Urogenital Pain Including Pelvic Pain

Abstract

Chronic pelvic pain (CPP) is defined as noncyclical pain below the umbilicus for at least 6 months' duration involving the pelvis, anterior abdominal wall, lower back, and/or buttocks severe enough to cause functional disability or require treatment. It has been reported to affect up to 15% of women with an estimated annual cost of $2.8 billion [1]. Proper diagnosis and treatment are elusive: While 70% of women with CPP will receive proper diagnosis and treatment plans, 61% of patients will remain undiagnosed [2,3]. Many of these patients subsequently develop chronic pain with depression, pain out of proportion to pathology that adversely affects roles in marriage, family, and career [1,2]. Early and appropriate diagnosis and intervention is important. CPP is multifactorial with several possible sources of pain originating within the gastrointestinal, urinary, reproductive, musculoskeletal, or neurological structures [4]. One study found the distribution of sources of pain to include gastrointestinal disorders (37%), followed by urological (31%), gynecological disorders (20%), and myofascial disorders (12%) [5]. Additionally, there often exists more than one etiology of pain-a thorough evaluation for additional sources of pain is necessary when assessing patients. In at least one-half of cases, there are one or more associated entities, such as irritable bowel syndrome, interstitial cystitis/painful bladder syndrome, endometriosis, or pelvic adhesions [1,[6][7][8]. The presence of concomitant