What Is Chronic Pelvic Pain Syndrome?
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Medically reviewed by Peter Weiss, MD
Chronic pelvic pain syndrome (CPPS) is a condition that occurs when a person experiences chronic pain in the pelvic region that lasts longer than six months. This pain is typically debilitating and affects your quality of life. CPPS affects up to 10% of people, but is more common in people who have a uterus.
Symptoms of this condition can include burning, cramping, and electrical pain that is either sharp or dull in the pelvic region. It’s also common to experience increased urination and abdominal pain, among other symptoms.
Managing CPPS is complex and often requires a multidisciplinary healthcare team. Your team may consist of your primary care provider, cognitive behavioral therapist, and other medical specialists depending on the location of your pain. While treatment can vary from person to person, there are some therapies available to help relieve your symptoms.
Symptoms
Anyone can develop CPPS, but most people who develop symptoms are those who have a uterus. If you have CPPS, symptoms can occur across the entire pelvic region or may be more apparent in a particular organ or area—such as the uterus, pelvic floor, prostate, intestines, or bladder. Common symptoms of this condition include:
Dull, sharp, burning, or electrical pelvic pain
Pain that feels constant and is not due to period cramping
Discomfort during a bowel movement
Bloating or feeling of fullness
Abdominal pain or cramping
Difficulty sleeping
Constipation or diarrhea
Depression or anxiety
It’s worth noting that some people with CPPS may also experience co-occurring conditions (or health conditions that exist at the same time as CPPS). These conditions may include fibromyalgia, irritable bowel syndrome, or endometriosis—all of which may worsen CPPS symptoms.
Causes
Researchers don’t know the exact cause of chronic pelvic pain syndrome, but there are several health events that may play a role in the development of symptoms. For some people, symptoms begin after pelvic surgery. One study found that 20% of people experienced chronic pelvic pain six months after cesarean delivery (C-section). You may also develop CPPS if you have an underlying condition that causes a recurrent source of pain such as endometriosis or pelvic inflammatory disease (PID).
There also appears to be a link between chronic pelvic pain syndrome and a history of trauma. In a study of more than 700 people with CPPS, almost 50% of respondents reported a history of sexual assault or physical abuse, and approximately 31% had post-traumatic stress disorder (PTSD). These traumatic events can change the way your brain processes pain.
When you experience an acute or chronic source of pain—whether that’s physical or emotional—your brain may become more sensitive to the perception of pain. This process is called central sensitization. Although some people may be able to identify an event that triggered their chronic pain, many have an unknown cause.
Diagnosis
Diagnosing chronic pelvic pain syndrome can be a challenging process. Unfortunately, research also estimates that 50% of cases are undiagnosed. Currently, there are no specific diagnostic tests available for chronic pelvic pain syndrome so diagnosis often undergoes an exclusion process. This basically means that your healthcare provider will evaluate you for other possible causes of your symptoms before diagnosing you with chronic pelvic pain syndrome.
Your healthcare provider will investigate your chronic pain symptoms by asking about your medical history, lifestyle habits, recent events, and current symptoms. You can also expect them to perform or order one or more of the following tests to better assess your pain:
Physical exam: Allows your healthcare provider to look at your pelvic region and press on it to learn which areas hurt
Imaging scan: Creates detailed images to visualize your pelvic cavity for signs of damage or inflammation via an ultrasound, X-ray, or MRI
Laparoscopy: Creates a small incision (cut) in your abdomen and then visualizes the pelvic cavity through a small device called a laparoscope
Endoscopy: Uses a small camera to view the inside of your colon or bladder to assess for digestive or urinary diseases
Laboratory tests: Takes samples of your blood or urine to test for other potential causes of pain such as a urinary tract infection
Neurological exam: Evaluates how well your nervous system functions
Mental health or trauma screening: Asks questions about symptoms related to anxiety, depression, or trauma
Diagnostic nerve blocks: Numbs certain pain receptors to learn where the pain is occurring
The tests that your healthcare provider orders will depend on the location of your pain and the symptoms you may be experiencing. Many conditions may mimic chronic pelvic pain syndrome and finding treatable alternative diagnoses is the first step in evaluating someone for chronic pelvic pain syndrome.
