If you're reading this, you've undoubtedly been suffering from persistent pelvic discomfort for a long time. You may have seen multiple doctors, urologists, and andrologists, and tried a variety of medications, yet your pelvic discomfort persists and may recur on a regular basis.
Discomfort in the testicles, perineum, and suprapubic region makes it challenging to pee, and pain can also be felt following ejaculation, which has a significant influence on life satisfaction.
Who We Are
The London Male Pelvic Pain Clinic is dedicated to investigating and treating pelvic pain disorders in males utilising the Castiglione-De Oliviera Protocol.
Among the pelvic pain disorders treated at our centre are prostatitis, pelvic floor dysfunction, elevator ani, syndrome, chronic pelvic pain syndrome (CPPS), and chronic abacterial prostatitis.
Dr. Fabio Castiglione, Andrologist and Urologist director of the Holistic Andrology clinic and physiotherapist André de Oliveira, head of the Alo Physiotherapy clinic in central London, developed our protocol.
Dr Fabio Castiglione
André de Oliveira, head of the Alo Physiotherapy
History of the Castiglione – De Oliviera Protocol for Male Pelvic Pain
It began with Andre De Oliviera, a Physiotherapist who had suffered from CPPS and chronic prostatitis for many years. He contacted several urologists, including Dr Fabio Castiglione.
After taking a medical history and conducting a thorough examination of the pelvic muscles, Dr Castiglione explained to De Oliviera that pathological contractions of the pelvic muscles partly caused the pain he felt and that his prostate was fine.
They then began a programme of therapy based on shockwave therapy, muscle relaxant drugs, and prostate massage.
AFTER YEARS OF SUFFERING, ANDRE DE OLIVERA FOUND A WAY TO BE FREE OF HIS CHRONIC PROSTATIC PAIN.
De Oliviera was amazed by the therapy's advantages and started researching physiotherapy approaches for relaxing the pelvic muscles. Because of his developing interest, he has attended international seminars on the issue and travelled throughout the globe to acquire current procedures for treating pelvic muscle pain.
De Oliviera and Castiglione started working together in 2019 to treat males with chronic pelvic pain, prostatitis, elevator ani syndrome, pelvic floor dysfunction, myalgia, and other chronic pelvic pain syndromes. They created and executed an unique therapeutic strategy for male pelvic discomfort that combines medical and physical therapies.
Their Protocol incorporates modern physiotherapy treatments such as shockwave, muscle relaxant medications, PDE5i, and pelvic floor physiotherapy. The protocol's intensity is determined by the patient's characteristics.
Chronic pelvic pain (CPPS)
Chronic pelvic pain (CPPS) is diagnosed when no particular cause or underlying disease can be found. CPPS is a prevalent clinical illness with an unclear cause that is often accompanied with urinary problems, intestinal malfunction, or sexual dysfunction.
In 1995, the US National Institute of Health (NIH) reclassified prostatitis into a broader group of patients that included males with prostatitis symptoms but no inflammation or infection of the gland. Chronic pelvic pain syndrome (CPPS) was named after this disorder, which is also known as chronic abacterial and non-inflammatory prostatitis type IIIB. This classification shows that the pathophysiology of the ailment is not primarily due to prostate issues.
CPPS is a complicated clinical scenario marked by a slew of symptoms, as well as microbiological negative in urine and sperm and the lack of white blood cells in prostate discharge. Furthermore, a large proportion of men with CPPS had previously experienced non-bacterial prostatitis.
The incidence of CPPS is growing as diagnostic tools improve, and it affects males of all ages, from adolescent to old life. Despite the fact that it is often diagnosed, the causes of this condition are difficult to identify and are generally unknown.
Despite the fact that these factors are established, the pathophysiology of CPPS is not fully understood. However, the syptomatology is assumed to be caused by involuntary hypertonia of the pelvic floor muscles (a pathological increase in muscular tone). In other words, cramping or persistent spasm of the pelvic floor muscles characterises chronic male pelvic discomfort.
Ischemia, or a diminished delivery of oxygen to muscle cells, causes cramping and promotes anaerobic metabolism. Toxic catabolites build as a consequence of anaerobic metabolism, the intracellular pH rises, becoming acidic, and vasoactive chemicals are produced. These processes irritate the nerve terminals in the area affected by the muscle cramp, resulting in the formation of a tiny inflammatory nucleus (trigger point) that causes the pain.
CPPS, ON THE OTHER HAND, CAN BE CLASSIFIED INTO FOUR GROUPS:
Urethritis, prostatitis, renal colic, inguinal hernia, prostate or bladder cancer, gonorrhoea, and syphilis are all genitourinary conditions.
Infections, inflammation, and intestinal tumours affect the gastrointestinal tract.
Anxiety, sadness, and excessive stress are all neurological conditions.
Musculoskeletal issues include acute muscular stretching or inguinal and perianal lacerations, as well as public and postural changes.
The Castiglione – De Oliviera Protocol for Male Pelvic Pain has three phases:
The first phase consists of correctly diagnosing the condition. Dr Castiglione will perform a medical examination to identify the possible cause of pelvic pain:
Genitourinary: urethritis, prostatitis, renal colic, inguinal hernia, prostate or bladder cancer, gonorrhoea and syphilis.
Gastrointestinal: infections, inflammations and intestinal tumours.
Neurological: anxiety, depression and excessive stress.
Musculoskeletal: acute muscle stretching or inguinal and perianal lacerations, public and postural alterations.
If CPPS is diagnosed, medical therapy and shockwave treatment will be immediately started. This is known as the AMAPAS protocol:
Alpha-blockers (which relax the prostate muscle and help passing urine)
Anticholinergic drugs (which relax the bladder muscle and help passing urine)
PDE5 inhibitors (such as Viagra, which, when taken regularly can alleviate exercise-induced skeletal muscle ischaemia and improve muscle relaxation)
Anti-inflammatories (including steroidal and non-steroidal anti-inflammatories as well as food supplements.
Shockwave treatment, using low-intensity extracorporeal shock wave therapy (LI-ESWT), which has been reported to improve pain, urinary symptoms, and even sexual function by inducing neovascularization and anti-inflammation, reducing muscle tone, and influencing nerve impulses. In our Protocol, we usually perform
6–12 sessions based on the intensity of the pain.
In the case of ED, the P -Shocks®: The most advanced treatment for Peyronie's disease and Erectile dysfunction in London will be applied www.p-shotlondon.com
Physiotherapy is critical for the multidisciplinary treatment of pelvic pain. Most patients suffering from chronic pelvic pain have hypertonia of the pelvic floor muscles and the abdominal muscles, which can be the primary cause of pain.
Our protocol uses several rehabilitation techniques: therapeutic exercise, vibration therapy and thermo-therapy. Through these conservative rehabilitation techniques, Mr Oliviera aims to reduce pelvic and abdominal muscle tension and, therefore, the resolve hypertonia. This approach seeks to break the vicious circle of ‘hypertonia–pain’ using individualized therapeutic pathways, to make the patient an active and conscious participant in their recovery.
Each of these treatments helps relieve pelvic pain symptoms, but none of them are able to eliminate the painful symptoms when used individually. Thus, a combination of pharmacological, physiotherapeutic, psychological, and behavioural therapies is required for proper rehabilitation of the pelvic floor, following each step of our protocol.