Chronic pelvic pain (CPP)

What is CPP?

It is pain in the pelvis or lower abdomen that lasts for more than 6 months.

Sometime the cause of the pain is known. Other times it can be hard to find the cause. It may have started with an injury, but the pain did not get better when the injury is better.

You may notice one or more symptoms:

Physical symptoms

  • Pain
  • Trouble sleeping
  • Loss of appetite

Psychological symptoms

  • Depression
  • Changes in behavior
  • Change in relationships due to:
    • Physical problems
    • Psychological problems

What causes CPP?

Causes may be:

  • Gastrointestinal (GI tract)
  • Urinary or bladder
  • Gynecological
  • Myofascial pain (Pain in muscles or fascia. This is a type of connective tissue that surrounds muscles.)
  • Neuropathic (nerve) pain

Learn more by reading the Chronic Pelvic Pain handbook from the International Pelvic Pain Society.

Your provider will take your history and talk with you about the best treatment.

What is chronic pelvic pain syndrome?

Pain that lasts longer than 6 months, causing people to change their activity because of the pain. The pain may be physically and mentally exhausting.

You may notice:

  • You have had pain for 6 or more months.
  • Normal treatments have not helped or have given only a little relief.
  • The pain is stronger than you would expect from what first caused the pain.
  • You may start to do less and less physical activity.
  • Changes in how you relate to your role in relationships.

Will I be given pain medicine?

Pain medicine can only be used for a short time. It will not treat the cause. The therapies your provider suggests will help long term.

Nonsteroidal anti-inflammatory drugs (NSAIDs) and antidepressants are the best choice for treatment of chronic pain.

First choice for both acute and chronic pain:

  • Acetaminophen (Tylenol®)
  • NSAIDs (ibuprofen, Naprosyn®, Toradol®, Anaprox®, Relafen®)

Second choice:

  • Tramadol

Tranquilizers do not work well. They are not made to lessen pain. Over time they can cause sleep problems and depression.

Opioids should not be used long term to treat pain due to side effects, such as:

  • Dependence (they can make your pain worse)
  • Tolerance
  • Immune suppression
  • Osteoporosis
  • Sexual dysfunction
  • Opioid hyperalgesia
  • Constipation
  • Dizziness
  • Nausea

Opioids stop your body from making your own painkillers, called endorphins.

You make endorphins: 

  • More with sleep and exercise
  • Less with lack of sleep and opioid use

Therapies that help CPP are:

  • Home exercise
  • Physical therapy
    • Aqua therapy is good for general conditioning and strengthening.
    • In the chronic phase there is no need for formal physical therapy.
  • Pain psychologists can help with:
    • Cognitive behavioral therapy
    • Coping mechanisms
    • Relaxation techniques
    • Biofeedback
    • Mindfulness
    • Meditation
  • Other medicines:
    • Neuropathic pain medicine
    • Antidepressants
    • Anticonvulsants (seizure medicine)
      • Gabapentin
      • Pregabalin (Lyrica®)
    • Lidocaine patches
    • Muscle relaxants (in some cases):
      • Vaginal
      • Systemic

Your symptoms should slowly get better with treatment. 

Last reviewed: 
May 2020
Alternative Names: 
Chronic pelvic pain

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