Home • AltMed Home • Search • Feedback

Definition

There are several operational definitions of chronic pelvic pain (CPP):

1. Durational pain. Any type of pelvic pain that has lasted six months or longer.
2. Anatomic pain. CPP that lacks apparent physical cause sufficient to explain the pain (laparoscopy disclosed minimal, if any, pathology.
3. Affective-behavioral pain. Pain accompanied by disturbance of mood and by significantly altered physical activity, including work, recreation, sexual life, and so forth.

Causes of Chronic Pelvic Pain

• Gastrointestinal
  • Constipation
  • Irritable bowel syndrome
  • Inflammatory bowel disease
  • Diverticulitis
• Urinary
  • Urethral syndrome
  • Interstitial cystitis
• Musculoskeletal/Neurologic
  • Pelvic floor tension myalgia
  • Piriformis syndrome
  • Nerve entrapment
  • Ventral hernia
  • Rectus tendon strain
  • Myofascial pain
  • Back or pelvic postural changes
• Gynecologic
  • Pelvic vascular congestion
  • Cervical stenosis
  • Endometriosis
  • Pelvic adhesions
  • Pelvic support
  • Residual ovary
  • Ovarian remnant

Treatment

• General guidelines
  • Evaluation often reveals a number of contributing factors which include, but are not limited to the following:
    • Bladder irritability
    • Irregular bowel function
    • Poor posture
    • 
      Emotional and relationship stresses
    • Laparoscopically visualized pathology

     

  • Singly treating each contributing factor is common practice, although employing polypharmacy often allows better relief
  • Close follow-up visits

• Medications
  • Analgesics. Acetaminophen, which is relatively nontoxic and nonaddicting. Potential hazards may exist with:
    • NSAIDs: gastric irritation, renal damage
    • Aspirin or NSAIDs in combination with milder narcotics (codeine, oxycodone, and pentazocine): constipation, sedation, habituation
    • Pure narcotics: addiction, diminished analgesic potency over time
  • Antidepressants. Tricyclics may potentiate the effects of analgesics in CPP. SSRIs also show promise.
  • Anxiolytics. Alprazolam has demonstrated a surprising degree of analgesia in moderate to high doses in patients with chronic pain of malignant origin and concomitant mood changes or anxiety.
  • Medroxyprogesterone acetate. Treatment sufficient enough to suppress ovarian function may reduce the diameter of engorged pelvic veins and thereby reduce the discomfort of pelvic congestion.
  • GnRH agonists. Recommended to distinguish gynecologic from nongynecologic sources of pain.

• Surgery
  • 
    Two approaches have been used to treat CPP: removing pelvic organs, and treating visible disease while leaving the pelvic organs intact.
  • Hysterectomy. In the U.S., approximately 12% of hysterectomies are performed with pelvic pain as the primary indication. In about one-third of hysterectomies performed for pain, no pathology is found.
  • Laparoscopy/laparotomy. Intrapelvic diseases such as endometriosis, adhesions or chronic pelvic inflammatory disease may be treated by these procedures.
• Alternative management
  • Biofeedback
  • Transcutaneous electrical nerve stimulation units
  • Relaxation training
  • Counseling
  • Chiropractic