Pelvic Myoneuropathy
Encyclopedia
Pelvic myoneuropathy is a new term given to the most common form of non-bacterial pelvic pain experienced by men. It is sometimes referred to as chronic nonbacterial prostatitis or male chronic pelvic pain syndrome (CP/CPPS or CPPS
). The mechanisms of pelvic myoneuropathy may also underlie the etiology of IC (Interstitial cystitis
).
For a full description of the symptoms and treatment of pelvic myoneuropathy, see the article on CPPS
. This article will merely expand on the definition of pelvic myoneuropathy.
-prone) dispositions, develop a chronic process in the pelvis
that involves muscle
s, nerve
s and mast cell
s. Such individuals tend to tense the muscles of their pelvic floors subconsciously and continuously. This clenching of deep muscles can be provoked either by the individual's tense disposition, or it can be the result of a "guarding" response to a preceding trauma to the pelvic or spinal area, pelvic surgery, bicycling, long periods of sitting and stress
at work, and in some cases, urinary tract infection
s (prostatitis
and cystitis
). Other common events that lead to injury are:
The subsequent muscle spasm and hypertonicity of the pelvic muscles leads to a hyperirritability of the muscle fibers. The hyperirritable bundles of fibers within the muscles of the pelvic floor become "knotted", inelastic and unable to contract or relax. Trigger points are formed. The overstimulated nerves innervating these muscles, through a complex process involving central sensitization, intermingling of afferent (sensory) fibers, neural wind-up, intercommunication among nerve plexuses, neural cross-talk, viscerosomatic convergence, the nature of visceral afferentes, and individual variations of anatomy and neurophysiology, eventually set up a process in the tissues of the genitourinary tract that leads to pathology. This pathology results when the nerve endings overproduce chemicals called neuropeptides. Neuropeptides stimulate powerful immune defence cells called mast cells. Once stimulated, these cells produce a wide range of chemicals (histamine
, TNF-alpha, inflammatory prostaglandin
s, leukotriene
s) that cause pain, inflammation and the symptoms of sterile prostatitis
, urethritis
, orchalgia, epididymitis
, and/or interstitial cystitis
. Therapy is multimodal, involving intrapelvic deep muscle "trigger point" massage and release, specific stretching exercises, stress control and special forms of pelvic muscle relaxation training, nerve therapy (neurontin, elavil, botox), mast cell protectives and mast cell byproduct amelioratives (ProstaQ, Q-Urol, antihistamines, alpha-blockers, etc.).
CPPS
CPPS may stand for:*Chronic pelvic pain syndrome, a pelvic pain condition affecting men* The post-nominal initials of the Missionaries of the Precious Blood...
). The mechanisms of pelvic myoneuropathy may also underlie the etiology of IC (Interstitial cystitis
Interstitial cystitis
Interstitial cystitis or bladder pain syndrome is a chronic, oftentimes severely debilitating disease of the urinary bladder...
).
For a full description of the symptoms and treatment of pelvic myoneuropathy, see the article on CPPS
CPPS
CPPS may stand for:*Chronic pelvic pain syndrome, a pelvic pain condition affecting men* The post-nominal initials of the Missionaries of the Precious Blood...
. This article will merely expand on the definition of pelvic myoneuropathy.
Definition
Pelvic Myoneuropathy, in its most simplified and broadest terms, describes a process in which people of a particular genetic type and often with tense, anxious, and frequently atopic (allergyAllergy
An Allergy is a hypersensitivity disorder of the immune system. Allergic reactions occur when a person's immune system reacts to normally harmless substances in the environment. A substance that causes a reaction is called an allergen. These reactions are acquired, predictable, and rapid...
-prone) dispositions, develop a chronic process in the pelvis
Pelvis
In human anatomy, the pelvis is the lower part of the trunk, between the abdomen and the lower limbs .The pelvis includes several structures:...
that involves muscle
Muscle
Muscle is a contractile tissue of animals and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to...
s, nerve
Nerve
A peripheral nerve, or simply nerve, is an enclosed, cable-like bundle of peripheral axons . A nerve provides a common pathway for the electrochemical nerve impulses that are transmitted along each of the axons. Nerves are found only in the peripheral nervous system...
s and mast cell
Mast cell
A mast cell is a resident cell of several types of tissues and contains many granules rich in histamine and heparin...
s. Such individuals tend to tense the muscles of their pelvic floors subconsciously and continuously. This clenching of deep muscles can be provoked either by the individual's tense disposition, or it can be the result of a "guarding" response to a preceding trauma to the pelvic or spinal area, pelvic surgery, bicycling, long periods of sitting and stress
Stress (medicine)
Stress is a term in psychology and biology, borrowed from physics and engineering and first used in the biological context in the 1930s, which has in more recent decades become commonly used in popular parlance...
at work, and in some cases, urinary tract infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
s (prostatitis
Prostatitis
Prostatitis is an inflammation of the prostate gland, in men. A prostatitis diagnosis is assigned at 8% of all urologist and 1% of all primary care physician visits in the United States.-Classification:...
and cystitis
Cystitis
Cystitis is a term that refers to urinary bladder inflammation that results from any one of a number of distinct syndromes. It is most commonly caused by a bacterial infection in which case it is referred to as a urinary tract infection.-Signs and symptoms:...
