Chronic Pelvic Pain

Chronic Pelvic Pain (CPP) is non-cyclic pain perceived in structures related to the pelvis that persists for six months or longer, often associated with functional disability or negative emotional consequences.

Definition

Chronic Pelvic Pain (CPP) is non-cyclic pain perceived in structures related to the pelvis that persists for six months or longer, often associated with functional disability or negative emotional consequences.

Epidemiology

Affects 15–20% of women worldwide
Also occurs in men, often related to urological or musculoskeletal causes
Most common in women aged 25–50 years
Significant impact on quality of life and work productivity
Frequently associated with comorbid conditions like IBS, endometriosis, or interstitial cystitis
Often underdiagnosed due to complex etiology
Healthcare utilization is high due to chronic symptoms

Etiology

Gynecologic causes: endometriosis, adenomyosis, pelvic inflammatory disease
Urologic causes: interstitial cystitis, chronic prostatitis
Gastrointestinal causes: irritable bowel syndrome, chronic constipation, inflammatory bowel disease
Musculoskeletal causes: pelvic floor muscle dysfunction, myofascial pain
Neuropathic pain from nerve entrapment or injury
Psychological factors: stress, anxiety, depression
Idiopathic or multifactorial in many patients

Pathophysiology

Chronic nociceptive input from pelvic organs or musculoskeletal structures
Central sensitization leading to heightened pain perception
Neurogenic inflammation and altered pain signaling pathways
Pelvic floor muscle hypertonicity contributing to pain
Viscero-somatic and viscero-visceral reflexes perpetuating symptoms
Inflammatory mediators from chronic infection or tissue injury
Interplay of physical and psychological factors sustaining chronicity