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Address:#09-09 Gleneagles
Medical Centre 6 Napier Rd.
Singapore 258499
Phone:+65 6476 0181 
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Chronic Pelvic Pain

What is Chronic Pelvic Pain?
Chronic pelvic pain (CPP) is any pelvic pain that exists for a prolonged period of time, usually more than 6 months. Many times, the problem that originally caused the pain has resolved, but the pain continues. Sometimes, the patient can tell that the characteristics of the pain has changed over time. New "pain generators" develop in the pelvic support tissue, such as muscles and connective tissue. Nerves transmitting the sensations from the painful areas often become hypersensitive. The chronic pain itself has now become the disease.
In women, CPP may be in the lower abdomen, the vulva/vagina, the perineum, the anus, or the tailbone. Males can have pain in the lower abdomen, perineum, penis, testes and anus, or tailbone. In many patients, low back pain is also a common feature. Bladder, bowel, sexual pains, and changes in function of these organs are common.
If a patient has pain over a prolonged period of time, it can be physically and emotionally draining. Many patients alter their lifestyles as well as emotional/ behavioural response to try to cope. This increases anxiety which can also worsen the pain, leading to a vicious cycle of suffering. This state is sometimes referred to as "Chronic Pelvic Pain Syndrome".
When should you see a doctor to evaluate for chronic pelvic pain?
Sufferers of CPP will often have experienced the following:
  1. Pain present for six months or more in the pelvis.
  2. The pain is similar or stronger than would be expected from the injury/surgery/condition which initially caused the pain.
  3. Pain is not relieved by conventional medication or physiotherapy.
  4. Difficulty sleeping, poor appetite, persistent lethargy, symptoms of depression and/or anxiety.
  5. Limitations in physical activity and exercise. Some patients have difficulty sitting or standing for more than 30 minutes.
  6. Pain is associated with abnormal bladder or bowel pattern. Some have frequent bladder or bowel movement while others have delayed bladder or bowel movement.
  7. Difficulty or pain with sexual intercourse (both male and female).
If you have any of the above symptoms, you should seek medical advice. Female patients with CPP should seek a consultation with a urogynaecologist or female urologist first if they have symptoms related to the bladder or vagina. Male patients with urinary symptoms as well as CPP should seek a consultation with a urologist. When bowel symptoms are present or if a gynaecologist/ urologist is unable to identify the problem, you should see a colorectal surgeon who specializes in functional bowel disorders.
How is CPP evaluated?
A detailed history of your diet, daily schedule, lifestyle (including exercise habits) and medications is required. Your past medical and surgical history is crucial too as there may be an underlying disease to your pain. A targeted pelvic examination will be performed to attempt to elicit the pain as you may have a "trigger point" (pain originator site). Often, your doctor will need to perform non-invasive tests of your bladder or bowel function as well. If inflammation or a growth is suspected in any of the pelvic organs, your doctor may want to perform endoscopy to assess the affected organ. Radiologic tests such as ultrasound, CT scan or MRI of the pelvis is frequently needed to visualize the pelvic organs, muscles and connective tissue.
Is my CPP treatable?
Chronic pelvic pain is treatable but for most patients, the journey of recovery can take several weeks to months. There are patients who do not recover completely several years later. Treatment is usually a combination of medication, physical therapy (physiotherapy and/or trigger point massage), counseling and lifestyle modifications. Patients with significant anxiety may benefit from psychological assessment. In some cases, there may be a pathology causing persistent inflammation in the pelvis such as adhesions or endometriosis. In such cases, surgery may be needed. Occasionally, if the pain appears to be arising from nerves instead of muscles/ connective tissue, a pain specialist can help to modify the nerve sensation or numb the nerve ending. During the assessment of chronic pelvic pain, your doctor will need to exclude other conditions that may mimic CPP. If your diagnosis is not CPP, your doctor will advise and treat you accordingly.
What is trigger point massage?
When underlying causes of CPP have been excluded, the trigger point of the pelvic pain is usually in one of the pelvic muscles or connective tissue. This is also referred to as "myofascial pain". Massage of the trigger point can relieve the pain, similar to massage for sore muscles of your back. Triger point massage in the pelvis (TPM) can be difficult to do as the trigger point may only be reachable through the vagina or rectum. TPM is not a stand-alone treatment and is combined with other forms of physiotherapy and medication. TPM is not considered a “standard” conventional treatment currently as there is little data in medical literature to support its result. Anecdotally, many patients improve after TPM, especially when combined with other treatments, but it can take several months before the patient is cured.
If you have feedback or would like to know more about treatment for these conditions, feel free to contact us or make an appointment.