Brief Overview: Chronic pelvic pain (CPP) is pain perceived in the pelvis (lower abdomen, hips, or pelvic floor) lasting 6 months or more. It may be constant or intermittent, and often has multiple contributing factors — gynecologic, urologic, gastrointestinal, musculoskeletal, or psychological. CPP frequently leads to reduced quality of life and functional impairment.
Prevalence: Affects ~15–20% of women at some point; less common but present in men (often linked to prostatitis or pelvic floor dysfunction)
Etiology:
- Gynecologic: endometriosis, pelvic adhesions, uterine fibroids.
- Urologic: interstitial cystitis/painful bladder syndrome, chronic prostatitis.
- GI: irritable bowel syndrome, inflammatory bowel disease, diverticulitis.
- Musculoskeletal: pelvic floor myofascial pain, hip or lumbar spine disorders.
- Neuropathic: pudendal neuralgia, nerve entrapments.
- Psychological: trauma history, depression, anxiety.
- Often multifactorial — more than one system involved.
Risk Factors:
- Female
- Prior pelvic surgery or trauma
- History of endometriosis or gynecologic disorders
- Recurrent urinary tract infections or bladder dysfunction
- GI conditions (IBS, diverticulitis)
- Musculoskeletal abnormalities (poor posture, pelvic instability)
- Depression, anxiety, PTSD, history of abuse
Commonly Associated Conditions:
- Interstitial cystitis/painful bladder syndrome.
- Irritable bowel syndrome.
- Pelvic floor dysfunction.
- Fibromyalgia, chronic fatigue syndrome.
- Anxiety, depression, sleep disorders.
Common Medications:
- Analgesics: acetaminophen, NSAIDs
- Neuropathic pain agents: gabapentin, pregabalin, duloxetine, amitriptyline
- Hormonal therapy (women): combined OCPs, progestins, GnRH agonists (if endometriosis-related)
- Bladder-focused: pentosan polysulfate (interstitial cystitis)
- Muscle relaxants: baclofen, diazepam (pelvic floor dysfunction)
- Topical vaginal estrogens (in postmenopausal atrophy)
- Opioids: generally avoided long-term, reserved for refractory cases with palliative oversight
Common Labs, Imaging, and Tests:
- Ultrasound, CT, MRI
- Colonoscopy, sigmoidoscopy
- Laparoscopy, cystoscopy
- Blood and urine tests
- Physical exam: abdominal, pelvic, rectal, etc.
Common Symptoms:
- Persistent pain in pelvic region (dull, pressure-like, or sharp).
- Pain may worsen with sitting, standing, urination, bowel movements, or sex.
- Associated urinary frequency/urgency, constipation/diarrhea, bloating.
- Low back, hip, or thigh pain.
- Fatigue, mood changes, sleep disturbance.
Common Treatments:
- Non-Pharmacologic:
- Physical therapy: pelvic floor therapy, posture correction, stretching.
- Behavioral therapy: CBT, mindfulness, stress management.
- Lifestyle changes: diet modification (avoid bladder/GI irritants).
- Complementary therapies: acupuncture, yoga, relaxation exercises.
- Support groups for coping strategies.
- Pharmacologic:
- Analgesics, neuropathic agents, hormonal therapy, bladder-directed meds (as above).
- Antidepressants (TCAs, SNRIs) when mood and pain are interconnected.
- Interventional:
- Nerve blocks (pudendal, hypogastric plexus).
- Trigger point injections.
- Surgical management (endometriosis excision, adhesiolysis) in selected patients.
Physical Findings:
- Pelvic or abdominal tenderness on exam
- Myofascial trigger points in pelvic floor muscles
- Tender bladder or uterus on palpation
- Limited hip or lumbar spine range of motion if musculoskeletal cause
- Exam may be normal despite severe symptoms (functional pain)
Potential Complications and Contraindications:
- Complications:
- Reduced quality of life, disability.
- Depression, anxiety, relationship/sexual difficulties.
- Sleep disruption, fatigue.
- Unnecessary surgeries if diagnosis unclear.
- Contraindications:
- Caution with long-term opioids (dependence, poor efficacy for chronic pelvic pain).
- Caution with muscle relaxants or benzodiazepines in seniors (fall/sedation risk).
General Health and Lifestyle Guidance:
- Encourage regular gentle activity (walking, stretching, yoga). Ask your healthcare provider what exercises are recommended for you.
- Pelvic floor physical therapy is often very effective. Discuss with your healthcare provider if this might be appropriate for you.
- Maintain a healthy bowel routine (hydration, adequate dietary fiber (as advised by your healthcare provider), avoid constipation).
- Identify and avoid bladder/GI irritants (caffeine, alcohol, spicy foods).
- Use heat therapy (warm baths, heating pads) for relief.
- Manage stress with relaxation techniques, support groups, or counseling.
- Ensure adequate sleep hygiene.
Suggested Questions to Ask Patients:
- Where do you feel the pain, and how long have you had it?
- Does it get worse with urination, bowel movements, or sexual activity?
- What makes the pain better or worse?
- Have you had prior pelvic surgery, infections, or trauma?
- How does the pain affect your daily activities, mood, or sleep?
- Do you have urinary or bowel changes?
- Have you tried pelvic floor therapy or relaxation strategies?
- What medications are you taking now for pain or other conditions?
Suggested Talking Points:
- Chronic pelvic pain can have many causes, often involving more than one body system.
- It’s important to look at the whole picture — bladder, bowel, muscles, and stress can all contribute.
- Pelvic floor therapy and lifestyle changes often help more than medications alone.
- Generally, you want to avoid long-term opioid use when possible, since safer options are available.
- Managing stress, sleep, and bowel/bladder health is part of managing pain.
Sources:
- https://www.mayoclinic.org/diseases-conditions/chronic-pelvic-pain/diagnosis-treatment/drc-20354371
- https://www.acog.org/womens-health/faqs/chronic-pelvic-pain
- https://my.clevelandclinic.org/health/symptoms/12106-pelvic-pain
- https://www.uptodate.com/contents/chronic-pelvic-pain-in-adult-females-evaluation?search=chronic%20pelvic%20pain&source=search_result&selectedTitle=1~127&usage_type=default&display_rank=1
- https://www.uptodate.com/contents/chronic-prostatitis-and-chronic-pelvic-pain-syndrome?search=chronic%20pelvic%20pain&source=search_result&selectedTitle=4~127&usage_type=default&display_rank=4
This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.