Treatment
Chronic Pelvic Pain Syndrome is highly treatable, especially with a coordinated approach. At Maze, treatment focuses on addressing the root cause: chronic pelvic muscle tension.
Our most effective therapy is pelvic floor physical therapy, which retrains tight, overactive muscles and often delivers relief in just 6–8 sessions. To enhance results, we combine targeted medications such as daily tadalafil, alpha-blockers, and anti-inflammatories with low-intensity shockwave therapy to improve blood flow, reduce pain, and support healing.
Because many men also experience erectile dysfunction or premature ejaculation, we treat sexual symptoms at the same time rather than waiting for them to resolve. When these therapies are layered together, men typically see significant improvement — and many become completely pain-free, even after years of frustration. This comprehensive strategy is why Maze succeeds where standard prostatitis treatments fail.
How is CP/CPPS Treated?
In an ideal world, once a diagnosis of CP/CPPS has been made, definitive treatment of each symptom of the underlying disease can begin at once. For example, if a strep infection is causing a sore throat, fever, body aches and chills, antibiotics are given to treat all of these at once.
Unfortunately, this is not the optimal way to treat CP/CPPS. Since we do not really know what causes it, there is often no single treatment that helps with all the symptoms.
However, we have found that active management/treatment does help most patients feel significantly, and often completely, better. There are some universal therapies that we use on our patients, while simultaneously treating the specific issues they are having (like ED or PE).
Pelvic Floor Therapy
The most important part of any treatment regimen for CP/CPPS is pelvic floor therapy. Though this may sound “new agey”, endless, and iffy, it is “none of the above”, and has a high rate of success. Again, we find that almost all men with CP/CPPS have very tight and chronically clenched pelvic floor muscles. This leads to spasm, tenderness, and discomfort. (Think of it almost as a headache in the pelvis.)
The treatment usually involves pelvic floor therapy, biofeedback, stretching, and postural work. We find that most of the time, the actual therapy of the pelvic floor is the most important part of the intervention.
We refer patients to physical therapists specializing in pelvic floor disorders/dysfunction. They often start making a significant difference in 6-8 sessions. We have identified and worked with pelvic physical therapists in most geographic areas where our patients reside.
This treatment is usually covered by most insurances, as it is considered standard of care by most of them.
Daily Tadalafil (Cialis)
Daily tadalafil is a treatment option for men with significant voiding symptoms and is frequently used in men with Lower Urinary Tract Symptoms (LUTS) from an enlarged prostate. How it works to help these symptoms is not clearly understood, but it seems to relax the pelvic floor and bladder outlet muscles. We have found that it can help with many of the symptoms of CP/CPPS, particularly with pain and voiding symptoms.
We will often start men on tadalafil/5mg daily for several months. (Fortunately, it’s dramatically less expensive since going generic, and even if not covered by insurance, it’s available for less than one dollar a pill.) It is important to note that tadalafil, as well as all the medications in its class (PDE5 inhibitors), is not addictive (physically or psychologically) and has no long-term negative effects on health.
For all men, tadalafil can help with erectile function. For men who are not having ED issues, it will make their erections (during nighttime, masturbation, and sex) better, which is an added benefit. However, if a symptom of CP/CPPS is ED, we will evaluate and treat this simultaneously. Tadalafil/5mg daily is often not strong enough to manage a man’s ED. We can get anyone an erection, even if he has CP/CPPS.
Alpha 1 Blockers
We use alpha-blockers in most men with CP/CPPS. Alpha blockers are a first line medical therapy for men with voiding symptoms due to an enlarged prostate. They work by relaxing smooth muscles in the bladder neck (which has to relax and let the urine into the urethra), in the capsule around the prostate (which surrounds the urethra), and in the part of the urethra going through the prostate itself.
We have found them to be a useful adjunct to pelvic floor therapy and daily tadalafil/5mg in our patients with CP/CPPS. Since voiding symptoms are not being caused by an enlarged prostate in our CP/CPPS patients, often they can discontinue them as treatment progresses.
The main two side effects are decreased blood pressure and ejaculation issues.
The medication is usually taken at night, so the decreased blood pressure, if it happens, is while sleeping. Men should get up slowly at night when they first start the medication so that their blood pressure can equilibrate. They should also go up on the dosage slowly.
Alpha blockers can also temporarily but significantly affect ejaculation. Rarely, men will be unable to ejaculate while on the medication. It can delay ejaculation, making it hard for a man to reach an orgasm with sex. (We sometimes use this side effect and specifically prescribe an alpha-blocker, silodosin, to help men with premature ejaculation last longer.) It can also cause retrograde ejaculation; the ejaculate instead of being propelled forward and out of the tip of the penis, goes backwards into the bladder. The semen is then urinated out with the regular urine during the man’s next void. This is in no way dangerous, but most men enjoy the feeling of ejaculating semen forwards during orgasm. All these symptoms are reversible once the medication is discontinued.
We usually start with tamsulosin 0.4mg, at bedtime, for six weeks. It can be increased to two pills (a total of 0.8mg) after 4-6 weeks if needed.
Anti-Inflammatory Medications
Since it is thought that CP/CPPS has an inflammatory component, anti-inflammatory medications can be helpful. We will often start patients on ibuprofen (Advil, Motrin) 400mg three times a day for three weeks. It must be taken with food to minimize stomach ulcers and bleeding.
Low Intensity - Extracorporeal Shock Wave Therapy (LI-ESWT)
Shockwave therapy, which is actually a pressure wave, was originally used in high intensity dosages to treat kidney stones. When used at a low intensity, these pressure waves can increase blood flow, which is why we use it for the treatment of ED.
It can also decrease soft tissue pain and is in fact FDA approved for plantar fasciitis, which is an inflammation causing pain in the bottom of the foot.
Its proven efficacy in myofascial pain syndromes (like plantar fasciitis) and soft tissue pain has led to its use for CP/CPPS. Though there have been relatively few studies, the results of a few excellent ones have been positive, particularly in decreasing pain and increasing quality of life.
Is it safe?
What is the treatment?
You will receive four treatments, one per week for four weeks.
The probe will be placed against the skin of your perineum (the area between your testes and anus.) Pressure waves or impulses are generated by the probe and penetrate through the skin and into the underlying structures, particularly the fascia, muscles, tendons, and prostate.
A total of 3,000 pressure waves will be used, at a rate of 4 per minute. Thus, the treatment lasts for 13-15 minutes.
You will be able to continue all your normal activities for the day, both before and after the treatment.
Does it hurt?
Most importantly, does it work?
The data in various studies all indicate significant improvement from treatment. These improvements are seen in decreased pain, improved urinary symptoms, and quality of life.
Unfortunately, there are still not a lot of studies or data available. In the studies that exist, men were only followed for 3 months post treatment, so it unknown how long symptomatic improvements last.
Fortunately, there are no negative side effects seen and the treatments are painless.
At what point in my treatment should LI-ESWT be used?
Like all the non-specific treatments for CP/CPPS, pressure wave treatment can be utilized at any point in your treatment.
In an ideal world, it would be started simultaneously with all the other non-specific treatments in this section.
Specific treatments for ED and PE
As we have indicated, the symptoms of CP/CPPS are different in virtually every man who has it. Thus, there are both generalized treatments, including tadalafil/5mg daily, pelvic floor therapy, alpha blockers, and anti-inflammatories, which most men receive, as well as specific treatments for ED and PE.
Erectile dysfunction can always be managed. We do not wait for the general treatments for CP/CPPS to be effective but evaluate and treat the ED, which is often what disturbs men the most.
Likewise, if a man develops premature ejaculation, this is also simultaneously managed.