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​Pelvic Pain

Evidence-based Overviews | Associated Conditions | Work Accommodation  | Decision Aids and Toolkits
Videos and Poscasts | Pelvic Pain Organizations | Research Resources

Chronic pelvic pain is the most common reason for women to be referred to a gynaecology clinic, and the most common reason for men under 50 to visit a urologist.

It can affect both men and women, although women are much more likely to consult a health care professional about the problem.  Chronic pelvic pain affects approximately 15% of women aged 18-50.

There are a large number of causes of pelvic pain.  These can be related to the organs in the pelvis (like the bladder, or the uterus and ovaries in women), the muscles of the pelvic floor, or the nerves of the pelvis and low back.

Some of the more common chronic pelvic pain conditions are:

Other pelvic pain conditions may include:

  • Disorders of the bowel such as Irritable Bowel Syndrome
  • Previous abdominal surgery or infection that has resulted in adhesions
  • Musculoskeletal/myofascial pain (pain that arises from bones, joints, or muscles in the abdomen or pelvic floor or referred pain from other areas that produces felt pain in the abdomen or pelvic floor)  

Interstitial Cystitis 

Interstitial cystitis produces  recurring discomfort in the bladder and pelvic area. The symptoms vary between individuals, however some people can experience intense pain.  Pelvic pain may increase with a full bladder, when urinating, during periods or while having sex. Like regular cystitis, interstitial cystitis can create an urgent and frequent need to urinate. The condition doesn't respond to treatment with antibiotics as it is not caused by a bacterial infection. Both men and women can get interstitial cystitis, although the vast majority of cases are in women. 

Get more information from National Health Services [UK].

Prostatitis  

Prostatitis is an infection or inflammation of the prostate gland.  
There are different types of prostatitis:

  • acute bacterial prostatitis
  • chronic bacterial prostatitis
  • non-bacterial prostatitis
  • chronic pelvic pain syndrome (CPPS) – also called pelvic floor myalgia or prostatodynia

Get more information from the Canadian Cancer Society.

Vulvodynia 

Vulvodynia refers to pain or discomfort involving the vulva (the genital area between the legs and outside of the vagina). Symptoms include uncomfortable sensations such as burning, stinging, irritation, stabbing, or rawness. When no other obvious causes (e.g., skin conditions, infections, or diseases) can be found  these symptoms may indicate  vulvodynia..  Women who suffer from vulvodynia may find that the discomfort interferes with daily living activities including wearing clothes, sitting, or walking  and or sexual activities.

Get more information from the Vancouver General Hospital Multidisciplinary Vulvodynia Program.

Dysmenorrhea (menstrual cramps) 

Just before and during their menstrual periods, many women experience menstrual cramps or dysmenorrhea.Dysmenorrhea is an extremely common and sometimes debilitating condition for women of reproductive age.  

Symptoms include:

  • Throbbing or cramping pain in your lower abdomen that may be intense
  • Dull, constant ache
  • Pain that radiates to your lower back and thighs

Get more information from the Society of Obstetricians and Gynecologists of Canada and Canadian Pain Coalition

Endometriosis  

Endometriosis is the growth of excess tissue, similar to the kind that lines the uterus every month, and elsewhere in your abdomen. This excess tissue responds to your menstrual cycle each month. When the tissue breaks down, it can lead to inflammation, causing pain. Common sites for endometrial growth are the ovaries, on the uterus and behind the uterus. It can also be found on the bladder, rectum and intestines.

Symptoms:

  • Atypical menstrual pain: starting a few days before your period and lasting throughout your period, or which is very severe
  • Chronic pelvic pain, which may also be associated with sex
  • Painful urination during periods
  • Bowel problems (such as diarrhea, constipation and pain)
  • Difficulty conceiving

Get more information from the Society of Obstetricians and Gynecologists of Canada

Irritable Bowel Syndrome  

Irritable bowel syndrome (IBS) is a group of symptoms—which includes both pain or discomfort in ones abdomen as well as changes in ones bowel movement patterns.These  changes in your bowel movement patterns includes how often you have bowel movements or how your stools look. Doctors aren’t sure what causes IBS.

Get more information from NIHInternational Foundation for Functional Gastrointestinal Disorders, and HealthLinkBC

Musculoskeletal / Myofascial Pelvic Pain 

Chronic pelvic pain in women may have a number of factors involved rather than a single cause,  but studies have shown that 22% of chronic pelvic pain conditions have pain associated with musculoskeletal causes. Pelvic musculoskeletal dysfunction however is not routinely evaluated as a cause of pelvic pain by gynecologists. A pelvic musculoskeletal examination is an important component to investigate in chronic pelvic pain patients.

