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Chronic Pelvic Pain Syndromes

 

Also see Gynae guidelines

These may be bladder/urethral/prostatic (“prostatitis”)/scrotal/testicular/post vasectomy/penile/Vaginal/vulval/urethral/anorectal. Usually no sinister underlying cause or pathology.

 

Definition/description:

 Non malignant pain perceived in structures related to the pelvis of either men or women. There are often associated negative cognitive, behavioural, sexual or emotional consequences.

Pain is usually associated with symptoms suggesting lower urinary tract, sexual, bowel or gynaecological dysfunction in the absence of proven infection or other obvious pathology

 

Management prior to referral:

 Rule out pathology with simple investigations. Do not assume you will find pathology.

 Assessment:

  • History and examination to assess nature/duration of pain, localise end organ, look for associated symptoms/psychological issues and look for pathology
  • May be associated with IUCDs, consider trial of removal
  • Urine dipstick/MSU
  • Urine cytology
  • USS
  • Cystoscopy if haematuria
  • Frequency volume chart/Flow rates if associated lower urinary tract symptoms

 

Conservative measures:

  • Diet: avoid spicy/acidic foods, caffeine, alcohol, chocolate
  • Psychological/behavioural treatment

 

Medical treatment:

  • Antibiotics: if suspect underlying infection. Always send MSU/STI screen prior to treatment. If improved after 2 weeks continue for 6 weeks. If no improvement discontinue
  • Analgesics: particularly NSAIDS
  • Alpha blockers: not licensed but can be helpful in up to 60% of both men and women. Take for at least 6 weeks
  • 5-alpha reductase inhibitors in men. Take for at least 3 months.
  • Anticholinergics if frequency/urgency
  • Neuropathic pain modulators eg amitryptilline, gabapentin etc

 

Indications for referral:

Diagnosis of pathology: refer to appropriate specialty

Unsuccessful pain management: refer pain team

 

 

Contributors

 

Mr Christopher Blake, Consultant Urologist, RCHT

Dr Stephanie Jackson, GP Lead Urology

 

Reviewed: July 2018