Introduction

Pelvic pain is a symptom that can affect both women and men.  Pelvic pain that persists for a period of 3 months or more can be considered chronic, while less than this duration is considered acute. The pain may indicate the existence of poorly-understood conditions that likely represent abnormal psychoneuromuscular function.

Differentiating between acute and chronic pain is important in understanding chronic pelvic pain syndromes.   Acute pain is most common, often experienced by patients after surgery or other soft tissue traumas. It tends to be immediate, severe and short lived however, pain that extends beyond a normal recovery period and lasts longer than 3–6 months constitutes chronic pelvic pain.

Pelvic pain is due to continually holding tension sub-consciously in the pelvic floor as a learned response to stress and tension.   Since the muscle surrounds sensitive nerves and blood vessels, these structures are constantly irritated by this ongoing tension.

Very often scar tissue, that resulted from pelvic surgery, causes crushing pressures that lead to excessive pelvic muscle tension, along with uncoordinated motor patterns and can cause difficulties with normal bowel, bladder and sexual functioning.

Female Pelvic Pain

Most women, at some time in their lives, experience pelvic pain. As girls enter puberty, pelvic or abdominal pain becomes a frequent complaint. Chronic pelvic pain (CPP) accounts for visits to gynecologists.

Causes of Female Pelvic Pain

Many different conditions can cause pelvic pain including:

  • exaggerated bladder, bowel, or uterine pain sensitivity (also known as visceral pain)
  • pelvic girdle pain

Gynecologic

  • Endometriosis: pain caused by uterine tissue that is outside the uterus
  • Dysmenorrhea: pain during the menstrual period
  • Pelvic inflammatory disease: pain caused by damage from infections
  • Ovarian cysts—the ovary produces a large, painful cyst, which may rupture
  • Ovarian torsion—the ovary is twisted in a way that interferes with its blood supply
  • Ectopic pregnancy—a pregnancy implanted outside the uterus

Abdominal

  • Proctitis – infection or inflammation of the anus or rectum
  • Colitis – infection or inflammation of the colonAppendicitis – infection or inflammation of the bowel

Male Pelvic Pain

Chronic pelvic pain in men is referred to as Chronic Nonbacterial Prostatitis and is a condition that causes long-term pain and urinary symptoms. It involves the prostate gland or other parts of a man’s lower urinary tract or genital area. This condition is not caused by an infection with bacteria. Men in this category have no known infection, but do have extensive pelvic pain lasting more than 3 months. There are no standard diagnostic tests; diagnosis is by exclusion of other disease entities. Multimodal therapy is the most successful treatment option.

Causes, Incidence, and Risk Factors

Possible causes of nonbacterial prostatitis include:

  • A past bacterial prostatitis infection
  • Bacteria that are not typical (atypical), such as mycoplasma or ureaplasma
  • Irritation caused by a backup of urine flowing into the prostate
  • Irritation from chemicals
  • Nerve problem involving the lower urinary tract
  • Parasites (trichomonads)
  • Pelvic floor muscle problem
  • Sexual abuse
  • Viruses
  • Life stresses and some psychological factors

Symptoms

  • Blood in the semen
  • Blood in the urine
  • Pain that is located:
    • Above the pubic bone (suprapubic)
    • Between the genitals and anus (perineal)
    • Low back
    • Scrotum
    • Tip of penis
    • Urethra
  • Pain with bowel movements
  • Pain with ejaculation
  • Problems with urinating
    • Decreased urinary stream
    • Pain or burning with urination
    • Frequent urination
    • Incomplete emptying of your bladder
    • Weak urine stream