). Other common events that lead to injury are:
- chronic tense holding patterns that develop in childhood as a result of sexual abuse, traumatic toilet training, abnormal bowel patterns, guilt surrounding sexual feelings, dance training or stress
- repetitive minor trauma or straining with constipationConstipationConstipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation...
or urinary obstruction - other inflammations of pelvic organs such as urethritisUrethritisUrethritis is inflammation of the urethra. The most common symptom is painful or difficult urination.-Causes:The disease is classified as either gonococcal urethritis, caused by Neisseria gonorrhoeae, or non-gonococcal urethritis , most commonly caused by Chlamydia trachomatis...
, proctitisProctitisProctitis is an inflammation of the anus and the lining of the rectum, affecting only the last 6 inches of the rectum.-Overview:Symptoms are ineffectual straining to empty the bowels, diarrhea, rectal bleeding and possible discharge, a feeling of not having adequately emptied the bowels,...
or anal fissureAnal fissureAn anal fissure is a break or tear in the skin of the anal canal. Anal fissures may be noticed by bright red anal bleeding on the toilet paper, sometimes in the toilet. If acute they may cause severe periodic pain after defecation but with chronic fissures pain intensity is often less...
s, or referred pain from other attaching muscle groups or viscera or nerves.
The subsequent muscle spasm and hypertonicity of the pelvic muscles leads to a hyperirritability of the muscle fibers. The hyperirritable bundles of fibers within the muscles of the pelvic floor become "knotted", inelastic and unable to contract or relax. Trigger points are formed. The overstimulated nerves innervating these muscles, through a complex process involving central sensitization, intermingling of afferent (sensory) fibers, neural wind-up, intercommunication among nerve plexuses, neural cross-talk, viscerosomatic convergence, the nature of visceral afferentes, and individual variations of anatomy and neurophysiology, eventually set up a process in the tissues of the genitourinary tract that leads to pathology. This pathology results when the nerve endings overproduce chemicals called neuropeptides. Neuropeptides stimulate powerful immune defence cells called mast cells. Once stimulated, these cells produce a wide range of chemicals (histamine
Histamine
Histamine is an organic nitrogen compound involved in local immune responses as well as regulating physiological function in the gut and acting as a neurotransmitter. Histamine triggers the inflammatory response. As part of an immune response to foreign pathogens, histamine is produced by...
, TNF-alpha, inflammatory prostaglandin
Prostaglandin
A prostaglandin is any member of a group of lipid compounds that are derived enzymatically from fatty acids and have important functions in the animal body. Every prostaglandin contains 20 carbon atoms, including a 5-carbon ring....
s, leukotriene
Leukotriene
Leukotrienes are fatty signaling molecules. They were first found in leukocytes . One of their roles is to trigger contractions in the smooth muscles lining the trachea; their overproduction is a major cause of inflammation in asthma and allergic rhinitis...
s) that cause pain, inflammation and the symptoms of sterile prostatitis
Prostatitis
Prostatitis is an inflammation of the prostate gland, in men. A prostatitis diagnosis is assigned at 8% of all urologist and 1% of all primary care physician visits in the United States.-Classification:...
, urethritis
Urethritis
Urethritis is inflammation of the urethra. The most common symptom is painful or difficult urination.-Causes:The disease is classified as either gonococcal urethritis, caused by Neisseria gonorrhoeae, or non-gonococcal urethritis , most commonly caused by Chlamydia trachomatis...
, orchalgia, epididymitis
Epididymitis
Epididymitis is a medical condition in which there is inflammation of the epididymis . This condition comprises gradual onset of testicular pain that can vary from mild to severe, and the scrotum may become red, warm and swollen...
, and/or interstitial cystitis
Interstitial cystitis
Interstitial cystitis or bladder pain syndrome is a chronic, oftentimes severely debilitating disease of the urinary bladder...
. Therapy is multimodal, involving intrapelvic deep muscle "trigger point" massage and release, specific stretching exercises, stress control and special forms of pelvic muscle relaxation training, nerve therapy (neurontin, elavil, botox), mast cell protectives and mast cell byproduct amelioratives (ProstaQ, Q-Urol, antihistamines, alpha-blockers, etc.).
See also
- CP/CPPS
- Post-surgical adhesionsAdhesion (medicine)Adhesions are fibrous bands that form between tissues and organs, often as a result of injury during surgery. They may be thought of as internal scar tissue that connect tissues not normally connected.-Pathophysiology:...
- QuercetinQuercetinQuercetin , a flavonol, is a plant-derived flavonoid found in fruits, vegetables, leaves and grains. It also may be used as an ingredient in supplements, beverages or foods.-Occurrence:...
(alternative medicine- a flavonoidFlavonoidFlavonoids , are a class of plant secondary metabolites....
which has anti-inflammatoryAnti-inflammatoryAnti-inflammatory refers to the property of a substance or treatment that reduces inflammation. Anti-inflammatory drugs make up about half of analgesics, remedying pain by reducing inflammation as opposed to opioids, which affect the central nervous system....
properties; found in various foods) - Chronic pelvic pain
External links
- Pelvic Myoneuropathy - an in-depth explanation
- Diagrams of the Pelvic Floor Muscles - pelvic musculature involved in causing CP/CPPS symptoms.