Myofascial Release Therapy for Category III Chronic Prostatitis

R Anderson, D Wise, M Meadows

Stanford University School of Medicine, Department of Urology, Stanford, CA

Introduction and Objectives Male patients diagnosed with chronic abacterial prostatitis/chronic pelvic pain syndrome with no demonstrable infection are categorized by NIH classification into category IIIA (inflammatory with WBCs in prostatic fluid (EPS)) or IIIB (noninflammatory with no WBCs in EPS). We have evaluated a physiotherapy approach to management using frequent internal pelvic massage.

Methods Subjects underwent routine history, pain questionnaire/visual analog score (VAS), and physical examination with massage of the prostate to obtain EPS for microbiologic culture and stained to quantify leukocytes. Assessment of internal myofascial painful trigger points was done and surface anorectal electromyography (EMG) performed to evaluate baseline resting pelvic tension. Patients were then treated with weekly myofascial release massage and ischemic compression of trigger points. Reassessment of patients was performed after >90% resolution of symptoms or 2 months of therapy, whichever came first.

Results Nineteen (19) patients were assessed. They had an initial median VAS score of 4.5 (range 0-10), an initial median questionnaire pain score of 12.5 (range 0-40), and an initial median questionnaire urinary score of 6.0 (range 0-28). Median initial resting anorectal surface EMG was 7.39 _V.. Each patient underwent a median of 7 myofascial release treatments. Reassessment after treatment revealed a median VAS score of 1.5, questionnaire pain score of 5.5, questionnaire urinary score of 4.0, and resting EMG value of 3.0 _V..

Conclusions Internal myofascial release therapy may represent an alternative medical therapy for chronic prostatitis that reduces pain and resting pelvic tension levels during treatment.