Pelvic and perineal pain
Classification and external resources
Micrograph showing endometriosis (H&E stain), a common cause of chronic pelvic pain in women.
ICD-10	R10..2
ICD-9	625.9

Chronic pelvic pain (CPP) is a medical condition that can affect both women and men. The pelvic pain must persist for a period of 3 months or more to be considered chronic. This is a poorly-understood condition that likely represents abnormal neurological function, either in the peripheral nervous system or central nervous system.

Contents 1 Women and chronic pelvic pain 1.1 Etiology 2 Men and chronic pelvic pain 3 Misdiagnosis 4 See also 5 References 6 External links

[edit] Women and chronic pelvic pain

Most women, at some time in their lives, experience pelvic pain. Many different etiologies have been proposed, including:

• endometriosis
• 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
• 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.

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.

[edit] Etiology

• Gynecologic Etiologies
  • Dysmenorrhea
  • Endometriosis
  • Müllerian abnormalities
  • Pelvic inflammatory disease
  • Ovarian abnormalities

• Abdominal Etiologies
  • Loin pain hematuria syndrome
  • Proctitis
  • Colitis

[edit] Men and chronic pelvic pain

Men also experience chronic pelvic pain. In men it is called Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) and is also known as chronic nonbacterial prostatitis. Men in this category have no known infection, but do have extensive pelvic pain lasting more than 3 months.^[1] There are no standard diagnostic tests; diagnosis is by exclusion of other disease entities. Multimodal therapy is the most successful treatment option,^[2] and includes α-blockers,^[3] phytotherapy,^[4][5] and protocols aimed at quieting the pelvic nerves through myofascial trigger point release with psychological re-training for anxiety control.^[6][7] Antibiotics are not recommended.^[8][9]

[edit] Misdiagnosis

Chronic pelvic pain (category IIIB) is often misdiagnosed as chronic bacterial prostatitis and needlessly treated with antibiotics exposing the patient to inappropriate antibiotic use and unnecessarily to adverse effects with little if any benefit in most cases. Within a Bulgarian study, where by definition all patients had negative microbiological results, a 65% adverse drug reaction rate was found for patients treated with ciprofloxacin in comparison to a 9% rate for the placebo patients. This was combined with a higher cure rate (69% v 53%) found within the placebo group.^[10]

[edit] See also

• Abdominal adhesions
• Coccydynia (coccyx pain, tailbone pain)
• CP/CPPS

[edit] References

• 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

[edit] External links

• International Pelvic Pain Society
• American Pain Society
• University of Michigan Pelvic Pain Program
• University of North Carolina Pelvic Pain Program
• Tailbone pain (coccyx pain, coccydynia): Free medical article online at eMedicine
• Pelviperineology The multidisciplinary open access pelvic floor journal