What is CPPS?

Chronic pelvic pain syndrome (CP/CPPS), is long-term pelvic pain and lower urinary tract symptoms without medical evidence of a bacterial infection.

It can be related or unrelated to menstrual cycle, pregnancy, local trauma, or pelvic operations.

It is one of the most common diseases in gynecology.  Between 3% and 10% of women are affected by chronic pelvic pain and it is found in women of any age, with a typical peak onset in the early 30s.

Unfortunately, CPPS is still a poorly-understood disorder.

CPPS Symptoms

Women often experience pain in and around the vagina, groin, perineum, anus, lower abdomen, or lower back. This pain is often accompanied by urinary frequency, burning or painful urination, and/or pain after ejaculation. Some patients report low libido and increased pain when sitting. 

In addition to physical complaints, CPPS often results in psychological problems and anxiety that are triggered by hopelessness and a feeling of desperation when therapies don’t have the desired effect or no medical cause for the discomfort can be found.

Course & Diagnosis of CPPS

Since often no medical cause such as a bacterial infection can be found, the doctor often works according to the elimination procedure.

With chronic pelvic pain syndrome, when doctors conclude that bacteria are not the cause, they can assess whether previous medical conditions or the patient's medical history has impacted the symptoms. Nevertheless, no definitive diagnostic tests are available for chronic pelvic pain syndrome (CPPS).

The duration of chronic pelvic pain syndrome can vary from person to person and the symptoms can wax and wane. Women affected by chronic pelvic pain syndrome often go through a long period of suffering. In 60% of cases, the symptoms disappear at some point by themselves for unknown reasons. However, for 40% of sufferers, a chronic pelvic pain syndrome (CPPS) diagnosis can last for several years.

Causes & Difficulties of CPPS

Chronic pelvic pain syndrome (CPPS) is a psychological, neurological, and muscular disorder.  Nowadays, the widespread theory proposes that anxiety or stress results in chronic, unconscious contraction of the pelvic floor muscles, leading to the formation of trigger points and pain. The pain results in further anxiety and thus worsening of the condition.

The cause of this chronic muscle tension is difficult to pinpoint, but it may be related to posture, muscle damage, or previous infections too. 

The main difficulty is that the treatment has to be administered in an interdisciplinary manner by different specialists at the same time, and single physicians often lack the time or capabilities for such a holistic approach.

CPPS Treatment

In recent years, the prognosis has improved greatly, with promising chances of healing using a multimodal treatment.

Today, science supports a combination of physical therapy for pelvic floor such as stretches and techniques to release overtensed muscles in the pelvic, bladder, or anal area (trigger points); psychological therapy such as paradoxical and progressive relaxation techniques to reduce causative stress; and neuropathic irritation, which can help to cure or reduce causes and symptoms.

Therefore, the main difficulty lies in the patient's persistence and the will to change something, because often an interdisciplinary therapy is needed which requires the active participation of the patient over a longer period of time.

But if the patient is willing, the chances of a cure are very promising.