Urogenital Pain Syndrome

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Feb 12, 2015/ 0 Comments / in General Medical Posts / by
Urogenital Pain Syndrome

Urogenital Pain Syndrome

The diagnosis of chronic Urogenital pain syndrome is often made when a male patient presents with abnormal and persistent pelvic or/and perineal discomfort for a period of more than 3 months. The pain is usually gnawing in character and may radiates to lower abdominal region. Investigators and healthcare professionals have long believed that urogenital pain syndrome is a poorly understood condition that may present with localized (or generalized) pain syndromes that usually involve symptoms like:

– Urethral syndrome (presents with signs of urinary tract infection such as painful and burning urination, increased frequency of urination, pus in the urine and other signs of infection)

– Penile pain (pain in the penis and surrounding areas)

– Orchialgia (pain or discomfort in the testicles)

– Proctalgia fugax (severe, constricting spasms in the pelvic and rectal muscles that interferes with the defecation)

– Prostatodynia (pain in the prostate gland)

– Coccygodynia (pain in the coccyx region)

– Perineal pain (discomfort or pain in the perineum)

– Proctodynia (pain in the rectal region)

According to latest estimates, chronic urogenital pain is quite prevalent in general population. Based on latest estimates, more than 14.7% of the general population is currently living with one or more of the urogenital pain syndrome (1). Due to site and nature of symptoms, a lot of individuals feel embarrassed or shy in seeking medical evaluation by a registered healthcare provider. It is imperative to understand that symptoms may worsen in all such cases over time.


Why is it Important to Identify the Exact Etiology of Urogenital Pain Syndrome?

Epididymitis ImageClinical data indicates that the quality of life is significantly compromised in poorly managed or untreated cases of urogenital pain syndrome. Study reported in the peer reviewed The Journal of Sexual Medicine (2) suggested that individuals who suffer from urogenital pain syndromes are more like to experience:

– Health issues due to chronic constipation, recurrent urinary tract infections, urinary dysfunction etc.

– Sexual dysfunction due to an inability to engage in normal sexual activities. Most males experience moderate difficulty in arousal, sexual desires, ability to achieve orgasm and sexual satisfaction. Eventually, sexual dysfunction affects the quality of relationships and personal aspects of the patient’s life

– Psychological issues due to chronic pain, anxiety, embarrassment, frustration and depression

Urogenital pain syndromes are usually hard to manage clinically because in vast majority of cases, the symptoms are vague and does not fit in one clinical specialty.


How to Manage Urogenital Pain Syndrome?

Experts believes that the management of urogenital pain syndrome revolves around the accurate diagnosis of the etiology and source of pain. Primary causes of urogenital pain syndrome are:

– Organic pathology or disease process of pelvic or perineal region (such as a growing mass/ tumor, inflammatory or infectious conditions etc.). Management options are usually pharmacological or surgical.

Dyspareunia Image– Functional pain (also referred to as visceral pain) is responsible for dysregulation of urogenital muscles that may presents with pain, muscle spasm and discomfort. According to a study conducted by Hetrick (3) and colleagues, several factors like (increased tone and spasticity of pelvic/ perineal muscles) is observed in patients with urogenital pain syndrome. Management is usually multifactorial.

– Neurological pain that is often a result of nerve entrapment or inflammation in the setting of other chronic diseases of urogenital region.

For best results, it is recommended that every case of urogenital syndrome is assessed by a team of expert healthcare professionals (such as anesthesiologists, urologists, psychologists, pain management experts, gynecologists, neurologists and physiotherapists) to identify the site and origin of pain. Likewise, the team of professionals may also help in devising a practical treatment plan to improve the symptomatology and quality of life of patient.

Individuals who experience psychosocial issues due to chronic pain are highly benefitted by psychological support. Other helpful strategies include:

– Regular exercise or moderate physical activity

– Pelvic strengthening or training exercises

– Trigger point release

– Biofeedback training

In short, it is imperative to identify the specific etiology of urogenital discomfort in order to devise functional strategies for treatment or management of symptoms.


References:

  1. http://iasp.files.cms-plus.com/Content/ContentFolders/Publications2/PainClinicalUpdates/Archives/PCU08-6_1390262181984_2.pdf
  2. Davis, S. N., Morin, M., Binik, Y. M., Khalife, S., & Carrier, S. (2011). Use of pelvic floor ultrasound to assess pelvic floor muscle function in urological chronic pelvic pain syndrome in men. The journal of sexual medicine, 8(11), 3173-3180.
  3. Hetrick, D. C., Glazer, H., Liu, Y. W., Turner, J. A., Frest, M., & Berger, R. E. (2006). Pelvic floor electromyography in men with chronic pelvic pain syndrome: A case‐control study. Neurourology and urodynamics, 25(1), 46-49.