Minimally Invasive Therapies for Chronic Pelvic Pain Syndrome

Abstract

Chronic pelvic pain syndrome (CPPS) is a common problem among men and women worldwide. It is a symptoms-complex term for interstitial cystitis/painful bladder syndrome in women and chronic prostatitis/chronic pelvic pain syndrome in men. Patients often present with a combination of lower urinary tract symptoms with pelvic pain and sexual dysfunction. No gold standard exists for diagnosis or treatment of CPPS. The diagnosis is often challenging and is determined by elimination. Multiple treatment modalities exist, ranging from physical therapy to surgery. We discuss minimally invasive therapies for treatment of this complex of symptoms. Although data suggest reasonable efficacy of several medications, multimodal therapy remains the mainstay of treatment. We review the following minimally invasive therapeutic modalities: dietary modifications, physical therapy, mind-body therapies, medical therapy, intravesical therapies, trigger point injections, botulinum toxin injections to the pelvic floor, and neuromodulation. We report data supporting their use and efficacy and highlight the limitations of each.

Gynecological associated disorders and management

“…Lifestyle modifications includes weight loss, appropriate amount of sleep and exercise, management of mood disorders and other medical co‐morbidities . Dietary modification such as low oxalate diet or avoidance of certain acidic foods (coffee, alcohol, tomatoes and spices) can help reduce symptoms associated with vulvodynia and IC/BPS, thus decreasing the pain associated with sexual dysfunction …”

“…[72][73][74][75][76] Dietary modification such as low oxalate diet or avoidance of certain acidic foods (coffee, alcohol, tomatoes and spices) can help reduce symptoms associated with vulvodynia and IC/BPS, thus decreasing the pain associated with sexual dysfunction. 8,44,77,78 Physical therapy and the use of vaginal dilators are two non-pharmacologic treatments that can help improve sexual function. Vaginal dilators allow progressive increase of vaginal length and girth that are designed to reduce vaginal stenosis after pelvic radiotherapy and/or treatment of vaginal and pelvic pain.…”

Neuromodulation of Pelvic Visceral Pain: Review of the Literature and Case Series of Potential Novel Targets for Treatment

“…• Category IV-Asymptomatic inflammatory prostatitis: asymptomatic and is often an incidental finding during evaluation for infertility or prostate cancer. [33][34][35][36] Historically, it was thought that CP/PD was simply the result of inflammation; a hypothesis supported by the fact that symptomatic relief was often obtained with the administration of anti-inflammatory medications. 37 With further investigation, however, the disease process was also found to be associated with hypertrophy of smooth muscle, periurethral edema, and pelvic floor dysfunction resulting from increased tone in local musculature.…”

New Directions in the Treatment of Pelvic Pain

“…It should be noted that work in this arena has been largely experimental. Twice-daily use of quercetin (a red wine/green tea extract) was shown to improve male CPP in double-blind, placebo-controlled trials [48]. In murine models, there is ongoing research to evaluate epigallocatechin-3-gallate, a component of green tea that is thought to be responsible for its antiangiogenic, antioxidant and anti proliferative effects; and reservatrol, found on grape skin, responsible for antioxidant and anti-inflammatory effects of red wine.…”