Chronic Pelvic Pain

Chronic pelvic pain (CPP) is ongoing pain in the lower abdomen or pelvis. It is not caused solely by menstruation or sexual intercourse, although either can aggravate the condition. CPP is not related to pregnancy. CPP is common, affecting about one in six women. It tends to occur most often in women of child bearing age. CPP is not a disease or diagnosis, but rather a symptom. The cause can be difficult to diagnose. Sometimes no cause can be found.  It often consists of several disorders that occur at the same time. One difficulty is that no two women with CPP have the same experience of pain.


Possible Causes of Chronic Pelvic Pain:

Disorders of the female pelvic organs

  • Endometriosis: the growth of endometrium (tissue that normally lines the uterus) in the pelvis, outside the pelvis.
  • Pelvic inflammatory disease (PID): an infection of the fallopian tubes or ovaries.
  • Adhesions: bands of scar tissue that may form after injury, infection or surgery.
  • Retained ovarian syndrome: ovary that remains after surgery to remove the uterus.
  • Ovarian cysts
  • Cysts due to endometriosis may cause pain because they are often linked to scar-tissue adhesions and endometriosis.

Disorders of the urinary tract

  • Interstitial cysts: inflammation of the bladder lining that can cause scarring and ulceration of the bladder.
  • Bladder neoplasm: abnormal growth in the bladder that may be benign or malignant.
  • Urethral syndrome: inflammation of the urinary tract that causes symptoms similar to urinary tract infection.

Disorders of the gastrointestinal system

  • Irritable bowel syndrome
  • Chronic constipation
  • Inflammatory bowel disease
  • Diverticular disease
  • Celiac disease

Other known causes of CPP

  • Nerve entrapment:  “pinched” nerve. A surgical incision across the lower abdomen (example, caesarean section) may result in nerve entrapment after healing.


Diagnostic Tests

Medical tests to diagnose CPP may take a long time. Despite every effort, a precise cause cannot always be found.
Tests to help diagnose CPP include:

  • Physical examination
  • Pelvic examination- the doctor may perform genital, vaginal and rectal examinations
  • Abdominal or vaginal ultrasound
  • Urine test to check for infection or blood
  • Blood test to check hormone levels and screen for signs of infection or inflammation
  • Tests to check for sexually transmitted disease or pelvic inflammatory disease
  • Stool test to check for the presence of hidden blood in the stool which can suggest a range of gastrointestinal disorders
  • X-ray examinations
  • CT or MRI scans
  • Laparoscopy- a thin telescope (laparoscope) is inserted through a small incision to allow the doctor to see the patient’s abdominal and pelvic organs. A laparoscopy can help diagnose conditions such as endometriosis, chronic pelvic infection and adhesions.
  • Hysteroscopy- a thin telescope (hysteroscope) is inserted through the cervix to allow the doctor to see the inside of the uterus.
  • Other tests, depending on your symptoms and medical history, include nerve function tests, a bone scan or cystoscopy (insertion of a slender tube into the urethra to allow the doctor to see the inside of the bladder). Your doctor may refer you to other specialists, such as a urologist (bladder), gastroenterologist (bowel), or physiotherapist (muscles).