Chronic pelvic pain: a practical approach

Chronic pelvic pain is a serious and common disorder that is responsible for significant morbidity, impaired quality of life, and costs to health care providers. A consensus opinion believes chronic pelvic pain should be defined as non-cyclical (non-menstrual) pain of at least six months duration involving the pelvis, anterior abdominal wall, lower back, and/or buttocks, and serious enough to cause disability or to necessitate medical care. Other classifications exist for chronic pelvic pain, which accommodate the multiple and often overlapping predisposing conditions. A systematic approach to medical history taking and physical examination is mandatory to establish appropriate investigation, diagnosis, therapy and referral. Screening for co-existing gastrointestinal, urological, musculoskeletal, gynaecologic and psychological disorders may be aided by a specialist multidisciplinary pelvic pain clinic and use of a standardized pelvic pain questionnaire. This review elaborates on a practical approach to chronic pelvic pain for practitioners working in primary and secondary care, emphasising the importance of individualized assessment and treatment based on the multiple possible aetiologies and biopsychosocial circumstances.