Chronic pelvic pain syndrome

Chronic pelvic pain syndrome (CPPS) is a condition involving ongoing pain in the pelvic area. Pain in patients suffering from CPPS can range from mild to debilitating, can be dull or sharp, while being constant or intermittent. CPPS-related pain can spread to the gluteal region, lower back and hips.

The cause is unknown. However, several theories of causation exist:

  • Pelvic floor dysfunction
  • Enlarged spleen
  • Inflammation of the bowel
  • Kidney stones
  • Painful bladder syndrome
  • Constipation
  • Endocrine hormonal abnormalities
  • Neurogenic inflammation
  • Bacterial infection
  • Interstitial cystitis
  • Endometriosis in women

There are many symptoms associated with CPPS including:

  • Pelvic floor/perineal pain with no evidence of urinary tract infection lasting more than 3 months is the key symptom of CPPS.
  • Abdominal pain
  • Frequent urination
  • Genital pain
  • Low back pain
  • Pain during or after sex
  • Pain after ejaculation
  • Pain when sitting
  • Erectile difficulties
  • Sexual dysfunction
  • Unexplained fatigue

Physiotherapy aims to reduce symptoms, improve function and therefore improve quality of life. Chronic pain is often best treated through a multidisciplinary approach.

Treatments that would be applied could be:

  • Pelvic floor muscle manual therapy
  • Myofascial release of painful pelvic floor trigger points
  • Pelvic floor muscle exercises 
  • Specific stretches (pelvic floor muscles, adductors or iliopsoas for example)
  • Postural correction.
  • Breathing and relaxation techniques
  • Home programme
  • Modalities such as electrical stimulation, ultrasound, magnetic stimulation, etc.