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Please Note: Pre-Choice Triage is currently active for this specialty.
Symptoms characteristic of CPPS include:
Acute bacterial prostatitis is very uncommon.
Signs of acute prostatitis may include:
Does the patient have symptoms of UTI with signs LUTS? See Formulary chapter 5 - UTIs
Red Flag/Urgently refer patients if:
Pain is experienced by the majority, if not all, people across a lifetime.
On most occasions, the pain experienced is in the context of an acute injury or inflammatory process. The body's natural response to pain is to try to protect the injured area, usually by altering posture or muscle tone around this area while the injury, inflammation or infection is healing. Once healing has completed, the pain resolves and any postural and muscular changes return to normal.
However, in a small proportion of people who suffer an injury, inflammation or infection, the sensation of pain continues, despite the resolution or healing of the underlying problem. This sometimes happens because the pain nerves themselves have been damaged by the original injury or inflammation and, as a result, have become sensitised. Other factors that increase the risk of this happening include genetic factors, psychological problems associated with the original injury (e.g. anxiety) and prior experience of pain in the injured or inflamed area. In these circumstances, the ongoing pain sensation is due to over-sensitisation of the pain nervous system that supplies the painful area. The pain experienced by the patient is very real, but no longer provides a useful purpose as the injury has already healed or the infection has already resolved.
Thus, in patients with CPPS, the original infective or inflammatory episode of 'prostatitis' has resulted in sensitisation of the pain nervous system that supplies the prostate and surrounding area. The sensation of pain (which may mimic the original 'prostatitis' pain) continues, despite the fact that, in the vast majority of patients, any underlying infection has completely resolved.
However, the human body will react to pain by trying to protect the painful area, irrespective of whether the signal is due to a genuine injury or an abnormality in the nervous system. If the pain experience is prolonged, these protection mechanisms become entrenched. In the longer term, the changes in posture and muscular function can lead to secondary pain problems, resulting in increased disability and worsening of the pain condition.
If symptoms persist despite following suggested management and treatment then consider referral to Urology Pre-choice Triage for further advice. If the problem is not specifically urological then consider referral directly to one of the following services:
Refer using e-Referrals
Refer using e-Referrals
This guideline has been signed off on behalf of the NHS Devon Clinical Commissioning Group
Publication date: March 2020
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