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What is Chronic Pelvic Pain Syndrome (CPPS)

Chronic Pelvic Pain Syndrome (CPPS) is a urological condition characterised by discomfort or pain in the pelvic region, that is not associated with active bacterial infection. The causes of CPPS are not fully understood.

The condition impacts the quality of life, manifesting in various symptoms including urinary frequency, urgency, and pain in multiple areas such as the prostate, perineal, inguinal, scrotal, and suprapubic regions.

ESWT in the Treatment of CPPS

Extracorporeal Shock Wave Therapy (ESWT) is a non-invasive medical treatment, initially developed for kidney stones, now increasingly used for a range of urological conditions, including CPPS. ESWT involves delivering low-intensity shock waves to targeted areas, such as the perineum in CPPS, to stimulate tissue and promote healing.

The therapy aims to alleviate pain and encourage tissue repair by converting mechanical signals into biochemical responses. It can interrupt nerve impulse flow, reduce muscle tone and spasticity, and enhance revascularization, contributing to pain relief and tissue healing.

This targeted approach addresses the complex nature of CPPS, where traditional treatments may not always yield effective results.

Preparing for an ESWT Session

Patients scheduled for an ESWT session can take certain measures to prepare, ensuring a smooth and effective treatment process.

  • Medical Consultation: Patients should undergo a thorough consultation to discuss their medical history, current symptoms, and any medications they are taking.
  • Dietary Considerations: While there are no strict dietary restrictions, try to maintain a balanced diet and stay hydrated in the days leading up to the session.
  • Avoiding Blood Thinners: Patients often avoid blood-thinning medications or supplements several days before the session, to reduce the risk of bruising.
  • Clothing: Wear comfortable, loose-fitting clothing to the session to facilitate easy access to the treatment area.
  • Hygiene: Clean the pelvic area and keep personal hygiene, as the therapy is applied perineally.

ESWT for CPPS Procedure

The procedure for administering ESWT for CPPS involves a series of steps to ensure effective and safe treatment:

  1. Positioning: The patient is positioned comfortably, usually in a lying or sitting position, to allow easy access to the pelvic region.
  2. Application Site Preparation: The targeted area is cleaned, and a gel is applied to facilitate the transmission of shock waves.
  3. Machine Setup: The ESWT device is calibrated according to the treatment protocol, adjusting the intensity of shock waves and focal area.
  4. Shock Wave Delivery: Low-intensity shock waves are directed at the pelvic area. The patient may feel a tapping sensation during the procedure.

Each session typically lasts 15 to 30 minutes, depending on the treatment plan. ESWT usually requires multiple rounds of shockwave therapy, spaced over several weeks, to achieve optimal results.

Post-Procedure Care and Recovery

Patients usually rest briefly following each session, although they can typically resume normal activities shortly thereafter. Stay hydrated and avoid strenuous physical activities for the first 24 hours to ensure optimal healing.

Some patients may experience temporary mild discomfort or slight bruising in the treated area, which usually resolves on its own. Monitor the response to the treatment and report any unusual symptoms to resolve them promptly.

Generally, the recovery period is minimal, and patients can return to their daily routine with little to no downtime.

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Benefits of ESWT for CPPS Patients

ESWT offers several benefits for patients suffering from CPPS:

Pain Reduction

One of the primary benefits is a reduction in pelvic pain and discomfort, enhancing daily quality of life.

Improvement in Urinary Symptoms

Patients often experience improvements in urinary function, including decreased urgency and frequency.

Non-Invasive Procedure

Unlike surgical interventions, ESWT is a non-invasive treatment, reducing the risks associated with invasive procedures.

Minimal Side Effects

ESWT is known for having minimal side effects, making it a safer option compared to some other treatments that might have more adverse effects.

Improved Sexual Function

Some patients report improvements in sexual function, likely due to the reduction in pain and overall improvement in pelvic health.

No Need for Anaesthesia

The procedure does not require anaesthesia, making it suitable for a broader range of patients.

