Medically reviewed by: Melissa A. Delgado, MD, FACOG
Melissa A. Delgado, MD, FACOG is the founder and owner of The Chronic Pelvic Pain Center of Northern Virginia. Dr. Delgado is an experienced, board-certified OB/GYN and has spent the past 10 years dedicating her time to understanding complex and persistent pelvic pain.
Chronic pelvic pain syndrome can be challenging to diagnose and treat. And even if you’re diagnosed with this syndrome, it can be hard to figure out what caused it in the first place.
With the right information, however, you may be able to better manage the pain and improve your quality of life.
In this article, we’ll explore the causes, symptoms, and treatment options for chronic pelvic pain syndrome.
What Is Chronic Pelvic Pain Syndrome?
Chronic pelvic pain syndrome (CPPS) is a condition characterized by recurring pelvic pain lasting more than six months. This pain can be located anywhere in the pelvic region.
Common causes of CPPS
CPPS is a particularly complex condition because it can be caused by a wide variety of factors, including infections, injuries, psychological factors, and more.
Endometriosis: This condition impacts millions of women worldwide. Endometriosis (or "endo") occurs when tissue from the lining of the uterus (called the endometrium) grows outside of the uterus. These endometrial outgrowths get stuck in the abdomen, potentially leading to painful cysts and scar tissue. This can often lead to debilitating pain and many other complications over time.
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Ovarian remnant: Occasionally, after the surgical removal of the uterus, ovaries, and fallopian tubes, a small piece of the ovary may unintentionally remain, potentially causing the formation of painful cysts.
Musculoskeletal issues: Conditions affecting the bones, joints, and connective tissues — like fibromyalgia, pelvic floor muscle tension, inflammation of the pubic joint (pubic symphysis), or hernia — can result in recurring pelvic pain.
Chronic pelvic inflammatory disease (PID): This condition may develop when a long-term infection (often transmitted sexually) leads to scarring involving the pelvic organs.
Fibroids: Noncancerous growths in the uterus, called fibroids, can generate pressure or a feeling of heaviness in the lower abdomen. Typically, they don't cause sharp pain unless they degenerate due to a loss of blood supply.
Irritable bowel syndrome (IBS): Symptoms associated with irritable bowel syndrome, such as bloating, constipation, or diarrhea, can contribute to pelvic pain and pressure.
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Painful bladder syndrome (interstitial cystitis): This condition is characterized by recurrent bladder pain and a frequent urge to urinate. Pelvic pain may be experienced as the bladder fills, but it often temporarily improves after emptying the bladder.
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Pelvic congestion syndrome: Some medical professionals believe that enlarged varicose veins around the uterus and ovaries can lead to pelvic pain. However, there is less certainty among other doctors about pelvic congestion syndrome directly causing pelvic pain, as most women with enlarged pelvic veins do not experience associated pain.
Psychological factors: Factors like depression, chronic stress, or a history of sexual or physical trauma can increase the risk of chronic pelvic pain. Emotional distress exacerbates pain, and living with chronic pain contributes to emotional distress. These two factors often create a detrimental cycle.
Symptoms of Chronic Pelvic Pain Syndrome
The symptoms of CPPS vary from person to person, but they typically include pelvic pain, discomfort, and pressure. There are also sex-specific symptoms that tend to be shared by many people living with the condition.
In women, CPPS symptoms can include:
Frequent or urgent need to urinate
Pain during sex
Soreness or tenderness around the vagina
Sleep difficulties
Mental health issues, such as anxiety or depression
Whatever CPPS symptoms you may be experiencing, they can be (and often are) debilitating and may significantly your quality of life.
Diagnosis of Chronic Pelvic Pain Syndrome
Diagnosing CPPS can be challenging because there is no specific test for the condition. In fact, if you search for “how to diagnose CPPS” in Google, you won’t get great results.
The only way to get to the bottom of the condition is by visiting your doctor. They will likely perform a physical exam and ask you about your symptoms and medical history to try and deduce what may have caused your CPPS.
They may also perform urine or blood tests, or conduct imaging studies to rule out other conditions. Your doctor may even refer you to a specialist, such as a urologist or gynecologist, for further evaluation.
What Could Cause Chronic Pelvic Pain Syndrome?
There are several potential causes of CPPS and its symptoms. These conditions may also exist simultaneously, with each contributing to pelvic pain in different ways.
