Skip to main content

Advertisement

SpringerLink
Log in

Non-Surgical Management of Chronic Pelvic Pain in Females

  • Lower Urinary Tract Symptoms and Voiding Dysfunction (J Sandhu, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this paper is to review the most recent literature on non-surgical therapeutic options for chronic pelvic pain in females.

Recent Findings

Chronic pelvic pain can arise from virtually any organ system in the human body. If a precise etiology is identified, the management of chronic pelvic pain can be tailored accordingly. In some cases, patients with chronic pelvic pain can remain without a specific diagnosis. In these circumstances, adequate symptom control can still be achieved even if no underlying disorder is found.

Summary

Although chronic pelvic pain is often a difficult disorder to manage, several non-surgical management options exist. Employing a multidisciplinary approach, most patients can achieve adequate symptom relief, usually without the need for surgical intervention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Reproduced from the European Association of Urology. D. Engeler (Chair), A.P. Baranowski, B. Berghmans, J. Borovicka, A.M. Cottrell, P. Dinis-Oliveira, S. Elneil, J. Hughes, E.J. Messelink (Vice-chair), A.C. de C Williams Guidelines Associates: B. Parsons, S. Goonewardene, P. Abreu-Mendes, V. Zumstein. EAU Guidelines on Chronic Pelvic Pain 2020. ISBN 978–94-92,671–07-3. Available at: https://uroweb.org/guideline/chronic-pelvic-pain/#1_2

Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. • American College of Obstetricians and Gynecologists. Chronic pelvic pain. Published August 2011. Last updated 2020. Accessed July 30, 2021. Available at: https://www.acog.org/womens-health/faqs/chronic-pelvicpain#:~:text=Chronic%20pelvic%20pain%20is%20pain,it%20may%20occur%20during%20menstruation. Importance: The ACOG has provided important recommendations on the management of pelvic pain.

  2. Ahangari A. Prevalence of chronic pelvic pain among women: an updated review. Pain Physician. 2014;17(2):E141–7. PMID: 24658485.

  3. •• Engeler D, Baranowski AP, Borovicka J, et al. European Association of Urology. Guidelines on chronic pelvic pain. 2021. Available at: https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Chronic-Pelvic-Pain-2020.pdf. Importance: the European Association of Urology has published comprehensive guidelines on the management of pelvic pain.

  4. Speer LM, Mushkbar S, Erbele T. Chronic pelvic pain in women. Am Fam Physician. 2016;93(5):380–7. Importance: this reference provides a concise summary of CPP.

    PubMed  Google Scholar 

  5. Meltzer-Brody S, Leserman J, Zolnoun D, Steege J, Green E, Teich A. Trauma and posttraumatic stress disorder in women with chronic pelvic pain. Obstet Gynecol. 2007;109(4):902–8.

    Article  Google Scholar 

  6. Nickel JC, Shoskes D, Irvine-Bird K. Clinical phenotyping of women with interstitial cystitis/painful bladder syndrome: a key to classification and potentially improved management. J Urol. 2009;182(1):155–60. https://doi.org/10.1016/j.juro.2009.02.122 (Epub 2009 May 17 PMID: 19447429).

    Article  PubMed  Google Scholar 

  7. •• De EJB, Stern TA Eds. Facing pelvic pain. A guide for patients and their families. Massachusetts General Hospital Psychiatry Academy, Boston MA. Copyright. 2021. ISBN-13: 978–1–951166–22–9 (Print) https://www.facingpelvicpain.org. Importance: Facing Pelvic Pain provides a comprehensive but concise review of causes and management of CPP. The book is aimed at patients, so it is one of the few resources available for a complete yet comprehendible of understanding their condition.

  8. Fall M, et al. EAU guidelines on chronic pelvic pain. Eur Urol. 2004;46:681. https://www.ncbi.nlm.nih.gov/pubmed/15548433.

  9. Merskey H, et al. Classification of chronic pain. 1994. Seattle. https://pdfs.semanticscholar.org/281f/3f5476d2444bb53553f473ec83634e090ee2.pdf.

  10. Chen A, De E, Argoff C. Small fiber polyneuropathy is prevalent in patients experiencing complex chronic pelvic pain. Pain Med. 2018;20(3):521–7. https://doi.org/10.1093/pm/pny001PMID29447372.

    Article  Google Scholar 

  11. Terminology Discussions [Internet]. ICS. 2021 [cited 12 August 2021]. Available from: https://www.ics.org/committees/standardisation/terminologydiscussions.

