Treatment of Chronic Prostatitis and Chronic Pelvic Pain Syndrome with Acupuncture

Abstract:

By Joseph Alban, L.Ac. Abstract: Treating chronic prostatitis and chronic pelvic pain syndrome can be very rewarding for the Chinese medicine practitioner.  Most patients with the condition have tried many other approaches without success and fear that they will face a lifetime of pain and discomfort from this problem.  Men with this condition suffer from [...]

By Joseph Alban, L.Ac.

Abstract:

Treating chronic prostatitis and chronic pelvic pain syndrome can be very rewarding for the Chinese medicine practitioner.  Most patients with the condition have tried many other approaches without success and fear that they will face a lifetime of pain and discomfort from this problem.  Men with this condition suffer from a constant or intermittent pain in the pelvis and perineum.  They can also have sexual dysfunction, voiding problems, depression, and anxiety.  This article focuses on Chronic Pelvic Pain Syndrome because it is the most prevalent and least understood type of chronic prostatitis. However, the Chinese medicine theory and treatment discussed here can be used for all types of chronic prostatitis.

Introduction:
Chronic Pelvic Pain Syndrome (CPPS), or Chronic Prostatitis Category III, is a painful condition that causes mild to severe pelvic pain. Men with CPPS may also experience painful, frequent, urgent, or difficult urination, as well as sexual dysfunction. These symptoms can affect all aspects of their life. In addition to the pain and discomfort, it can result in depression, lost work and educational opportunities, and trouble in relationships. Chinese medicine and acupuncture are powerful therapies for men with CPPS with a history of treating painful urination going back over 200 years.

Symptoms of CPPS

Symptoms of Chronic Pelvic Pain Syndrome can effect every aspect of the patient’s life.¹ The main symptom of Chronic Pelvic Pain Syndrome is pelvic and perineal pain. The pain can be very severe and can be located anywhere in the lower back and pelvic area including the lumbar, sacrum, lower abdomen, penis, scrotum, and rectum.

The quality of the pain can be dull, shooting, sharp, or a combination of them all. It often cycles in periods of exacerbation and relief. Other principle signs include voiding and sexual dysfunction as well as general complaints. Voiding problems include reduced urine flow, hesitancy, dribbling, and a sensation of incomplete urination. Related sexual complaints include ejaculatory pain, erectile dysfunction, and decreased libido. The general complaints include depression, fatigue, chronic body aches, and headaches.¹

Causes of Chronic Pelvic Pain Syndrome
The exact cause of Chronic Pelvic Pain Syndrome is not entirely understood. It is important to remember that while CPPS has the same symptoms as chronic bacteria prostatitis, and may develop after an infection, for the most part, there is no infection and the majority also do not have inflammation.¹ Some scientists believe that CPPS may be caused by referred pain from muscle tightness in the pelvis and back and contracture of smooth muscle such as the bladder.² Others believe that undetected inflammation is the cause. Another theory is that the syndrome is caused by intrapelvic congestion of fluids.³ Many physicians are now moving towards describing the issue as a pain syndrome, focusing more on the relief of symptoms and less on the cause of the disease. ²

Certain events of injuries can trigger the disease like the aftermath of a bacterial infection, emotional stress, physical injury, prolonged sitting, or bicycling ride.¹

The lack of clarity about the condition is troublesome to both patients and clinicians. Patients feel uneasy because they do not have a clear explanation about the cause of their problem, and clinicians cannot help solve it.

Chronic Prostatitis and CPPS in Chinese medicine
Both patients and clinicians should be happy to learn about the Chinese medicine treatment. Chinese medicine bases the diagnosis and treatment upon the manifestation of the symptoms, rather than the presence of infection or inflammation.

I find that combination treatment works best for those with CP/CPPS. Acupuncture, tui na, electric stimulation, and gua sha can address many of the physical issues associated with this condition. It is also important to consider that many men with CPPS also require education and counseling in ongoing self care.

There are some similarities between CPPS and the Qi Lin syndrome described in Su Wen (Elementary Questions) which is the first known text to mention these syndromes.⁴ Qi Lin is one of the Five Lin syndromes, or five stranguries, associated with painful urination which were classified according to the characteristics of the urine- bloody, cloudy, stony, heat, and qi. Qi lin means that the root of the disorder is caused by a problem of the qi, either qi stagnation or qi deficiency.

With CPPS, the urine most often has little change in appearance which suggests qi lin. However, some men with CPPS have a history of stones, therefore stony lin may also be a factor. The treatment for qi lin depends on differentiating of patterns and the location of the qi stagnation.

Diagnosis and Treatment Considerations

We all know the saying, “When there is stoppage, there is pain. When there is movement, there is no pain.” This means that with any pain there is some form of stagnation. The treatment must combine strategies to move the qi and blood which will stop the pain as well as correct the underlying imbalance. The most important organs to consider are the spleen, liver, kidney, and urinary bladder.

