Chronic pelvic pain (CPP) is a condition that can quietly wreak havoc on a person’s life. While acute pain usually resolves after treatment, CPP can persist for six months or more, often without an obvious cause, turning everyday life into a balancing act between discomfort and normalcy.
Though women are most often affected, with 1 in 7 women experiencing chronic pelvic pain, all ages and genders can suffer from chronic pelvic pain, including up to 1 in 10 men. Causes and symptoms can be difficult to diagnose and pinpoint — but make no mistake: chronic pelvic pain is a legitimate medical issue, deserving both attention and treatment.
As we explore the causes, symptoms, and potential treatments for CPP, our goal is to provide education and help for those hoping to achieve a better quality of life.
What Causes Chronic Pelvic Pain?
Chronic pelvic pain can be as complex as it is stubborn. Often caused by a combination of factors, finding a single culprit can be difficult. A few common causes include:
Reproductive Disorders
More commonly among females, conditions such as endometriosis, ovarian cysts, fibroids, or adenomyosis can cause inflammation and adhesions in pelvic tissues, leading to deep, aching pain that often worsens during menstruation, intercourse, or ovulation. Endometriosis, for example, occurs when tissue similar to the uterine lining grows outside the uterus, causing pain that can become chronic. However, symptoms are not constrained to any one gender. For example, in males, conditions such as chronic prostatitis or acute bacterial prostatitis can lead to chronic pelvic pain, erectile dysfunction, and pain with intercourse.
Gastrointestinal Disorders
Irritable Bowel Syndrome (IBS), inflammatory bowel disease (IBD), constipation, and diverticulitis are common examples of gastrointestinal disorders that can lead to chronic pelvic pain. The gut’s close proximity to the pelvic floor means GI issues often impact pelvic muscles and nerves. Chronic constipation can lead to straining, which puts pressure on pelvic muscles and nerves. IBS, with its alternating constipation and diarrhea, may cause pelvic floor tension as the body reacts to irregular bowel movements.
Urologic Disorders
Common urologic disorders include interstitial cystitis (IC), urinary tract infections (UTIs), and/or an overactive bladder. For example, conditions like IC can cause persistent bladder pain and urgency, leading to constant tension and overactivity in pelvic floor muscles. Even after a UTI clears, residual muscle tension or nerve sensitivity can cause recurring pain. Over time, this can develop into a chronic pain cycle as the pelvic floor overcompensates.
Neuromuscular Disorders
Pelvic floor dysfunction, pudendal neuralgia, and myofascial pain syndrome are common neuromuscular issues that can cause spasms, tightness, and nerve-related pain in the pelvic region. Pudendal neuralgia is a nerve condition causing severe pain due to compression or irritation of the pudendal nerve, resulting in sensitivity and aching in the pelvis. Muscle overuse or injury can also cause myofascial pain, where tight muscle bands create trigger points, leading to ongoing discomfort.
Pelvic floor dysfunction is a common cause for chronic pain. Your pelvic floor muscles support the bladder, bowel, and reproductive organs, playing a vital role in controlling basic bodily functions. When they become weakened, overactive, or uncoordinated, the result can be persistent pain and discomfort that disrupts daily life. Chronic pelvic pain is frequently rooted in this muscle dysfunction, which can be triggered by a variety of factors, from childbirth and surgery to stress or injury.
Psychological Stress
Psychological stress and anxiety can play a significant role in chronic pelvic pain by triggering a constant state of tension in the pelvic muscles. When we experience prolonged stress, the body often responds by tensing muscles, including those in the pelvic floor. This ongoing contraction can restrict blood flow, irritate nerves, and increase inflammation, creating a feedback loop of pain. Over time, this tension can develop into chronic discomfort, even if the original stressor is gone. Addressing both the physical and emotional aspects is essential in managing chronic pelvic pain, making it crucial to approach treatment holistically. Studies have shown that 25-50% of those suffering from chronic pelvic pain have a correlation with depression or anxiety.
Given the multiple, simultaneous factors that could contribute to chronic pelvic pain, it’s important to find a circle of providers who understand your specific condition and who work together to create a treatment plan for you.
Chronic Pelvic Pain Symptoms
To complicate matters further, CPP symptoms can vary wildly by person. Some experience a persistent dull ache, while others endure sharp, stabbing pains that come and go. For many, the pain intensifies during menstruation or intercourse. Others deal with discomfort during urination or bowel movements. These symptoms routinely disrupt daily quality of life, highlighting the importance for early diagnosis and treatment:
If you’re experiencing any of the below symptoms for more than 6 months, you may be experiencing chronic pelvic pain:
– Intense pain in an isolated area
– Widespread, dull pain
– Constant pain or sharp and stabbing
– Pressure or heaviness deep within the pelvis
– Pain internally (in the uterus) or externally in the pelvic area
– Frequency or urgency when urinating
– Bloating
– Upset stomach
– Constipation or diarrhea
Treatments for Chronic Pelvic Pain
While chronic pelvic pain can be complex with a range of causes and symptoms, there are treatments that can offer relief.
Pelvic floor physical therapy (PFPT) is a highly effective, non-invasive approach to managing chronic pelvic pain by targeting the muscles and functions that contribute to discomfort. Trained specifically in pelvic health, pelvic floor physical therapists provide specialized, targeted care for your symptoms. Your first appointment will typically start with a conversation on your medical history and symptoms. Based on your comfort level, your therapist will then suggest an external and/or internal exam. It is important to progress at your own pace and the pace in which you feel comfortable. After your initial appointment, your therapist will create a personalized treatment plan for you that may include manual therapy to release tension, modalities such as dry needling, heat, electrical stimulation to manage pain and promote healing, biofeedback to enhance muscle control, and exercises for strength and flexibility.
At Pelvic Health Solutions, we also focus on education as a key component of our treatment – making sure you understand the anatomy behind your symptoms. This holistic approach not only provides pain relief but also addresses underlying causes, offering long-term solutions for chronic pelvic discomfort.
Outside of PFPT, other treatments may involve anti-inflammatory or nerve pain medications, trigger point or nerve injections, hormone therapy for imbalances, or in severe cases, surgery. Early diagnosis and intervention are crucial for effective management and symptom prevention.
Living with Chronic Pelvic Pain
Chronic Pelvic Pain (CPP) often requires adaptability, resilience, and perseverance. While quick fixes are rare, with a dedicated team of experts by your side, relief is possible. The first step is understanding and voicing your symptoms. The next is finding the right providers who not only understand your experience but also work with you to create a personalized treatment plan.
At Pelvic Health Solutions, we’ve helped many patients who have previously sought treatment with little to no relief. Whether you’ve tried different providers, treatments, or medications, we’re here to help. If you think you may be suffering from chronic pelvic pain, don’t hesitate to reach out—we’re ready to support you on your journey toward healing.
