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.
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.
- 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
- Cystoscopy if haematuria
- Frequency volume chart/Flow rates if associated lower urinary tract symptoms
- Diet: avoid spicy/acidic foods, caffeine, alcohol, chocolate
- Complementary medicine
- Psychological/behavioural 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