Chronic pelvic pain syndrome (CPPS) describes long-term pain in the pelvic area, which is below the abdomen and between the hip bones. It is more common in females but can also affect males.
CPPS is a pain in the pelvic area that lasts for more than
This pain may be constant or may come and go. People may also experience changes in urination and sexual dysfunction.
CPPS may also have links to mental health issues, such as depression and anxiety.
This article examines the symptoms, causes, diagnosis, and treatment of pelvic pain syndrome.
A note about sex and gender
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.
People with CPPS may experience a dull, aching pain or sharp, burning, or shooting pain. They may also feel a heaviness or pressure within the pelvic area.
The pain may follow a cycle, such as menstruation, or occur during certain activities, such as during sex, urinating, or before or after eating.
Symptoms of CPPS in females may also include:
- a 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
Symptoms of CPPS in males may include:
- pain in the pelvic area, including the genitals
- ejaculatory pain and dysfunction
- lower back and abdominal pain
- an atypical urine stream
- an urgent need to urinate or pain when urinating
- urogynecological system
- gastrointestinal system
- musculoskeletal system
- nervous system
A combination of psychological factors and atypical function of the immune, neurological, and endocrine systems may cause symptoms of CPPS.
Causes and risk factors of CPPS in females
- pelvic trauma or surgery
- C-section delivery
- history of sexual or physical abuse
- pelvic inflammatory disease
- bladder pain syndrome
- painful periods, which may cause severe pain lasting 1–2 days each month
- urinary tract problems, including recurrent urinary tract infections, kidney stones, or bladder cancer
- digestive system disorders, including inflammatory bowel disease, diverticulitis, or cancer
- lower back pain, disk injuries, or pelvic muscle spasms
- obesity or being overweight
- pregnancy or peripartum pelvic pain syndrome
- posture issues
- myofascial pain syndrome, a chronic condition that affects the musculoskeletal system
Other medical conditions that
- irritable bowel syndrome
- interstitial cystitis, a chronic bladder syndrome
- chronic fatigue syndrome
- mental health disorders, such as post-traumatic stress disorder and major depressive disorder
- pelvic adhesions
In some cases, doctors may not be able to find a specific cause for CPPS.
Causes and risk factors of CPPS in males may include:
- certain infections or conditions, such as urethritis or prostatitis, which may lead to chronic inflammation in the pelvic area
- pelvic floor dysfunction, which causes spasms in the pelvic floor muscle
- nerve injury
- central sensitization, an increased pain response to a stimulus that is not usually painful, such as the feel of clothes on skin
To diagnose pelvic pain syndrome, a doctor may carry out a physical exam to inspect the muscles and organs in the pelvic area, which includes the bladder and lower abdominal wall, and in females, the cervix and uterus.
A doctor may also examine the male prostate gland and genitals.
Doctors may also use certain tests to diagnose pelvic pain syndrome, such as:
- a urine test for laboratory examination, including testing for infections
- a pelvic ultrasound
- a cystoscopy with hydrodistension, where doctor will use a thin tube with a camera to examine inside the bladder while filling it with water to find out the cause of pain
- a laparoscopy, where a surgeon makes a small incision in the abdomen to examine the abdominal and reproductive organs
A doctor will examine the pelvic area for any signs of pain or tenderness.
In some cases, CPPS can be due to a psychological pain perception disorder, so there may be few to no physical changes to observe.
Treatment will depend on the underlying cause of pelvic pain, and treating the cause may resolve pelvic pain. If there is no known cause, treatment aims to relieve pain and prevent it from worsening.
Depending on the underlying cause, treatment for CPPS may include:
- lifestyle changes, including regular exercise, weight loss, and appropriate posture
- pain relief medication, such as nonsteroidal anti-inflammatory drugs, antidepressants, or nerve pain medications
- physical therapy, such as relaxation exercises, biofeedback, and nerve stimulation therapy
- alternative medicine, such as acupuncture and acupressure
- nutritional therapy, which may include taking vitamin B1 and magnesium supplements
- antibiotics to treat a bacterial infection or pelvic inflammatory disease
- hormonal birth control, to treat causes such as menstrual cramps and endometriosis
- if other options are ineffective, people may require surgery to remove fibroids, cysts, or nerves to block pain signals
Doctors may be able to treat CPPS if they discover the underlying cause of pain.
If there is no known cause, treatment focuses on relieving pain and preventing it from worsening.
According to a
Physical therapy may also be an effective treatment. After receiving physical therapy, people with CPPS had a 22% reduction in medication use compared with those who did not undergo physical therapy.
Physical therapy may help reduce pain and urinary symptoms such as increased frequency and urgency.
Treating the underlying cause of CPPS may result in an optimal outlook, including improved quality of life and management of any co-existing psychological issues.
Pelvic pain syndrome is long-term, persistent pain in the pelvic area lasting for more than 6 months.
The pain may come and go and cause other symptoms, such as sexual dysfunction, changes in urination, or lower back pain.
CPPS may affect a person’s emotional and mental health and may negatively affect their quality of life.
Treatment may include lifestyle changes, physical therapy, medications, or surgery.
If doctors know the underlying cause of CPPS, they may be able to treat it. If there is no known cause, treatment can help relieve pain and improve quality of life.