Chronic Pelvic Pain Syndrome (CCPS)

What is it?

CCPS is characterised by pain experienced in the lower abdomen, pelvis, perineum, testes, penis, anus or groin area for longer than 6 months. It occurs in approximately 1 in 12 Australian men, although this statistic is likely higher, with men underreporting symptoms or the diagnosis is missed as it is not directly found through routine investigations.

The persistent pain has a negative effect on an individual’s quality of life through complex mechanisms within the pelvic structures, including the nervous system, muscles and psychological factors.

Signs and symptoms

CCPS may present differently, yet symptoms that individuals report may include:

• Pain in the testes, penis, perineal area, anus, lower abdomen or groin area
• Pain before, during or after intercourse, or ejaculation
• Pain when holding on to urine, during urination or after
• Pain when seated in the perineum, testes, sit bones, or groin
• Bowel issues such as pain when passing, incomplete emptying, anal or rectum pain
• Pressure, throbbing, tingling, twitching and/or spasm in your pelvic floor muscles or urethra
• Change in erectile function including uncomfortable sensation, reduced tumescence or pain
• Sensitivity to tight clothes around the stomach, groin or perineum

Common causes

• History of bacterial prostatitis

• Problems with the pelvic floor muscles
• History of low back, groin and/or pelvic pain
• History of bowel issues such as chronic constipation, bowel dyssynergia, haemorrhoids, anal fissures
• History of urological issues, including urinary tract infections, STDs or skin conditions
• Psychological distress
• History of trauma and/or abuse

How can physiotherapy help?

Physiotherapy involves a comprehensive valuation including your subjective history, hands on assessment and use of real-time ultrasound of your pelvic floor. Your physiotherapist will develop a personalised plan to help you regain your quality of life. Treatment strategies utilised in your plan may include:

• Down-regulation of the central nervous system drivers within the pelvic floor
• Manual therapy techniques to desensitise the nerves and muscles of the pelvic floor
• Prescribed exercises to improve mobility of your lumbo-pelvic region
• Bladder habits and bowel retraining
• If indicated, the use of a Focused Shockwave Therapy or TENS to help manage your pain
• Advice on lifestyle factors including general exercise, sleep, diet, strategies to improve erectile function and stress management

We also work closely with you GP and urologists to ensure a holistic approach is taken.