What is chronic pelvic pain syndrome (CPPS)?
Chronic Pelvic Pain Syndrome (CPPS) is a complex and often debilitating condition that affects up to 15–20% of women. It is defined as persistent pain in the pelvic area lasting three months or more. This pain can range from mild to severe and may worsen with sexual intercourse, urination, bowel movement, or prolonged sitting. For many women, CPPS significantly impacts quality of life, sexual function, and emotional well-being.
At Tower Urology, we offer a comprehensive, multidisciplinary approach to managing chronic pelvic pain. Our expert team uses advanced diagnostics, personalized treatment strategies, and a strong focus on patient education to uncover the causes of chronic pelvic pain and provide long-term pain relief.
What causes chronic pelvic pain in females?
The etiology, or cause, of CPPS is complex and can involve multiple overlapping conditions. Identifying the exact causes of chronic pelvic pain usually requires a thorough evaluation. These causes include:
Gynecological conditions
Gynecological conditions are often among the most common causes. Endometriosis, adenomyosis, uterine fibroids, ovarian cysts, and pelvic inflammatory disease (PID) can all cause chronic pain in the pelvic organs, including the uterus, fallopian tubes, ovaries, and surrounding structures. Infections such as chlamydia and gonorrhea may also lead to PID, resulting in lasting inflammation and discomfort.
Urological disorders
Conditions like painful bladder syndrome (also called bladder pain syndrome) and recurrent urinary tract infections (UTIs) may cause urinary urgency, frequency, and chronic pelvic pain. Interstitial cystitis, a type of painful bladder syndrome, is particularly associated with CPPS and can cause significant discomfort.
Gastrointestinal issues
GI conditions such as irritable bowel syndrome (IBS), colitis, diverticulitis, or chronic constipation can lead to lower abdominal pain and pressure that radiates to the pelvis. In some cases, straining with a bowel movement may aggravate symptoms and cause a pelvic pain flare.
Musculoskeletal issues
Musculoskeletal dysfunction is yet another common contributor. Tight or weakened pelvic floor muscles, myofascial trigger points, or structural issues like a hernia may cause pain in the lower back, hips, and genital region. Women who have had pelvic surgery or given birth to a child are at higher risk for myofascial or nerve-related pain in the pelvic muscles.
Mental health concerns
Mental health issues like anxiety, depression, and trauma can intensify pain perception.
The many possible causes of women’s chronic pelvic pain syndrome highlight the importance of receiving a comprehensive evaluation by a provider who can develop a well-rounded treatment plan.
What are the symptoms of chronic pelvic pain in women?
Women with CPPS often report a variety of symptoms, such as:
- Persistent or intermittent pain in the lower abdomen, pelvic area, or lower back
- Pain with intercourse
- Discomfort during urination and bowel movements
- Pain that is sharp, dull, or cramp-like and occurs in cycles or continuously
- Fatigue
- Trouble sleeping
- Mood changes
- Pain that worsens with physical activity
Inflammatory or hormonal conditions may cause menstrual cramps, while structural issues may lead to pressure in the pelvic organs, including the bladder and ovaries, resulting in different types of CPPS pain, depending on the cause.
How is female chronic pelvic pain diagnosed?
At Tower Urology, diagnosis begins with a thorough consultation and physical examination. We evaluate the pelvic floor muscles, bladder, uterus, ovaries, and surrounding areas. This assessment helps detect tenderness, tension, or abnormalities contributing to pain.
We also take a complete medical history, covering menstrual cycle patterns, past infections (such as chlamydia), surgeries, urinary and digestive issues, and sexual health. Imaging studies, such as ultrasound, MRI, or laparoscopy, can help identify fibroids, adhesions, or other growths within the pelvic organs.
Urine analysis and cultures rule out painful bladder syndrome or urinary tract infections (UTIs). For some patients, laparoscopy may be needed to examine the reproductive organs directly and identify hidden causes of chronic pelvic pain, like endometriosis.
When appropriate, we may also explore mental health contributors to chronic pain. This is a key part of our whole-person approach.
What are the treatment options for female chronic pelvic pain?
Managing CPPS requires a tailored plan targeting the primary causes and the symptoms.
