoulders or once again prescribe a standard course of antibiotics, which provides only temporary relief.
If this situation sounds familiar, it is most likely not a typical infection, but a condition known in medicine as chronic pelvic pain syndrome (CPPS). This is not simply “undertreated prostatitis,” but a complex clinical syndrome that requires a completely different way of looking at the problem.
What chronic pelvic pain syndrome is, in simple terms
Chronic pelvic pain syndrome is a condition in which a man experiences pain or discomfort in the pelvic area for at least three of the past six months. At the same time, doctors do not find any other obvious cause that could explain these sensations (such as an active infection or a tumor). CPPS in men is often accompanied by urinary symptoms or changes in sexual function. This is an extremely common problem: it affects 2–10% of adult men worldwide. It is important to understand that this condition is officially recognized by medicine and has clear diagnostic criteria, even if your test results look perfect.
Why this is not always prostatitis
Many patients — and even some doctors — are used to using the term “prostatitis” for any pain in this area. However, statistics tell a different story: the vast majority of men given this diagnosis actually suffer from CPPS rather than a bacterial infection. The key difference is that in CPPS, the prostate may not be the source of the pain at all. This is why situations arise in which there is prostate pain, but tests are normal. Studies show that the presence or absence of inflammatory cells in prostatic secretions often does not correlate with what the patient feels. Even microorganisms such as chlamydia or ureaplasma, in most cases, are not the cause of this syndrome.
Main causes of chronic pelvic pain
When a patient asks, “Why does the pelvis hurt in men?”, modern medicine offers several explanations, which often act together:
• Inflammation without infection: it may be caused by trauma or even a reaction to the body’s own microbiota
• Autoimmune processes: when the immune system mistakenly attacks the body’s own tissues
• Psychosomatic pelvic pain: psychological stress and anxiety are very common in men with CPPS and may be factors that sustain the pain
• Nervous system features: sometimes pain signaling mechanisms “malfunction,” and the brain continues to receive pain messages even when there is no tissue damage
Not uncommonly, pelvic pain without an obvious cause is associated with other conditions in the body, such as irritable bowel syndrome or migraines.
How muscles, nerves, and pain are connected
In CPPS, so-called neuropathic pelvic pain often develops. Nerve endings in the pelvic area become overly sensitive. In addition, the muscles of the pelvic floor play an important role. During examination, doctors often find muscle spasms or painful trigger points in the perineum and along the pelvic walls. This involvement of nerves and muscles is precisely why chronic lower abdominal pain occurs in men. Pelvic organs share a common innervation system, so irritation in, for example, the intestines can “refer” pain to the bladder or groin.
Why pills often don’t help
The main patient question is: “Why doesn’t prostatitis treatment work?” The answer is simple: if pain is caused by muscle spasm or dysfunction of the nervous system, standard antibiotics will not help, because they only target bacteria. Moreover, treatment with a single medication is rarely effective in CPPS. The modern approach involves a combination of methods that address inflammation, muscle tone, and the nervous system. If one tries to treat this condition only with “anti-infective” pills, years may pass without meaningful improvement.
How doctors diagnose CPPS
Since this is a “diagnosis of exclusion,” it is important for the physician to first make sure that the patient does not have other diseases. Diagnosis usually proceeds in several stages:
• Infection screening — urinalysis and urine culture are mandatory to rule out bacterial prostatitis or cystitis
• Physical examination — the doctor assesses not only the prostate itself, but also the pelvic muscles, and looks for possible hernias or other causes of discomfort
• Exclusion of “red flags” — the physician must ensure there is no blood in the urine, no testicular tumors, and no serious neurological deficits (such as leg weakness) that would require a completely different approach
If all dangerous conditions are excluded and the pain persists for more than three months, CPPS is confirmed.
How CPPS differs from chronic prostatitis
Although these terms are often confused, the difference is significant:
• Chronic bacterial prostatitis is always caused by an infection confirmed by tests. It is often accompanied by recurrent cystitis and fever
• CPPS is pain in the absence of an obvious infection
Interestingly, CPPS overlaps significantly with painful bladder syndrome (interstitial cystitis): almost half of men with CPPS have symptoms of both conditions.
What is important for a man with long-term pelvic pain to understand
If you are living with this condition, it is important to know how it behaves. CPPS is characterized by a relapsing course: periods of well-being alternate with “flares” of pain. These exacerbations may last from a few seconds to several months, and their intensity can vary. The good news is that in most cases, over time, the frequency and severity of these flares decrease. It is important not to withdraw into yourself, as chronic pain can affect quality of life and mood, which in turn amplifies pain perception.
Chronic pelvic pain in men is not a sentence and not a reason for endless “just in case” antibiotic use. It is a signal from the body that the interaction between muscles, nerves, and the immune system in the pelvic region is disrupted. Modern medicine calls for a comprehensive approach. Treatment should be individualized, based on which symptoms predominate in a particular person — whether it is muscle pain, urinary disturbances, or psychological discomfort. The key is to find a doctor who looks at the problem more broadly than simply searching for bacteria in test results.