Endometriosis: Endometriosis occurs when tissue from the lining of the uterus (called the endometrium) grows outside of the uterus. These tissue deposits respond to hormonal changes, thickening, breaking down, and bleeding with each menstrual cycle. However, since they are located outside the uterus, the blood and tissue cannot exit the body through the vagina. Instead, they remain in the abdomen, potentially leading to the formation of painful cysts and scar tissue adhesions.
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Musculoskeletal problems: Conditions affecting your bones, joints, and connective tissues (musculoskeletal system) — such as fibromyalgia, pelvic floor muscle tension, inflammation of the pubic joint (pubic symphysis), or hernia — can lead to recurring pelvic pain.
Chronic pelvic inflammatory disease: This can occur if a long-term infection (often a sexually transmitted infection, or STI) causes scarring that involves your pelvic organs.
Ovarian remnant: After surgical removal of the uterus, ovaries, and fallopian tubes, a small piece of the ovary may accidentally be left inside and later develop painful cysts.
Fibroids: These noncancerous uterine growths may cause pressure or a feeling of heaviness in your lower abdomen. They rarely cause sharp pain unless they become deprived of a blood supply and begin to die (degenerate).
Irritable bowel syndrome: Symptoms associated with irritable bowel syndrome — bloating, constipation, or diarrhea — can be a source of pelvic pain and pressure.
Painful bladder syndrome (interstitial cystitis): This condition is associated with recurring pain in your bladder and a frequent need to urinate. You may experience pelvic pain as your bladder fills, which may improve temporarily after you empty your bladder.
Pelvic congestion syndrome: Some medical professionals have suggested that enlarged, varicose-type veins around your uterus and ovaries may result in pelvic pain. However, other doctors are much less certain that pelvic congestion syndrome is a cause of pelvic pain because most women with enlarged veins in the pelvis have no associated pain.
Psychological factors: Depression, chronic stress, or a history of sexual or physical trauma may increase your risk of chronic pelvic pain. Emotional distress makes pain worse, and living with chronic pain contributes to emotional distress. These two factors often become a vicious cycle.
Treatment Options for Chronic Pelvic Pain Syndrome
Treatments for CPPS depend on the underlying cause of the condition. In some cases, the cause may not be clear, so treatment may focus instead on managing symptoms to improve your symptoms and quality of life.
Medication for pelvic pain relief
Medications can be used to manage pain and discomfort associated with CPPS.
These can include over-the-counter (OTC) pain relievers, such as ibuprofen or acetaminophen, or prescription medications like muscle relaxants or antidepressants.
Physical therapy for pelvic pain relief
Physical therapy can be an effective treatment for CPPS, as well. It can help improve muscle strength and flexibility, reduce pain and discomfort, and improve overall pelvic floor function.
You might be referred to a physical therapist who uses techniques such as massage, stretching, and pelvic floor muscle exercises to help manage your symptoms.
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Alternative remedies for pelvic pain relief
Several complementary and alternative remedies may be helpful in managing the symptoms of CPPS. These can include acupuncture, massage therapy, and herbal supplements.
It’s essential to speak with your doctor before trying any of these remedies to ensure that they are safe and effective.
Coping With Chronic Pelvic Pain Syndrome
Coping with CPPS can be challenging, but there are things you can do to manage your symptoms and improve your quality of life.
These can include staying active, practicing relaxation techniques such as deep breathing or meditation, and seeking support from friends, family, or a mental health professional.
Practicing good hygiene, using protection during sexual intercourse, and developing effective daily techniques for managing your stress and anxiety are also good prevention and management strategies.
When to Seek Professional Help
If you're experiencing any of the symptoms associated with CPPS, don't hesitate to seek professional help.
Some warning signs that indicate you should see your doctor or ask for a referral to a specialist include:
Inability to control urination or bowel movements
Severe and incapacitating pelvic pain
Persistent or worsening symptoms over time
The Chronic Pelvic Pain Center of Northern Virginia is dedicated to providing compassionate and comprehensive care for women living with CPPS.
Dr. Delgado is an expert in treating and managing the conditions that cause chronic pelvic pain, including endometriosis, interstitial cystitis, and more. She combines traditional treatments and holistic therapies to provide effective, lasting relief from pain.
Find relief and improve your quality of life by reaching out to The CPP Center today.