Chronic pelvic pain

Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Most women (and some men), at some time in their lives, experience pelvic pain. When the condition persists for longer than 3 months, it is called chronic pelvic pain (CPP). This is a poorly-understood condition that likely represents abnormal neurological function, either in the peripheral nervous system or central nervous system. Many different etiologies have been proposed for CPP, but a major problem is that virtually none of them have been validated. Commonly proposed etiologies include:

• endometriosis (very controversial)
• infection or post-infectious neurological hypersensitivity
• exaggerated bladder, bowel, or uterine pain sensitivity (also known as visceral pain)
• ovarian cysts, uterine leiomyoma - often found in asymptomatic patients as well, however
• less common emergencies: ovarian torsion - sudden loss of circulation to the ovary, appendicitis - infection of one part of the intestine, with right lower abdominal pain, ectopic pregnancy - where an early pregnancy grows outside of the uterus, and can cause sudden, heavy intra-abdominal bleeding
• pelvic girdle pain (SPD or DSP)

Women with symptoms of pain may want to see a gynecologist if problems don't go away after a few days, and workup should begin with a careful history and examination, followed by a pregnancy test. Some women may also need bloodwork or additional imaging studies, and a handful may also benefit from having surgical evaluation using small telescopes (laparoscopy). Many women will also benefit from a consultation with a physical therapist, a trial of anti-inflammatory medications, hormonal therapy, or even neurological agents.

This is a condition that although common, direly needs to be studied more closely.

Chronic Pelvic Pain in Female Adolescents

As girls enter gynecologic maturity, pelvic or abdominal pain becomes a frequent complaint.

Chronic pelvic pain (CPP) accounts for 10% of all visits to gynecologists. In addition, CPP is the reason for 20 - 30% of all laparoscopies in adults.

Causes

Causes by Organ System

Cardiovascular	No underlying causes
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

Adenomyosis Adhesions in the pelvic area Anal fissure Appendicitis Cervical polyps Chronic bacterial prostatitis Chronic bladder irritation Chronic non bacterial prostatitis Chronic pelvic pain syndrome Chronic stress Chronic urethritis Chronic vulvovaginitis Clitorodynia Coccydynia Colitis Colon cancer Colonic polyps Constipation Depression Diarrhea Diverticulitis Dysmenorrhea Ectopic pregnancy Endometrial polyps Endometriosis Epididymal cysts Epididymo-orchitis Fibroids Fibromyalgia Gastrointestinal cancers Hemorrhoids Hydrocele Internal hernia Interstitial cystitis Irritable bowel syndrome Loin pain hematuria syndrome

Low back pain Miscarriage Mittelschmerz pain Mullerian abnormalities Muscle spasm Nerve entrapment in pelvis Neuromas Ovarian cysts Ovarian remnant Ovarian torsion Pelvic congestion syndrome Pelvic girdle malrotation Pelvic inflammatory disease Pelvic relaxation Pelvic tumor Pelvic vein thrombosis Peripheral neuropathy in pelvis Physical abuse Placental abruption Porphyria Post herpetic neuralgia Post infectious neurological hypersensitivity Proctitis Pudendal nerve neuralgia Reproductive tract cancers Retroverted uterus Sexual abuse Strangulated hernia Tension in the pelvic floor muscles Testicular tumors Ulcerative colitis Urinary tract calculi Uterine leiomyoma UTI Varicocele Vulvodynia

Additional Resources

• Milburn A, Reiter R, Rhomberg A: Multi-disciplinary approach to chronic pain. Obstet Gynecol Clin 1993;20:643 - 661.
• Stovall DW: Endometriosis associated pelvic pain: Evidence for an association between the stage of disease and a history of chronic pelvic pain. Fertil Steril 1997;68:13 - 17.
• Schroeder B, Sanfillippo JS: Chronic Pelvic Pain and Recurrent Abdominal Pain in Female Adolescents. Pediatr Clin North Am 1999;46:566 - 567.
• Elisabeth Thibaud, Hyams JS: Clinical aspects of recurrent abdominal pain. Pediatric and Adolescent GynecologyPediatr Ann 2001;30:17–21.
• Jantos M.: Understanding Chronic Pelvic Pain. Pelviperineology Vol. 26 N.2 June 2007 66-68

Related Chapters

• Abdominal adhesions
• Coccydynia (coccyx pain, tailbone pain)

External Links

• International Pelvic Pain Society
• Pelvic Floor Digest: Free Selected medical abstracts on pelvic pain. Updated
• American Pain Society
• Endometriosis Research Center
• endometriosis.org
• Endometriosis Association
• Pelviperineology The multidisciplinary open access pelvic floor journal

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