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The Invisible Patient: The Symptoms of Chronic Prostatitis and Chronic Pelvic Pain Patients

Pain Blog – The Invisible Patient: The Symptoms of Chronic Prostatitis and Chronic Pelvic Pain Patients

Our Pain Blog covers research on chronic prostatitis and chronic pelvic pain.

A recent article in the Korean Journal of Urology (see below) documented that men diagnosed with chronic prostatitis/chronic pelvic pain syndrome (chronic prostatitis, chronic pelvic pain syndrome) were significantly more stressed than control groups. The report showed that higher levels of depression, anxiety, and perceptions of stress were closely related to increased levels of pain and decreased the quality of life levels.

The symptoms of chronic prostatitis, chronic pelvic pain are invisible to the eye and x-ray. 

Many of our patients have reported their distress in hearing from bosses, friends, or family members that they looked fine. The fact is that the greatly distressing symptoms of chronic prostatitis —urinary frequency and urgency, genital and rectal pain, pain associated with sex, and sitting discomfort among others—are neither visible to the eye nor any imaging technology that currently exists. It is for this reason that examining physicians will often scratch their heads and tell the patient that there is nothing wrong with him, and perhaps his problem is psychiatric. This experience has left more than a few of our patients describing their time with the doctor as one of the most upsetting in memory. To be told that there is nothing wrong with you and that you don’t look like you have a problem when you’re suffering greatly, often leaves the patient feeling frightened, lost with nowhere to go and catastrophizing about the future.

While the eye can’t see the problem, a physician or physiotherapist experienced in treating prostatitis, chronic pelvic pain can detect the disorder with an educated finger.

Many patients have undergone expensive, high-tech evaluations complete with blood, urine, and other testing that yielded no useful information. When a physician is familiar with muscle-based pelvic pain and has been trained to evaluate trigger point and myofascial constriction inside and outside the pelvis, the problem of prostatitis and most causes of pelvic pain can be easily diagnosed within the time frame of a conventional medical appointment. More important, this diagnosis can point in the direction of a real solution to the problem. Unfortunately, many urologists who are consulted for chronic pelvic pain are not trained to evaluate the presence of trigger points and myofascial constriction in the pelvic muscles. Their focus typically remains on the organs.

The Wise-Anderson Protocol has pioneered a new understanding that many cases are caused by an ongoing charley horse in the muscles of the pelvis.

The Wise-Anderson Clinical Protocol was developed and researched at Stanford University between 1995 and 2003 and continues to be offered monthly in a 6-day immersion clinic in Santa Rosa, California. A number of research articles have documented its effectiveness. This protocol represents a new and pioneering understanding of symptoms typically diagnosed as prostatitis. It focuses on teaching men to release the chronic spasm in the pelvic muscles and calm the nervous arousal that perpetuates their symptoms. A popular book called “A Headache in the Pelvis,” now in its 6th edition, offers the most detail of this new understanding and treatment.

In reviewing the data from an ongoing study we are conducting, we find that men and women who have undergone the Wise-Anderson Protocol experience a significant reduction in their emotional distress when they are able to reduce the symptoms of chronic prostatitis by virtue of their own trained self-treatment.

Korean J Urol. 2012 Sep;53(9):643-8. doi: 10.4111/kju.2012.53.9.643. Epub 2012 Sep 19.

Depression, anxiety, stress perception, and coping strategies in Korean military patients with chronic prostatitis/chronic pelvic pain syndrome.

Ahn SG, Kim SH, Chung KI, Park KS, Cho SY, Kim HW.


Department of Urology, St. Paul’s Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.



The objective of this study was to examine the psychological features and coping strategies of patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).


The participants consisted of 55 military personnel suffering from CP/CPPS and 58 military personnel without CP/CPPS symptoms working at the Military Capital Hospital. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) was used to assess CP/CPPS symptoms. The Responses to Hospital Anxiety and Depression (HAD) scale, Social Readjustment Rating Scale, and Global Assessment of Recent Stress (GARS) scale were compared between the two groups. The Weisman Coping Strategy Scale was used to assess coping ability with CP/CPPS.


The NIH-CPSI score of the CP/CPPS group was significantly higher than that of the control group for all domains including pain, urinary symptoms, quality of life, and summed score. The Anxiety and Depression domain of the HAD showed significant differences between the two groups. There were no significant differences in the Social Readjustment Rating Scale between the two groups, but the sum of the GARS score was higher in the CP/CPPS group than in the control group. These were correlated with the pain, quality of life, and sum domains of the NIH-CPSI. The Weisman Coping Strategy Scale showed that intellectualization, redefinition, and flexibility were higher in frequency in descending order, and that fatalism, externalization, and self-pity were lower in frequency.


The CP/CPPS patients had depression, anxiety, and higher perception of stress. In particular, these were closely related to the pain and quality of life of the patients