Pelvic myoneuropathy

Overview
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 nonbacterial chronic 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 prostatitis. 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 (allergy-prone) dispositions, develop a chronic process in the pelvis that involves muscles, nerves and mast cells. 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 infections (prostatitis and cystitis). 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 constipation or urinary obstruction
 * other inflammations of pelvic organs such as urethritis, proctitis or anal fissures, 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, TNF-alpha, inflammatory prostaglandins, leukotrienes) 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).