Understanding Multisymptom Presentations in Chronic Pelvic Pain: The Inter-relationships Between the Viscera and Myofascial Pelvic Floor Dysfunction

Invited Commentary


Patients presenting with chronic pelvic pain frequently complain of multiple symptoms that appear to involve more than one organ system, creating diagnostic confusion. The multisymptom presentation of chronic pelvic pain has been frequently described. This article describes four proposed explanations for the clinical observation of multisymptom presentations of patients with chronic pelvic pain. These include the concepts of viscerovisceral convergence; viscerosomatic convergence; hypertonicity of pelvic floor muscles creating visceral symptoms along with somatovisceral convergence; and central sensitization with expansion of receptive fields.


Viscerovisceral convergence Viscerosomatic convergence Somatovisceral convergence Central sensitization Pelvic floor muscle dysfunction Myofascial pain 


  1. 1.
    Peters K et al. Characterization of a clinical cohort of 87 women with interstitial cystitis/painful bladder syndrome. Urology. 2008;71(4):634–40.PubMedCrossRefGoogle Scholar
  2. 2.
    Berkley KJ. A life of pelvic pain. Physiol Behav. 2005;86(3):272–80.PubMedCrossRefGoogle Scholar
  3. 3.
    Brinkert W et al. Dysmenorrhea is associated with hypersensitivity in the sigmoid colon and rectum. Pain. 2007;132(Suppl1):546–51.Google Scholar
  4. 4.
    Howard FM. Pelvic pain diagnosis and management. Lippincott Williams &Wilkins; 2000. p. 285.Google Scholar
  5. 5.
    Giamberardino MA et al. Pain threshold variations in somatic wall tissues as a function of menstrual cycle, segmental site and tissue depth in non-dysmenorrheic women, dysmenorrheic women and men. Pain. 1997;71(2):7187–97.CrossRefGoogle Scholar
  6. 6.
    Wesselmann V et al. Mechanisms of referred visceral pain: uterine inflammation in the adult virgin rat results in neurogenic plasma extravasation in the skin. Pain. 1997;73:309–12.PubMedCrossRefGoogle Scholar
  7. 7.
    Giamberardino MA, Berkley KJ. Influence of endometriosis on pain behaviors and muscle hyperalgesia induced by a urethral calculosis in female rats. Pain. 2002;95:247–57.PubMedCrossRefGoogle Scholar
  8. 8.
    Travell J, Simons D. The trigger point manual, vol. 1. Baltimore: Williams & Williams; 1983.Google Scholar
  9. 9.
    Fitzgerald MP, Kotarinos R. Rehabilitation of the short pelvic floor. I: Background and patient evaluation. Int Urogynecol J. 2003;14:261–8.CrossRefGoogle Scholar
  10. 10.
    Weiss J. Chronic pelvic pain and myofascial trigger points. Pain Clin. 2000;2(6):13–8.Google Scholar
  11. 11.
    Doggweiler R, Jasmin L, Schmidt RA. Neurogenically mediated cystitis in rats: an animal model. J Urol. 1998;160:1551–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain. 2009;10(9):895–926.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Gundersen Lutheran- Onalaska ClinicOnalaskaUSA

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