Chronic Pelvic Pain Syndrome

At Montefiore Einstein Urology, you can access exceptional care for chronic pelvic pain syndrome. As a global leader in urology, we are an academic-based, national and international referral site for the most complex and high-risk cases. For over a century, we have been at the forefront of innovation, research and clinical care for genitourinary (GU) conditions.

Ranked in the top 1% of all hospitals in the nation for urology according to U.S. News & World Report, Montefiore Einstein continues to make advances in the diagnosis and treatment of GU conditions. Our multidisciplinary team of world-renowned specialists is passionate about uncovering the latest diagnostic approaches and treatments that can improve outcomes.

At Montefiore Einstein Urology, you can expect compassionate, personalized, research-based treatment plans that meet the highest standards for quality and safety. In addition, we offer patients a full range of support services, from nutritional guidance to rehabilitative therapies.

When you need chronic pelvic pain syndrome care, turn to our dedicated providers who will develop a highly personalized treatment plan.

Chronic pelvic pain refers to pain in the area below the belly button and between the hips that lasts six months or longer. Relatively common, chronic pelvic pain may have more than one cause. It is often associated with other conditions such as irritable bowel syndrome (IBS), major depressive disorder or pelvic inflammatory syndrome, or it may be a condition in its own right.

In some cases, chronic pelvic pain may be caused by a single disease. In other cases, the pain may be the result of more than one medical condition. Some causes of chronic pelvic pain include:

• Endometriosis: This chronic disease occurs when tissue similar to the lining of the uterus grows outside of the uterus.
• Fibroids: These growths inside or on the uterus aren’t cancer, but they may cause pressure or a feeling of heaviness in the lower stomach or lower back. 
• Chronic pelvic inflammatory disease: An infection of the female reproductive organs, it most often occurs when sexually transmitted bacteria spread from your vagina to your uterus, fallopian tubes or ovaries.
• Ovarian remnant: Ovarian remnant is tissue that is left behind after the surgical removal of one or both ovaries. This can happen if part of the ovary is left behind during surgery, or if ovarian tissue is naturally located in an abnormal place.
• Irritable bowel syndrome (IBS): This common, chronic digestive condition causes a range of symptoms, including abdominal pain, bloating and changes in bowel habits.
• Interstitial cystitis (IC): Also known as bladder pain syndrome, interstitial cystitis is a chronic condition that causes pain and discomfort in the bladder and pelvic region.
• Pelvic congestion syndrome: This is a chronic condition that causes pelvic pain and is often caused by enlarged veins in the lower abdomen.
• Muscle and bone problems: Conditions including fibromyalgia, tension in pelvic floor muscles, swelling of the pubic joint or a hernia may lead to chronic pelvic pain.

Chronic pelvic pain may occur in different parts of the pelvic area, rather than in just one spot, and may be described as dull aching, sharp pains, pressure, heaviness or cramping. It may also come and go. It may become more apparent during sex, while urinating, having a bowel movement or sitting. Other symptoms may include bloating, upset stomach, constipation and diarrhea.

The diagnosis of chronic pelvic pain is made after three to six months of pelvic pain and is often based on the patient’s history and a physical examination. To confirm the diagnosis, the patient may require additional tests such as:

• Pelvic exam to find symptoms of illnesses, unusual growths or tense pelvic floor muscles
• Lab tests to check for illnesses such as chlamydia or gonorrhea. You may also need a blood test to measure your blood cells or a urine test to check for a urinary tract infection.
• Ultrasound to look for growths or cysts in the ovaries, uterus or fallopian tubes
• Other imaging tests, such as computed tomography (CT) or magnetic resonance imaging (MRI) scans, to find growths or other unusual structures inside the body
• Laparoscopy to help find and treat conditions such as endometriosis and chronic pelvic inflammatory disease

Treatment of chronic pelvic pain is focused on easing symptoms and improving quality of life. Depending on the cause or causes, you may need more than one treatment. These include:

Medicines, such as:

• Pain relievers: Over-the-counter medications, including aspirin, ibuprofen and acetaminophen, may ease pain. Sometimes, a strong prescription pain reliever is needed.
• Hormone treatments: Some patients find that the days when they experience pelvic pain overlap with a phase of their period. In this case, birth control pills or other hormonal medicines may help relieve pelvic pain.
• Antibiotics: If the condition is caused by bacteria, you may need antibiotics.
• Antidepressants: Some types of medicines that treat depression may also be helpful for chronic pain.
• Muscle relaxers: Medicines such as cyclobenzaprine might help relax muscles linked with pelvic pain.

In addition to medicines, other treatments for chronic pelvic pain include:

• Physical therapy: For some patients, physical therapy can manage chronic pelvic pain.
• Spinal cord stimulation: Called neuromodulation, this treatment involves implanting a device that blocks nerve pathways, so that the pain signal can’t reach the brain.
• Trigger point injections: Trigger points are tight, sensitive spots on the body. Shots of numbing medicine may help block pain in these spots.

Surgeries to treat chronic pelvic pain include:

• Laparoscopy: If you have endometriosis, this type of surgery can treat or remove the tissue outside of the uterus that causes pain.
• Hysterectomy: In rare cases, patients suffering from chronic pelvic pain may need surgery to remove the uterus, called hysterectomy. It may also be necessary to remove one or both ovaries.