  12. The International Pelvic Pain Society. Pelvic pain assessment form. 2008. Available at: https://www.pelvicpain.org.

  13. De EJB, Stern TA (Eds). Facing pelvic pain. A guide for patients and their families. treatment map. Massachusetts General Hospital Psychiatry Academy, Boston MA. Copyright. 2021. ISBN-13: 978–1–951166–22–9. Available at: https://www.facingpelvicpain.org/treatment-map.

  14. Melzack R. The short-form McGill Pain Questionnaire. Pain. 1987;30(2):191–7.

    Google Scholar 

  15. Centers for Disease Control and Prevention. Infographic: 6 guiding principles to a trauma-informed approach. 2020. Available at: https://www.cdc.gov/cpr/infographics/6_principles_trauma_info.htm.

  16. Gyang A, Hartman M, Lamvu G. musculoskeletal causes of chronic pelvic pain. Obstet Gynecol. 2013;121(3):645–50. https://doi.org/10.1097/aog.0b013e318283ffea.

    Article  PubMed  Google Scholar 

  17. As-Sanie S, Steege J. Prevalence of pelvic musculoskeletal disorders in a female chronic pelvic pain clinic. J Reprod Med. 2006;51:185–9.

    PubMed  Google Scholar 

  18. Frawley H, Shelly B, Morin M, Bernard S, Bø K, Digesu GA, Dickinson T, Goonewardene S, McClurg D, Rahnama’i MS, Schizas A, Slieker-Ten Hove M, Takahashi S, Voelkl Guevara J. An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment. Neurourol Urodyn. 2021;40(5):1217–60. https://doi.org/10.1002/nau.24658. Epub 2021 Apr 12. PMID: 33844342.

  19. Singh HP. Female myofascial pelvic pain syndrome. Center for Digestive Diseases. 2018. Available at: https://centerfordigestivediseases.com/female-myofascial-pelvic-pain-syndrome/.

  20. Elkadry E, Mynihan LK. Clinical manifestations and diagnosis of myofascial pelvic pain syndrome in women. UpToDate. 2019. Available at: https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-myofascial-pelvic-pain-syndrome-in-women?search=clinical-manifestations-and-diagnosis-of-myofascial-pelvic-pain.

  21. Prather H, Dugan S, Fitzgerald C, Hunt D. Review of anatomy, evaluation, and treatment of musculoskeletal pelvic floor pain in women. PM&R. 2009;1(4):346–58. https://doi.org/10.1016/j.pmrj.2009.01.003VanTulderMW,TourayT,FurlanA,etal.Musclerelaxantsfornonspecificlowbackpain:asystematicreviewwithintheframeworkoftheCochraneCollaboration.Spine.2003;28(17):1978-1992.

    Article  Google Scholar 

  22. Witenko C, Moorman-Li R, Motycka C, et al. Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low back pain. P T. 2014;39(6):427–35.

    PubMed  PubMed Central  Google Scholar 

  23. Prather H, Spitznagle TM, Dugan SA. Recognizing and treating pelvic pain and pelvic floor dysfunction. Phys Med Rehabil Clin N Am. 2007;18(477–496):ix.

    Google Scholar 

  24. Purwar B, Khullar V. Use of botulinum toxin for chronic pelvic pain. Womens Health (Lond). 2016;12(3):293–6. https://doi.org/10.2217/whe-2016-0007.

    Article  CAS  Google Scholar 

  25. Triolo O, Laganà AS, Sturlese E. Chronic pelvic pain in endometriosis: an overview. J Clin Med Res. 2013;5(3):153–63. https://doi.org/10.4021/jocmr1288w.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. Vannuccini S, Petraglia F. Recent advances in understanding and managing adenomyosis. F1000Res. 2019;8:F1000 Faculty Rev-283. Published 2019 Mar 13. https://doi.org/10.12688/f1000research.17242.1.

  27. Johns Hopkins Medicine. Fibroids. Accessed 08/13/2021. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/uterine-fibroids.

  28. Wozniak S. Chronic pelvic pain. Ann Agric Environ Med. 2016;23(2):223–6. https://doi.org/10.5604/12321966.1203880.

    Article  PubMed  CAS  Google Scholar 

  29. Bonnema R, McNamara M, Harsh J, Hopkins E. Primary care management of chronic pelvic pain in women. Cleve Clin J Med. 2018;85(3):215–23. https://doi.org/10.3949/ccjm.85a.16038.

    Article  PubMed  Google Scholar 

  30. Tam T, Levine EM. Female sexual dysfunction in women with pelvic pain. Semin Reprod Med. 2018;36(2):152–8. https://doi.org/10.1055/s-0038-1676115.

