The ‘evil twin syndrome’ in chronic pelvic pain: A systematic review of prevalence studies of bladder pain syndrome and endometriosis

Abstract

Almost two thirds of women presenting with CPP have BPS. Large variations in prevalence may be due to variable study selection and quality. Clinicians need to actively investigate patients for BPS, a condition that appears to co-exist with endometriosis.

Bladder pain syndrome: validation of simple tests for diagnosis in women with chronic pelvic pain: BRaVADO study protocol

“…Estimates of prevalence of BPS vary. A recent systematic review suggested the prevalence of BPS in women with CPP is as high as 61% [3,4]. Since the exact prevalence in unknown, a range of sample sizes have been calculated based on various levels of prevalence (Table 1).…”

Endometriosis

“…1 A systematic review has shown that associated bladder pain syndrome/interstitial cystitis affects around two thirds of women with endometriosis and chronic pelvic pain. 9 Deep infiltrating nodules can have more specific pain symptoms, such as deep dyspareunia, because of their location but there does not seem to be any clear association between the severity of pain reported and the extent or type of disease present. The mechanisms by which endometriosis causes pain are poorly understood but potentially include hormonal stimulation of the deposits, stimulation of neural pathways, inflammation, local bleeding, or a combination of these.…”

Management of Bladder Pain Syndrome

“…40,44 However, opioids should be used with caution as there is little evidence they are useful for long-term chronic pain. Early referral to a pain clinic should be considered for patients with refractory symptoms.…”