Chronic pelvic pain syndrome (CPPS)

• Chronic pelvic pain syndrome
• Levator ani syndrome
• Urogential pain disorders

• 338.4 Chronic pain syndrome
• Associated medical diagnoses
  • 564.6 Anal spasm
  • 569.42 Anal or rectal pain
  • 595.1 Chronic interstitial cystitis
  • 601.1 Chronic prostatitis
  • 617 Endometriosis
  • 625.0 Dyspareunia
  • 625.5 Pelvic congestion syndrome
  • 625.7 Vulvodynia
  • 625.71 Vulvar vestibulitis
• Associated Physical Therapy Diagnoses
  • 719.45 Pain in joint, pelvic region and thigh
  • 724.7 Disorders of coccyx
  • 728.2 Muscular wasting and disuse atrophy, not elsewhere classified
  • 728.85 Spasm of muscle
  • 728.89 Other disorders of muscle, ligament, and fascia
  • 729.1 Myalgia and myositis, unspecified
  • 729.2 Neuralgia, neuritis, and radiculitis, unspecified
  • 729.9 Other and unspecified disorders of soft tissue
  • 780.7 Malaise and fatigue
  • 782.3 Edema

• G89.4 Chronic pain syndrome
• N30.10 Interstitial cystitis (chronic) without hematuria
• N30.11 Interstitial cystitis (chronic) with hematuria
• N41.1 Chronic prostatitis
• N80 Endometriosis
• R10.2 Pelvic and perineal pain
• Symptom specific diagnoses
  • K59.4 Anal spasm
  • N53.12 Painful ejaculation
  • N94.1 Dyspareunia
  • N94.81 Vulvodynia
  • N94.810 Vulvar vestibulitis
  • N94.818 Other vulvodynia
  • N94.819 Vulvodynia unspecified
  • N94.89 Other condition associated with female genital organs and menstrual cycle

• As of March 2013, the APTA’s Guide to Physical Therapist Practice does not include practice patterns for organ system pathology
• Associated or secondary musculoskeletal patterns include
  • 4C Impaired muscle performance1
  • 4D: Impaired joint mobility, motor function, muscle performance, and range of motion associated with connective tissue dysfunction1

Description2

• Defined by a process of exclusion
• Non-specific, poorly localized pelvic pain or regional pelvic pain syndrome without obvious pathology
• No evidence of infection or inflammation
• Chronic urogential pain syndromes often associated with end organ pain conditions (such as bladder, vulva) and psychological conditions (such as emotional, sexual, behavioral)
• Genitourinary pain syndromes are all chronic in their nature
• Pain is the major complaint but concomitant complaints include lower urinary tract, bowels, or are sometimes sexual or gynecological in nature3

Essentials of Diagnosis

• Unknown etiology
• Rule out end organ pathology
• Symptoms may be initiated by an acute infection, injury, or inflammation of a pelvic or urogential organ, however pain persists beyond the duration of the original inciting event or disease

General Considerations

• Chronic pain condition
• Often misdiagnosed
• PT intervention is often appropriate for associated musculoskeletal impairments
• Diagnosis is a process of exclusion and often takes time, requiring intensive diagnostic testing
• Urogenital pain disorders frequently affect nearby body areas; especially back, pelvic, hip, and groin regions and so may be inappropriately referred to PT
• May mimic other visceral pain conditions including colon cancer or tumors, irritable bowels, colitis
• May mimic gynecologic problems in females: endometriosis, uterine fibroids, ectopic pregnancy

Demographics

• More prevalent in females
• Exact prevalence of chronic pelvic pain is not known, estimates vary in the literature from 3.8% to 24%4
• Of the estimated 10 million women with chronic pelvic pain, less than 70% will receive proper diagnosis and ...