Chronic Pelvic Pain (CPP)

Chronic pelvic pain (CPP) is pain in the pelvis that lasts six months or longer. The pain may be constant or recurrent. It is not linked to menstruation alone. It interferes with daily life or requires medical care.

Chronic pelvic pain is a symptom, and it requires a diagnosis.

Many conditions can cause CPP, including endometriosis, adenomyosis, and pelvic adhesions (bands of scar tissue). Bladder pain syndrome (interstitial cystitis), irritable bowel syndrome, and pelvic floor dysfunction can also cause it. More than one cause is often present at the same time.^[208]

The true source is often missed when care stops at pain relief. Endometriosis is a common finding when surgeons examine the pelvis by laparoscopy for CPP. Yet many women go years without a diagnosis.

Subtle lesions and deep lesions can escape detection at standard laparoscopy. Near-contact laparoscopy finds lesions that the standard view misses.

Identifying the cause changes the treatment. Excision of endometriosis treats the root cause. So does lysis of adhesions, the surgical release of scar tissue. So does surgical repair of a structural problem.

These steps treat the source rather than only dulling the pain. Muscle and joint problems often add to the pain alongside other disease. In that case, pelvic floor physical therapy is part of the evaluation.

Diagnostic laparoscopy remains the standard method to confirm causes inside the abdomen.