Spleen qi vacuity: The spleen is responsible for the movement of water in the body, therefore spleen disharmonies will impair urination. It is very common to have CPPS from spleen qi vacuity, particularly if frequent urination and distention in the pelvis are the most predominant symptoms. If there are spleen qi vacuity signs, the accompanying congestion in the pelvis is often due to dampness.

Other common spleen qi symptoms are bloating, loose and sticky stools, fatigue, shortness of breathe, sinus headaches, soft voice, and a scalloped tongue. Dampness can also be factor with the spleen. Spleen 9 is effective for spleen qi deficiency with dampness. SP 9 and ST 40 are a well known and effective combination for draining damp. Sp 9 can also be used in combination with Lu 5 to regulate the qi in the tai yin.⁵ If there is more deficiency, then SP 3 is a good choice. If there is tightness at Sp 8, then needling this point will help clear the stagnation in the channel. This is especially powerful when combined with UB 58.

Liver Qi stagnation: If the problem derives from referred pain due to muscle tightness, liver qi stagnation may be the problem. Other common signs include a string like pulse, rib side pain, stress, and headache. The liver channel encircles the genitalia, and is especially important to consider.

If the liver is the root problem, the combination of Lv 3 and Lv 14 is effective. Use Lv 2 if there is also heat from stagnation. GB 34 can be effective at relaxing the tight muscles. If there is pain in the genitals or scrotum, Lv 5, the luo connecting point, can be effective at opening the liver channel.

Kidney: We all know that the kidneys govern water and control most aspects of urination including both the production of urine and the opening and closing of the bladder. Weak kidney qi could be the root of the inhibited or frequent urination if it is accompanied by a weak lower back, weak knees, and a weak pulse. Also, kidneys are more likely to be the cause in older men and those who have had the symptoms for an extended period of time.

Kid 3 and Kid 7 are both effective for tonifying the kidney. Use Kid 7 if there is more of a yang vacuity. Ren 4, Du 4, and UB 23 all tonify the kidney and are local points to bring qi and blood to the area.

Urinary Bladder channel stagnation: The UB channel and organ are always involved with chronic prostatitis and it is very helpful to treat this channel. UB channel stagnation can cause painful and inhibited urination.

Palpate the channel on the leg, especially at UB 58, the luo point of that channel. If this point is tight, deep needling upwards to open the UB channel can be effective. UB 65 is also effective at clearing deep UB channel stagnation. Ren 3 is important, as it is the front mu of the UB.

Local points are also very important. Ren 3, 4, and KD 12 can be used for frequent urination. If there is yang deficiency use moxa to warm the yang. If after a few treatments, there is no improvement in frequent urination, low frequency electric stimulation on Ren and Kidney points can be effective.

Local points on the lower back and sacrum are essential to relieve pain. UB 32, 33, and Du 1 are the most important. It is important to precisely locate UB 32 and 33, and needle deep enough find de qi, using a 1.5 or 2 inch needle. Ren 1 can be helpful as well. Also, instruct the patient to massage their perineum to relieve spasm muscles.

Ashi points on the lower back and pelvis can release tight muscles throughout the hips, pelvis, and lower back. Palpate to find the tense areas.

Tui na on the lower back and pelvis will be helpful to relieve the tension. I use rolling and kneading technique of pinching the muscles to loosen the muscles. For a feeling of distention in the pelvis with inhibited urination, use gua sha UB 20-23 and pelvic area or needling with electric stimulation.

How to create an Acupuncture Treatment

Before treatment, you should get a full idea of the symptoms each patient is facing. The treatment should specifically target the root imbalance and relax the muscles of the lower back and pelvis.

Most likely there is a very deep imbalance that will take time in resolving. Start with trying to gently move the stagnated qi with only a few needles. Treat the main pattern and address the qi stagnation with the shu stream points and luo connecting of the effected channels. This will move the qi in the effected channel, but not cause muscle spasms. After one or two sessions, begin to treat the UB and Du points of the lower back and sacrum, which will help move the qi stagnation in this area of the body. Combine the treatments with rolling and pinching technique on the pelvis as well as other therapies mentioned to get the best results.

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2. Potts JM. Physical Therapy for Chronic Prostatitis/Chronic Pelvic Pain Syndrome. In: Chronic Prostatitis/Chronic Pelvic Pain Syndrome (Current Clinical Urology). Totowa, NJ: Humama; 2008.

3. Honjo H, Kamoi K., Naya Y, et al. The Effects if Acupuncture for Chronic Pelvic Pain Syndrome with Intravenous Congestion: Preliminary Results. International Journal of Urology. 2004 Aug; 11(8): 607-612.

4. Wiseman N, Feng Y. Practical Dictionary of Chinese Medicine
. Brookline: Paradigm; 1998:583.

5. Wang JY, Robertson JD. Applied Channel Theory in Chinese Medicine
. Seattle: Eastland Press. 2008.

Joseph Alban, L.Ac. practices in New York City. He can be contacted at Joseph Alban, L.Ac. 57 West 57th Street, Suite 1109 New York, NY 10019 917.887.4946.