Causes of Chronic Pelvic Pain Syndrome

Pelvic pain is not only a medical problem, but also a psychosocial problem. Women with chronic pelvic pain often have increased levels of stress, anxiety, and depression, as well as difficulty forming personal relationships. Partners of such women often experience emotional distress, isolation and a sense of powerlessness in trying to establish normal relationships.

Find out in the article on estet-portal.com under which pathologies the chronic pelvic pain syndrome most often develops.

• endometriosis as a common cause of chronic pelvic pain
• cystitis and myofascial syndrome in chronic pelvic pain
• venous congestion in chronic pelvic pain

Endometriosis as a common cause of chronic pelvic pain

Endometriosis is the most common gynecological cause of CPP, characterized by a  significant fluctuations in pain during the menstrual cycle.

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Therefore, for women with cyclic chronic pelvic pain syndrome, it is reasonable to empirically administer hormone therapy for at least 3-6 months prior to exploratory laparoscopy (Royal College of Obstetricians and Gynecologists).

Read also: Chronic cystitis: etiology and clinical picture

Oral contraceptives, gonadotropin-releasing hormone (GHG) analogs, progestogens and danazol have proven efficacy, however, their safety profiles differ significantly. Thus, in one comparative study, women who received HGH analogues had a greater pronounced decrease in pain scorescompared to those who took oral contraceptives, but they observed a significant decrease in bone mineral density.

 

 

This adverse effect of HGH analogs can be mitigated by the addition of low doses of norethindrone, estrogen, or a combination of estrogen and progesterone, which simultaneously reduces hot flashes andvaginal symptoms.

Cystitis and myofascial syndrome in chronic pelvic pain

Intermediate cystitis accompanies endometriosis and CPP in 60% of patients. Under these conditions, pentosan polysulfate sodium is indicated as initial therapy, the oral use of which for interstitial cystitisapproved by the Food and Drug Administration USA (Food and Drug Administration, FDA). This drug restores the protective layer of glycosaminoglycans in the bladder. Amitriptyline is also recommended for the treatment of nocturia associated with interstitial cystitis.

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A recent systematic review of the treatment of chronic pelvic pain demonstrated the efficacy of neuromuscular blockade in patients with symptoms of myofascial pain.

Reported lower pain scores 6 months after botulinum toxin treatment in women with chronic pelvic pain caused by pelvic floor spasm compared to women whoinjected with placebo.

Venous congestion in chronic pelvic pain

Pelvic venous stasis syndrome can be treated with hormonal, radiological, or surgical therapy. In study participants with pain due to pelvic congestion, the use of medroxyprogesterone acetate or the GH agonist goserelin, which significantly improved pelvic symptoms.

 

 

A Cochrane review of the non-surgical treatment of chronic pelvic pain caused by pelvic congestion syndrome or adhesions found that medroxyprogesterone acetate predominantly resulted in a 50% reduction in pain with a duration of action of the drug up to 9 months compared with patients who took placebo. In comparative studies, GRH analogs were more effective in reducing chronic pelvic pain than gestagens. X-ray therapy is as effective in eliminating CPP as hysterectomy and even has an advantage, since this procedure can be performed on an outpatient basis.

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Irritable Bowel Syndrome ─ 

most likely cause, if chronic pelvic pain combines with changes in stool consistency or frequency of defecation. These patients are often prescribed antispasmodics, but their anticholinergic effects may exacerbate constipation. Diet therapy and dietary fiber supplementation improve symptoms.

Physical therapy aims to restore strength, elasticity, balance and  

coordination of the pelvic floor muscles and surrounding lumbopelvic muscles, which improves bowel, bladder and genital function. Especially indicated for patients with dyspareunia, vaginismus or pinpoint tenderness on examination. This type of treatment is performed by a physical therapist using specific pelvic floor muscle training techniques.

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The purpose of relaxation exercises is to reduce the tone of overactive pelvic muscles, which improves the symptoms of chronic pelvic pain, vulvodynia, and perineal neuralgia. The patient is told what exactly 

causes excessive tone of the pelvic floor muscles, and a set of exercises is offered that reduces muscle tone.

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