    Article  PubMed  Google Scholar 

  31. Valentine LN, Deimling TA. Opioids and alternatives in female chronic pelvic pain. Semin Reprod Med. 2018;36(2):164–72. https://doi.org/10.1055/s-0038-1676102.

    Article  PubMed  Google Scholar 

  32. Hanno P, Dmochowski R. Status of international consensus on interstitial cystitis/bladder pain syndrome/painful bladder syndrome: 2008 snapshot. Neurourol Urodyn. 2009;28:274.

    Article  Google Scholar 

  33. Hanno PM, Erickson D, Moldwin R, et al. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment. J Urol. 2015;193:1545.

    Article  Google Scholar 

  34. Greenwell TJ, Spilotros M. Urethral diverticula in women. Nat Rev Urol. 2015;12(12):671–80. https://doi.org/10.1038/nrurol.2015.230.

    Article  PubMed  Google Scholar 

  35. Young A, Toncar A, Wray AA. Urethritis. [Updated 2020 Dec 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537282/.

  36. Pedersen KV, Drewes AM, Frimodt-Møller PC, et al. Visceral pain originating from the upper urinary tract. Urol Res. 2010;38:345–55.

    Article  Google Scholar 

  37. Maddukuri G. Evaluation of the urologic patient. 2020. MSD Manual Professional Version. Available at: https://www.msdmanuals.com/professional/genitourinary-disorders/approach-to-the-genitourinary-patient/evaluation-of-the-urologic-patient.

  38. Paredes Mogica JA, De EJB. Pentosan polysulfate maculopathy: what urologists should know in 2020. Urology. 2021;147:109–18. https://doi.org/10.1016/j.urology.2020.08.072 (Epub 2020 Oct 10 PMID: 33045286).

    Article  PubMed  Google Scholar 

  39. Di XP, Luo DY, Jin X, Zhao WY, Li H, Wang KJ. Efficacy and safety comparison of pharmacotherapies for interstitial cystitis and bladder pain syndrome: a systematic review and Bayesian network meta-analysis. Int Urogynecol J. 2021;32(5):1129–41. https://doi.org/10.1007/s00192-020-04659-w (Epub 2021 Feb 27 PMID: 33638677).

    Article  PubMed  Google Scholar 

  40. Ford AC, Lacy BE, Talley NJ. Irritable bowel syndrome. N Engl J Med. 2017;376(26):2566–78. https://doi.org/10.1056/nejmra1607547.

    Article  PubMed  CAS  Google Scholar 

  41. Schmulson MJ, Drossman DA. What is new in Rome IV. J Neurogastroenterol Motil. 2017;23(2):151–63. https://doi.org/10.5056/jnm16214.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Sairenji T, Collins KL, Evans DV. An update on inflammatory bowel disease. Prim Care. 2017;44(4):673–92. https://doi.org/10.1016/j.pop.2017.07.010 (Epub 2017 Oct 5 PMID: 29132528).

    Article  PubMed  Google Scholar 

  43. Jahnny B, Ashurst JV. Anal fissures. In: StatPearls [Internet]. 2020. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526063/.

  44. Fontem RF, Eyvazzadeh D. Internal hemorrhoid. [Updated 2020 Aug 8]. In: StatPearls [Internet]. 2022. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537182/.

  45. Seeras K, Qasawa RN, Akbar H, et al. Colovesicular fistula. [Updated 2020 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518990/.

  46. Flynn S, Eisenstein S. Inflammatory bowel disease presentation and diagnosis. Surg Clin North Am. 2019;99(6):1051–62. https://doi.org/10.1016/j.suc.2019.08.001.

    Article  PubMed  Google Scholar 

  47. Camilleri M. Diagnosis and treatment of irritable bowel syndrome: a review. JAMA. 2021;325(9):865–77. https://doi.org/10.1001/jama.2020.22532.

    Article  PubMed  CAS  Google Scholar 

  48. Alexander CE, Varacallo M. Lumbosacral radiculopathy. [Updated 2021 May 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430837/.

  49. Labat JJ, Riant T, Robert R, Amarenco G, Lefaucheur JP, Rigaud J. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria). Neurourol Urodyn. 2008;27(4):306–10. https://doi.org/10.1002/nau.20505.

    Article  PubMed  Google Scholar 

  50. Possover M. Laparoscopic management of endopelvic etiologies of pudendal pain in 134 consecutive patients. J Urol. 2009;181:1732–6.