Myofascial pelvic pain is a frequently unrecognized and untreated component of chronic pelvic pain.  Between 14% and 23% of women with chronic pelvic pain may have myofascial pelvic pain. Some studies say this may be as high as 78% among women with interstitial cystitis.  In a recent review, researchers found that very few providers actually perform a vaginal digital palpation of pelvic floor muscles during routine gynecological exams to examine for the presence of myofascial pelvic pain and trigger points.

Get more information from Recognizing Myofascial Pelvic Pain in the Female Patient with Chronic Pelvic Pain, in Journal of Obstetric, Gynecologic, & Neonatal Nursing, and Musculoskeletal Causes of Chronic Pelvic Pain: What a Gynecologist Should Know, in Obstectrics & Gynecology

Evidence-based Overviews    

  
Sponsor Organization
Below the Belt: Approach to Chronic Pelvic Pain [2006]
Canadian Family Physician
Brochure - Interstitial Cystitis [pdf]
Canadian Urological Association
Chronic Pelvic Pain in Men or Bacterial Prostatitis
Canadian Pain Coalition
Dysmenorrhea [pdf]
American College of Obstetricians and Gynecologists
Endometriosis – EndometriosisInfo.ca
Society of Obstetricians and Gynaecologists of Canada]
Endometriosis: An Overview of Cochrane Reviews
Cochrane [summary]
Non-Surgical Interventions for the Management of Chronic Pelvic Pain
Cochrane [summary]
Patient Education Brochure - Chronic Pelvic Pain
International Pelvic Pain Society
Recognizing Myofascial Pelvic Pain in the Female Patient with Chronic Pelvic [pdf]
n/a [journal article, in J Obstet Gynecol Neonatal Nurs.]
Vulvodynia [pdf]
American College of Obstetricians and Gynecologists

Associated Conditions 

People living with chronic physical health conditions experience depression and anxiety at twice the rate of the general population.  View our Depression page and our Anxiety page for more information, and for resources and tools that may help you to keep depression and anxiety at bay in spite of your chronic pain.

Decision Aids and Toolkits 

  
Sponsor Organization
Chronic Pelvic Pain E-Book
Chronic Pelvic Pain Foundation of Australia
Chronic Prostatitis - NIH-Chronic Prostatitis Symptom Index
an NIH-attributed questionnaire, but located on the Interstitial Cystitis Association website
Diagnosing and Treating Interstitial Cystitis
Harvard Medical School
Interstitial Cystitis - Pelvic Pain and Urgency/Frequency Patient Symptom Scale
Interstitial Cystitis Association
Interstitial Cystitis – Bladder Pain Syndrome (IC/BPS) Medical Records File [pdf]
Interstitial Cystitis Network
Interstitial Cystitis - How to Do a Voiding and Pain Diary
Interstitial Cystitis Network
Interstitial Cystitis - Voiding and Pain Indices - O'Leary/Sant Questionnaire
Interstitial Cystitis Association
Pelvic Pain E-Book
Treating Chronic Pelvic Pain: A Review of the Research for Women
Agency for Healthcare Research and Quality (US)

​Videos and Podcasts 

  
Sponsor Organization
CIRPD webinars – Chronic Pain and Mental Health
Canadian Institute for the Relief of Pain and Disability
CIRPD webinars - Self-Management
Canadian Institute for the Relief of Pain and Disability
Video - Central Nervous System Sensitization and Chronic Pelvic Pain – with Dr. Paul Yong, Gynecologist, BC Women’s Centre for Pelvic Pain & Endometriosis, Vancouver
BC Women’s Centre for Pelvic Pain & Endometriosis, Vancouver
Video - Chronic Pelvic Pain: How and Why Does it Happen? – with Dr. Christina Williams, Gynecologist, BC Women’s Centre for Pelvic Pain & Endometriosis, Vancouver
BC Women’s Centre for Pelvic Pain & Endometriosis, Vancouver
Video – Endometriosis, with Dr Krina Zondervan
University of Oxford
Video - Medical and Surgical Treatments for Chronic Pelvic Pain – with Dr. Catherine Allaire, Gynecologist, BC Women’s Centre for Pelvic Pain & Endometriosis, Vancouver
BC Women’s Centre for Pelvic Pain & Endometriosis, Vancouver
Video - Physiotherapy for Chronic Pelvic Pain – with Susannah Britnell, Registered Physiotherapist, BC Women’s Centre for Pelvic Pain & Endometriosis, Vancouver
BC Women’s Centre for Pelvic Pain & Endometriosis, Vancouver

​Pelvic Pain Organizations 

  
International Pelvic Pain Society
Interstitial Cystitis Association (US)
National Vulvodynia Association (US)

​Research Resources   

  
Non-surgical interventions for the management of chronic pelvic pain
Treatment of chronic prostatitis/chronic pelvic pain syndrome
​​Reviewed by Marc White PhD, Scientific & Executive Director, CIRPD (See Review Criteria)

Last Modified: 1/26/2016 4:05 PM

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