Medications often include nonsteroidal anti-inflammatory drugs for short-term relief, hormonal treatments for gynecological causes, and possibly neuromodulators such as antidepressants or anticonvulsants for nerve-related pain. If an infection is detected, antibiotics may be prescribed.
Pelvic floor physical therapy can also be important in treating myofascial and muscular causes of pelvic pain. Therapists use manual, guided, and relaxation techniques to address tight or overactive pelvic muscles. For patients experiencing stress-related symptoms, we may also recommend behavioral therapy, mindfulness, or biofeedback.
More advanced therapies include nerve stimulation (e.g., sacral or pudendal), trigger point injections, or procedures for painful bladder syndrome. Minimally invasive surgery may be necessary in cases of endometriosis, adhesions, or hernia.
Tower Urology’s innovative therapies: PRP and Shockwave Therapy
At Tower Urology, we’re proud to offer two of the most advanced noninvasive chronic pelvic pain treatments: platelet-rich plasma (PRP) therapy and shockwave therapy.
PRP therapy uses your blood platelets, which are injected into the pelvic area to stimulate healing. This regenerative technique helps restore damaged tissue and reduce inflammation, making it ideal for myofascial or muscular pain patients.
Shockwave therapy delivers high-energy sound waves to the skin over the painful region, increasing blood flow and accelerating tissue repair. It is especially helpful for women with chronic pelvic floor muscle dysfunction or painful bladder syndrome who have not responded to conventional treatment.
Why do women choose Tower Urology of Los Angeles to treat their chronic pelvic pain?
Tower Urology’s expert healthcare team provides compassionate, cutting-edge care informed by the latest NIH-backed research and clinical trials. We treat each woman individually, combining diagnostics, medication, physical therapy, surgical options, and patient education for optimal outcomes.
We serve patients from across the Los Angeles area—including Beverly Hills, Santa Monica, West Hollywood, and more—and are proud to offer comprehensive care to those living with chronic pelvic pain.
Chronic Pelvic Pain FAQs
You should reach out to a healthcare provider if you experience any of the following:
- Pelvic pain that lasts longer than six months
- Pain that interferes with daily life, work, or relationships
- Pain that worsens over time or doesn’t improve with rest or over-the-counter treatments
- Pain during or after sexual activity
- Painful urination, bowel movements, or discomfort in the rectum
- Signs of infection such as fever, chills, vaginal discharge, or burning sensation
You should seek immediate medical attention if you experience:
- Sharp or sudden pain in the pelvic or abdominal area
- Vaginal bleeding between periods or after menopause
- Unexplained weight loss
- Blood in your urine or stool
- Difficulty standing or walking due to severe pain
- A missed period and a risk of ectopic pregnancy (consider taking a pregnancy test)
Yes, some underlying conditions that cause chronic pelvic pain, such as endometriosis, pelvic inflammatory disease, or blocked fallopian tubes, may contribute to infertility. Early diagnosis and treatment are essential to protect reproductive health.
While medical intervention is essential for chronic pelvic pain management, lifestyle modifications can enhance outcomes and improve quality of life:
- Regular physical activity can improve circulation and reduce tension in the pelvic muscles
- A low-inflammatory diet may help minimize symptoms associated with gastrointestinal issues like IBS, colitis, or bloating
- Practicing stress management techniques such as meditation or yoga
- Working with a pelvic floor physical therapist to address muscular and myofascial sources of pain
- Using heat therapy to relieve menstrual cramps or ligament pain
Depending on the primary cause, various specialists may be involved for the management of chronic pelvic pain. These include urologists, gynecologists, gastroenterologists, pelvic floor therapists, and pain specialists. At Tower Urology, we take a multidisciplinary approach, collaborating across specialties to offer the most effective and personalized care.
Sources
Evaluation of Acute Pelvic Pain in Women
http://www.aafp.org/afp/2010/0715/p141.html
Abdominal Adhesions
https://www.niddk.nih.gov/health-information/digestive-diseases/abdominal-adhesions
Association between past urinary tract infections and current symptoms suggestive of chronic prostatitis/chronic pelvic pain syndrome
https://pmc.ncbi.nlm.nih.gov/articles/PMC2576075/
