Finding Effective Treatments for Pelvic Pain

Chronic pelvic pain can be a baffling problem in men, racking up about 2 million doctor's office visits each year.

But a review of treatments to relieve pain and other symptoms of this condition found that three types of medication were most effective:

• Antibiotics
• Anti-inflammatory drugs
• Alpha-blockers

About 95 percent of chronic pelvic pain in men is brought on by chronic prostatitis, an inflammation of the prostate. This in turn is usually caused by a bacterial infection. The inflammation develops slowly and lasts for at least six months. In addition to chronic pain in the pelvis, other symptoms include pain in the urethra or penis, back pain, difficulty urinating, frequent urination, and sexual difficulties.

Men between ages 35 and 45 are at greatest risk of developing this condition.

Treatment combination

The review looked at 23 medical studies published between 1949 and 2010 and found that the most effective treatment was a combination of antibiotics and alpha-blockers, particularly when the main symptom was pain while urinating. But anti-inflammatory medications also were effective for pelvic pain.

Less effective treatments were steroids; phytotherapy, or plant-based alternative medicines; finasteride, a medication for enlarged prostate; and gabapentinoids, which are used to treat nerve pain.

Relieving pain

Alpha-blockers, which block the nerves going into the muscles of the prostate, are often prescribed along with antibiotics for chronic pelvic pain. If that combo doesn't work, another antibiotic is tried. But a man with chronic pelvic pain shouldn't just keep switching from one antibiotic to another, says Paul C. Cook, M.D., a Houston urologist.

"If the patient comes back and the treatment isn't working, it's time to rethink the diagnosis," he suggests.

Other conditions that can cause chronic pelvic pain include pudendal nerve entrapment, a condition in which nerves get trapped in bony canals, and compression of blood vessels in the pelvis, sometimes caused by long-distance bicycle riding, Cook says.

Always talk with your health care provider to find out more information.