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CONDITION/DISORDER SYNONYMS

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  • Category 3 nonbacterial prostatitis

  • Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)

  • Levator ani syndrome

  • Prostatodynia

  • Urogenital pain disorders

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ICD-9-CM CODES

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  • 338.4 Chronic pain syndrome

  • 601.1 Chronic prostatitis

  • Associated physical therapy diagnoses

    • 564.6 Anal spasm

    • 569.42 Anal or rectal pain

    • 719.45 Pain in the hip joint, pelvic region, and thigh

    • 724.7 Disorders of coccyx

    • 728.2 Muscular wasting and disuse atrophy

    • 728.85 Spasm of muscle

    • 728.89 Disorders of muscle, ligament, and fascia

    • 729.1 Myalgia

    • 729.2 Neuralgia/neuritis

    • 729.9 Other disorders of soft tissue

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ICD-10-CM CODES

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  • G89.4 Chronic pain syndrome

  • N41.1 Chronic prostatitis

  • R10.2 Pelvic and perineal pain

  • Symptom-specific diagnoses

    • N53.12 Painful ejaculation

    • N94.1 Dyspareunia

    • K59.5 Anal spasm

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PREFERRED PRACTICE PATTERN

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  • As of July 2014, the APTA Guide to Physical Therapist Practice does not include practice patterns for organ system pathology.

  • Associated or secondary musculoskeletal patterns include:

    • 4C: Impaired Muscle Performance1

    • 4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissue Dysfunction1

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PATIENT PRESENTATION

A 36-year-old man reports pain in the perineum and scrotum which worsens with sitting. He was originally diagnosed with acute bacterial prostatitis, and completed a 6-week course of antibiotics. The pain improved for several weeks, then returned. Testing is now negative for infection. Now, the patient complains that it feels like he is “sitting on a ball.” If he has been sitting and having pain for a while, then sexual intercourse and ejaculation are also painful.

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KEY FEATURES

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Description
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  • Pelvic pain or regional pelvic pain syndrome (perineal pain, penile pain, testicular pain, suprapubic pain, groin pain) without detectable pathology

  • No evidence of infection or inflammation

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Essentials of Diagnosis
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  • Unknown etiology

  • Rule out bacterial prostatitis and other organ pathology

  • Symptoms may be initiated by an acute infection, injury, or inflammation of a pelvic or urogenital organ, however, pain persists beyond the duration of the original inciting event or disease.2

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FIGURE 270-1

Structure of the prostate. (Redrawn, with permission, from Chandrasoma P, Taylor CE. Concise Pathology. 3rd ed. Originally published by Appleton & Lange. Copyright © 1998 by the McGraw-Hill Companies, Inc.)

Graphic Jump Location
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FIGURE 270-2

Anatomic relationships of the prostate. (Redrawn, with permission, from Lindner HH. Clinical Anatomy. Originally published by Appleton & Lange. Copyright © 1989 by the McGraw-Hill Companies, Inc.)

Graphic Jump Location
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General Considerations
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  • Chronic pain condition.

  • Etiology is unknown.

  • Diagnosis is a process of exclusion.

  • Urogenital pain disorders frequently affect nearby body areas; especially back, pelvic, hip, groin regions.3

  • PT intervention is often appropriate for associated musculoskeletal impairments.

  • May mimic other visceral pain ...

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