Treatment
Treatment for chronic pelvic pain syndrome is highly individualized and often requires a multidisciplinary healthcare team. For example, if your pain is located in your bladder and you have symptoms such as increased urination, you will likely have a bladder specialist on your care team. If you have a history of trauma or are experiencing anxiety or depression symptoms, a mental health provider will likely support you as you receive treatment.
The goals of treatment for CPPS are to address any underlying causes of pain and improve your quality of life.
Surgery
Some people may learn that underlying health conditions such as uterine fibroids, endometriosis, or adenomyosis (abnormal growth in the uterus) are contributing to their pain. Treating these conditions with surgery (such as a laparoscopy) may help improve your chronic pain symptoms.
Some medications can also help improve chronic pain symptoms. Your healthcare provider may prescribe the following medications to help reduce your pain symptoms:
Over-the-counter pain medications: Often include non-steroidal anti-inflammatory drugs (NSAIDs) and Tylenol (acetaminophen)
Opioid medications: These are stronger pain medications that you take under the supervision of your primary care provider
Hormone replacement therapy: Involves estrogen or progesterone therapy if your pain is related to your menstrual cycle
Neuropathic therapies: Medications such as Horizant (gabapentin) or tricyclic antidepressants may help reduce pain signals in the brain
Botulinum toxin injections: A medication that may reduce pain caused by muscle overactivity
Other Therapies
Depending on the underlying cause of your pain, your healthcare team may recommend other methods to treat your symptoms, which may include:
Pelvic floor therapy: This is a specialized form of physical therapy that can improve musculoskeletal pain in the pelvic floor
Cognitive-behavioral therapy: This is a form of psychotherapy from the supervision of a mental health provider to heal mental health conditions or trauma
How To Prevent Chronic Pelvic Pain Syndrome
Researchers and healthcare providers are still trying to understand how someone develops chronic pelvic pain syndrome. Because each case is unique, there is no specific action a person can take to reliably prevent the development of CPPS. However, central sensitization, a process by which your brain becomes more sensitive to pain, can play a role. You are more likely to experience central sensitization if you have acute or chronic pain that goes untreated. Seeking care for pain earlier may help reduce the risk of CPPS.
Additionally, treating any underlying conditions such as pelvic inflammatory disease, endometriosis, or irritable bowel syndrome may help prevent or delay symptoms of CPPS. Talk to your healthcare provider if you suspect you have symptoms of these conditions. They can help you develop a treatment plan to improve symptoms and your quality of life.
Related Conditions
It’s possible to have CPPS without any other underlying health conditions. But, some people with CPPS may have other health conditions that co-occur with CPPS. These conditions include:
Irritable bowel syndrome (IBS)
Endometriosis
Interstitial cystitis (also called painful bladder syndrome)
Fibromyalgia
Anxiety
Post-traumatic stress disorder
Living With CPPS
Chronic pelvic pain syndrome can greatly affect your quality of life, especially if you don’t receive treatment early. This condition often causes changes in your sleep quality, sex life, ability to work and carry out daily errands, and mental health. While CPPS can be invasive in your personal and professional life, talking to your healthcare provider about your symptoms and getting started on treatment sooner is a good first step to living well with this condition.
Frequently Asked Questions
Is chronic pelvic pain a disability?
Chronic pelvic pain can affect your daily life and ability to work. Depending on the severity of your symptoms and length of time you have been experiencing symptoms, chronic pelvic pain may be considered a disability for some people.
What kind of doctor do you see for pelvic pain?
A gynecologist (a medical doctor who specializes in treating conditions that affect the uterus, vagina, and ovaries), bladder specialist, gastrointestinal specialist, primary care provider, and mental health professional may all be a part of your care team if you have CPPS.
What happens if you leave pelvic pain untreated?
Pelvic pain can be caused by a variety of health conditions, such as pelvic inflammatory disease, endometriosis, and irritable bowel syndrome. If you leave some of these underlying conditions untreated, it’s possible to experience worsening symptoms and a lower quality of life.
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