Quick Sessions

ESWT sessions are relatively short, usually lasting no more than 30 minutes, and require no hospital stay. Patients can return to their normal activities soon after a session, with no extended recovery period needed.

Potential Long-Term Relief

While individual results vary, many patients experience long-term relief from their symptoms after completing the full course of ESWT sessions.

Risks and Complications of ESWT for CPPS Patients

While ESWT is generally considered safe for treating CPPS, like any medical procedure, it may have potential risks and complications.

  • Temporary Discomfort: Some patients may experience temporary discomfort or pain in the treated area during or immediately after the session.
  • Bruising or Swelling: There can be minor bruising or swelling at the site of treatment, typically resolving within a few days.
  • Skin Redness: Redness on the skin where the shock waves were applied is a common and usually transient reaction.
  • Temporary Increase in Symptoms: In rare cases, patients may experience a temporary increase in their CPPS symptoms following ESWT.
  • Allergic Reaction to Gel: If a gel is used during the procedure, there is a small risk of an allergic reaction to the gel substance.

Dr Lee Fang Jann image

Dr Lee is a urologist and kidney transplant surgeon with a broad-based expertise of all urological disorders

He has subspecialty focus on men’s health and male infertility, and special interest in minimally invasive prostate enlargement therapy and kidney stone treatment. Dr Lee has received numerous awards for service excellence such as the Service With A Heart Award (2006-2008, 2011) and the Singapore Health Quality Service Award (2016).

  • Bachelor of Medicine and Bachelor of Surgery (Singapore)
  • Membership of The Royal College of Surgeons (Edin)
  • Master of Medicine (Surgery) (Singapore)
  • Fellowship of the Academy of Medicine (Urology)
  • Clinical fellowship at Oxford Transplant Centre in the UK

Prior to entering private practice, Dr Lee served in the public sector for 16 years at SGH, where he initiated dedicated clinics evaluating and treating patients with complex men’s health and fertility issues. He also led the Renal Transplant Program and laparoscopic donor nephrectomy service as Surgical Director.

Apart from clinical work, Dr Lee is active in academia and believes in the importance of grooming the next generation of doctor. He was Senior Clinical Lecturer at NUS’ Yong Loo Lin School of Medicine and currently, Adjunct Assistant Professor at the Duke-NUS Medical School. Dr Lee is also regularly invited to share his experiences locally and regionally through lectures, workshops and surgical demonstrations.

Our Clinic Locations

Farrer Park Medical Centre, #08-05
1 Farrer Park Station Rd, Singapore 217562

Mon – Fri: 8:30am to 5:30pm
Sat: 8:30am to 12:30pm

3 Mount Elizabeth, #11-16 Medical Centre, Singapore 228510

Mon – Fri: 8:30am to 5:30pm
Sat: 8:30am to 12:30pm

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    Frequently Asked Questions

    Is ESWT painful?

    ESWT is generally not painful. Patients may experience a tapping sensation during the treatment, but it is usually well-tolerated without the need for anaesthesia.

    How many ESWT sessions are required for CPPS treatment?

    The number of ESWT sessions varies depending on the patient’s condition and response to treatment. Typically, multiple sessions over several weeks are required.

    Are there any side effects of ESWT for CPPS?

    ESWT is known for having minimal side effects. Some patients may experience temporary discomfort or minor bruising in the treated area, but serious side effects are rare.

    Can ESWT be used in combination with other treatments for CPPS?

    Yes, ESWT can be part of a multimodal treatment approach and is often used alongside other therapies for the comprehensive management of CPPS.

    How soon can I expect to see improvements after starting ESWT?

    The response to ESWT varies among individuals. Some patients report improvements soon after starting the treatment, while others may notice gradual changes through multiple sessions.

    Who is an ideal candidate for ESWT for CPPS?

    ESWT is suitable for most patients with CPPS, especially those who have not responded to conventional treatments.

    Is the improvement from ESWT for CPPS long-lasting?

    Many patients experience long-term relief from CPPS symptoms after completing ESWT, but results can vary. Ongoing or repeat sessions may be necessary for sustained benefits.