**2. Current Understanding of CP**/**CPPS Pathophysiology**

Considering that CP/CPPS symptoms are not localized to a singular organ, there is mounting evidence to support that symptoms emanate from the interplay between multiple organ systems. Several possible mechanisms are postulated to cause referred pain of CP/CPPS, prominent among them is neurogenic inflammation that describes activation of prostate afferent nerves by prostate inflammation [6]. The constellation of CP/CPPS symptoms necessitates multimodal treatment approaches including α-blockers, antimuscarinics, anti-inflammatory agents, or muscle relaxants [7]. However, the failure of most approaches to effectively treat patients with chronic prostatitis is a

source of great frustration. Thus, it is necessary to develop new therapy for patients with refractory CP/CPPS. The clinicians should not only pay attention to urological complaints but also evaluate if the co-existence of nonurological symptoms in the anorectal area, genital region or beyond these areas. Previous studies demonstrated the possible association between chronic pelvic pain and other chronic pain conditions such as irritable bowel syndrome. There are three proposed explanations for these conditions, including physiological dysfunction, victimization, and psychological distress [8,9]. Examining these factors perhaps can clarify the relationship between these comorbidities.