    Article  Google Scholar 

  51. Oaklander AL, Nolano M. Scientific advances in and clinical approaches to small-fiber polyneuropathy: a review. JAMA Neurol. 2019;76(10):1240–51. https://doi.org/10.1001/jamaneurol.2019.2917.Erratum.In:JAMANeurol.2019Dec1;76(12):1520 (PMID: 31498378).

    Article  PubMed  Google Scholar 

  52. Oaklander AL, Herzog ZD, Downs HM, Klein MM. Objective evidence that small-fiber polyneuropathy underlies some illnesses currently labeled as fibromyalgia. Pain. 2013;154(11):2310–2316. https://doi.org/10.1016/j.pain.2013.06.001. Epub 2013 Jun 5. PMID: 23748113; PMCID: PMC3845002.

  53. Bermejo PE, Oreja-Guevara C, Diez-Tejedor E. Pain in multiple sclerosis: prevalence, mechanisms, types and treatment. Rev Neurol. 2010;50:101–8.

    PubMed  Google Scholar 

  54. Ford B. Pain in Parkinson’s disease. Mov Disord. 2010;25(Suppl 1):S98-103.

    Article  Google Scholar 

  55. Borsook D. Neurological diseases and pain. Brain. 2012;135(Pt 2):320–44. https://doi.org/10.1093/brain/awr271.

    Article  PubMed  Google Scholar 

  56. Engeler D, Baranowski AP, Berghmans B, Borovicka J, Cottrell AM, Dinis-Oliveira P, Elneil S, Hughes J, Messelink EJ, de C WA. members of the EAU – ESTRO – ESUR –SIOG Chronic Pelvic Pain. 978–94–92671–13–4. Publisher: EAU Guidelines Office. Place published: Arnhem, The Netherlands. 2017.

  57. Pak DJ, Yong RJ, Kaye AD, Urman RD. Chronification of pain: mechanisms, current understanding, and clinical implications. Curr Pain Headache Rep. 2018; 22(2). https://doi.org/10.1007/s11916-018-0666-8.

  58. Chu LF, Angst MS, Clark D. Opioid-induced hyperalgesia in humans: molecular mechanisms and clinical considerations. Clin J Pain. 2008 Jul-Aug;24(6):479–96.

  59. Bannister K, Sikandar S, Bauer CS, Dolphin AC, Porreca F, Dickenson AH. Pregabalin suppresses spinal neuronal hyperexcitability and visceral hypersensitivity in the absence of peripheral pathophysiology. Anesthesiology. 2011;115(1):144–52.

    Article  Google Scholar 

  60. Tam J, Loeb C, Grajower D, Kim J, Weissbart S. Neuromodulation for chronic pelvic pain. Curr Urol Rep. 2018;19(5). https://doi.org/10.1007/s11934-018-0783-2.

  61. Louppe JM, Nguyen JP, Robert R, Buffenoir K, de Chauvigny E, Riant T, et al. Motor cortex stimulation in refractory pelvic and perineal pain: report of two successful cases. Neurourol Urodyn. 2013;32(1):53–7.

    Article  Google Scholar 

  62. Dydyk AM, M Das J. Radicular back pain. StatPearls. Treasure Island: StatPearls Publishing, 2019 Available from: https://www.ncbi.nlm.nih.gov/books/NBK546593/.

  63. Bridger C, Prabhala T, Dawson R, Khazen O, MacDonell J, DiMarzio M, Staudt MD, De EJB, Argoff C, Pilitsis JG. Neuromodulation for chronic pelvic pain: a single-institution experience with a collaborative team. Neurosurgery. 2021;88(4):819–27. https://doi.org/10.1093/neuros/nyaa537 (PMID: 33372201).

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Massachusetts General Hospital, Boston, USA

    Joe Yue Shi & Elise J. B. De

  2. Anahuac University, Mexico City, Mexico

    Jan Alberto Paredes Mogica

Authors
  1. Joe Yue Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jan Alberto Paredes Mogica
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elise J. B. De
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jan Alberto Paredes Mogica.

Ethics declarations

Conflict of Interest

Joe Yue Shi, Jan Alberto Paredes Mogica, and Elise J.B. De each declare no potential conflicts of interest. Elise De is a consultant for Laborie Medical Technologies.

Human and Animal Rights

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Lower Urinary Tract Symptoms and Voiding Dysfunction

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shi, J.Y., Paredes Mogica, J.A. & De, E.J.B. Non-Surgical Management of Chronic Pelvic Pain in Females. Curr Urol Rep 23, 245–254 (2022). https://doi.org/10.1007/s11934-022-01110-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-022-01110-z

Keywords

Search

Navigation