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Biofeedback, Pelvic Floor Re-Education And Bladder Training For Chronic Pelvic Pain Syndrome In Males.

J. Quentin Clemens, Robert B. Nadler, Anthony J. Schaeffer, Wade Bushman Ann Arbor, MI; Chicago, IL
Introduction And Objectives: Pelvic floor tension myalgia has been identified as a significant component of chronic pelvic pain syndrome (CPPS) in men. Patients with CPPS frequently report subjective improvement with measures that diminish pelvic floor spasm (warm sitz baths, relaxation techniques, etc). Based on these observations, we have enrolled 19 patients with CPPS in a 12-week program of biofeedback-directed pelvic floor re-education and bladder training
Methods: Instruction in pelvic floor muscle contraction and relaxation was achieved using a non-invasive form of biofeedback (EMPI) at biweekly sessions. Home exercises were combined with a progressive increase in timed-voiding intervals. Pre- and post-treatment assessments included pressure-flow studies (pre-treatment only), daily voiding logs, AUA symptom score and 10-point visual analog pain and urgency scores. Patient compliance with the treatment regimen was also assessed.
Results: All patients met the criteria for NIH Type IIIA or IIIB prostatitis. Mean age of the 19 patients was 36 years (range 18-67). Prior treatment included antibiotics (16), alpha-blockers (10) and anticholinergic agents (7). Four patients completed less than 3 treatment sessions. Reasons for withdrawal included sufficient improvement (2), insurance difficulties (1) and unknown (1). Five patients completed 3-5 sessions and 10 attended all 6 sessions. Mean followup was 6 months. Mean AUA symptom scores improved from 14.5 to 7.3 (p<0.01), mean pain scores improved from 4.7 to 1.0 (p<0.01), mean urgency scores improved from 4.8 to 2.5 (p<0.01), and mean daytime voiding frequency decreased from q1 to q3 hours (p<0.01). Neither urodynamic evidence of obstruction nor the presence of inflammatory cells in the prostatic fluid altered treatment results.
Conclusions: This preliminary study suggests that a formalized program of neuromuscular re-education of the pelvic floor muscles together with interval bladder training can provide significant and durable improvement in pain, urgency and frequency in patients with CPPS.
Supported by: None

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