Chronic pelvic pain (CPP) is pain in the area below a woman’s belly button and between the hips that has persisted for longer than usual and for at least three to six months. Generally, CPP refers to pain within the anatomic pelvis, and as such, not all perineal and vulvar pain disorders are categorized under CPP. The pain can be constant or episodic, but is unrelated to pregnancy.
Symptoms of Chronic Pelvic Pain
Symptoms of CPP include:
- Pain in the lower abdomen
- Painful cramps during menstruation and/or ovulation
- Painful bowel movements or pain when urinating
- Lower back pain
- Pain during or following sex
- Menstrual spotting between periods
- Abdominal bloating
Common Conditions leading to Chronic Pelvic Pain
Conditions that commonly lead to CPP include:
- Bladder cancer
- Interstitial cystitis/painful bladder syndrome
- Irritable bowel syndrome
- Musculoskeletal causes
- Ovarian cysts
- Pelvic inflammatory disease
- Recurrent/chronic urolithiasis
- Urethral syndrome
Less common causes include:
- Ovarian remnant syndrome
- Pelvic congestion syndrome
Diagnosing Chronic Pelvic Pain
The role of certain specialists is key to diagnosing chronic pelvic pain.
A gynecologist performs a pelvic exam, which may reveal the cause of CPP, as well as various tests, such as those for sexually transmitted infections or pregnancy. He or she will also likely do a urine test to determine if a urinary tract infection is the source of the pain. A gynecologist helps determine the presence of endometriosis, a common disorder causing CPP.
A urologist specializes in any pain related to the urinary tract. If an exam points to interstitial cystitis (IC) (a painful inflammation of that bladder not caused by an infection), a common cause of CPP, a urologist can confirm this diagnosis with specialized tests.
Details of the various tests performed by physicians for CPP are outlined below.
In addition to a review of CPP symptoms and medical history, various components of a physical exam are performed. Depending on the type of physician, these may include:
Gynecological exam–This exam includes palpitation of the abdominal and pelvic area to check for pain, as well as an internal examination of the vagina, uterus and rectum for an abnormal growth or tense pelvic floor muscles. Any discomfort or pain during the exam helps the doctor’s determination of the problem.
Laboratory Tests–Possible tests include blood work; urinalysis to check for urinary tract infection; pregnancy test; test for infections: chlamydia or gonorrhea
Imaging tests–X-rays, computed tomography (CT) or MRI (magnetic resonance imaging (MRI) to check for abnormality of structures or for growths
Chronic Pelvic Pain (CPP) in Men
Similarly to women, a number of conditions can lead to CPP in men. Challenges of diagnosis and treatment are also the same as with women, and although CPP may be more widely publicized in women, an estimated 50 percent of men are affected by pelvic pain due to prostatitis at some point in their lives.
Chronic prostatitis, or chronic pelvic pain syndrome (CP/CPPS), is a painful condition not characterized by a urinary tract infection, but nonetheless causing urinary symptoms. It is deemed CPP if it lasts longer than three months, with pain ranging from minor to severe and debilitating. Symptoms can come and go, and they include the following:
- Urinary difficulty or straining
- Frequent and/or urgent need to urinate
- Pain or burning during urination
- Genital pain following urination
- Pain with bowel movement or ejaculation
- Pain in the pelvic area and/or in the lower back
- Sexual dysfunction
Diagnosing CPP in Men
It is important to note that CP/CPPS, by definition, is not a bacterial infection, though it is often treated as such. Diagnostic methods include:
- A physical exam with digital rectal check of the prostate
- PSA (prostate-specific antigen) test
- A urine culture
- Sexually transmitted diseases tests
- Specialized imaging tests for renal (disease of the kidneys) and/or bladder conditions
- Discussion of psychosocial impacts of sexual history
A 2016 study analysis, Male chronic pelvic pain: An update, concluded that treatment for male CPP should begin with the least invasive methods. This is the approach taken at Nova Spine & Pain Centers, and the goal is to provide the patient with relief by choosing from a variety of effective and non-invasive modalities.
Pain Management and CPP
Pain management specializes in a comprehensive view toward all relevant conditions; prominent among them is CPP. At Nova Spine & Pain Centers, this begins with a thorough medical history and exam followed by an evaluation of possible treatment measures. Often, the easiest start is to consider lifestyle modifications, such as changes in diet and exercise. Losing weight as well as quitting smoking are clearly important. Smoking and being overweight are major risk factors for various types of chronic pain, including CPP.
Among treatments for CPP, physical therapy and biofeedback can be supplemented with various forms of pain injections and nerve blocks. In addition, Nova Spine & Pain Centers is very cognizant of the risks of certain pain medications, and careful to use all measures to avoid these medications and provide alternatives whenever possible.
In both female and male patients, CPP can cause anxiety and the possibility of insecurity and embarrassment. Thus they require experienced, sensitive healthcare providers who acknowledge and help them deal with their pain both medically and psychologically.
Treatments of CPP
Treatment options for CPP include:
- Physical therapy and biofeedback
- Diagnostic, therapeutic and peripheral nerve blocks
- Superior hypogastric plexus nerve blocks
- Ganglion impar blocks
- Ilioinguinal nerve blocks
- Genitofemoral nerve blocks
- Epidural steroid injections
- Sacroiliac joint injections
- IV infusion therapy
- Intrathecal (spinal) pump to deliver medication
- Spinal cord stimulation
Dr. Harris Shaikh
Dr. Harris Shaikh is a uniquely qualified pain management specialist. As a triple-board certified and fellowship-trained pain management expert, he has also been published on the topic of CPP. In a February, 2018 article, he stressed his philosophy of taking the most conservative approach to begin CPP treatment. He combines this with the ability to employ the full array of possible non-invasive and effective treatments.