Current Urology Reports

, Volume 12, Issue 4, pp 304–311 | Cite as

Pelvic Floor Therapies in Chronic Pelvic Pain Syndrome



Chronic pelvic pain syndrome is a poorly understood clinical entity associated with urinary symptoms, pelvic floor dysfunction, and multisystem disorders. Treatment of pelvic floor dysfunction is difficult and often frustrating for the patient as well as for the involved physician. The purpose of this review is to update clinicians on the latest research for the treatment of pelvic floor dysfunction in relation to chronic pelvic pain syndrome.


Chronic prostatitis CP Chronic pelvic pain syndrome CPPS Pelvic floor Pelvic floor dysfunction Pelvic floor therapy Psychosocial Multisystem disorder UPOINT Coping Catastrophizing Irritable bowel syndrome IBS Sacral nerve stimulation Sacral neurostimulation SNS Chronic pudendal nerve stimulation CPNS Sham acupuncture Electroacupuncture Extracorporeal shock wave therapy ESWT Transcranial direct current stimulation tDCS 



No potential conflicts of interest relevant to this article were reported.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Anothaisintawee T, Attia J, Nickel JC, et al. Management of chronic prostatitis/chronic pelvic pain syndrome. JAMA. 2011;305:78–86.PubMedCrossRefGoogle Scholar
  2. 2.
    • Baranowski AP. Chronic pelvic pain. Best Pract Res Clin Gastroenterol. 2009;23(4):593–610. This is a description of pelvic pain syndrome by a pain specialist with longstanding experience with these patients.PubMedCrossRefGoogle Scholar
  3. 3.
    Labat JJ, Riant T, Delavierre D, Sibert L, Watier A, Rigaud J. Global approach to chronic pelvic and perineal pain: from the concept of organ pain to that of dysfunction of visceral pain regulation systems. Prog Urol. 2010;20(12):1027–34.PubMedCrossRefGoogle Scholar
  4. 4.
    Messelink B, Benson T, Berghmans B, et al. Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society. Neurourol Urodyn. 2005;24(4):374–80.PubMedCrossRefGoogle Scholar
  5. 5.
    Vodusek DB. Anatomy and neurocontrol of the pelvic floor. Digestion. 2004;69(2):87–92.PubMedCrossRefGoogle Scholar
  6. 6.
    Ustinova EE, Fraser MO, Pezzone MA. Cross-talk and sensitization of bladder afferent nerves. Neurourol Urodyn. 2010;29(1):77–81.PubMedCrossRefGoogle Scholar
  7. 7.
    Andromanakos NP, Kouraklis G, Alkiviadis K. Chronic perineal pain: current pathophysiological aspects, diagnostic approached and treatment. Eur J Gastroenterol Hepatol. 2011;23(1):2–7.PubMedCrossRefGoogle Scholar
  8. 8.
    de Groat WC et al. Neural control of the urethra. Scand J Urol Nephrol Suppl. 2001;207:35–43.PubMedCrossRefGoogle Scholar
  9. 9.
    Raghunath N, Glassman MS, Halata MS, Berezin SH, Stewart JM, Medow MS. Anorectal motility abnormalities in children with encopresis and chronic constipation. J Pediatr. 2011;158(2):293–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Chatoor D, Emmnauel A. Constipation and evacuation disorders. Best Pract Res Clin Gastroenterol. 2009;23(4):517–30.PubMedCrossRefGoogle Scholar
  11. 11.
    Potts J, Payne RE. Prostatitis: infection, neuromuscular disorder, or pain syndrome? Proper patient classification is key. Cleve Clin J Med. 2007;74 Suppl 3:S63–71.PubMedCrossRefGoogle Scholar
  12. 12.
    Nickel JC, Shoskes DA. Phenotypic approach to the management of the chronic prostatitis/chronic pelvic pain syndrome. BJU Int. 2010;106(9):1252–63.PubMedCrossRefGoogle Scholar
  13. 13.
    Anderson RU, Sawyer T, Wise D, Morey A, Nathanson BH. Painful myofascial trigger points and pain sites in men with chronic prostatitis/chronic pelvic pain syndrome. J Urol. 2009;182(6):2753–8. Epub 2009 Oct 17.PubMedCrossRefGoogle Scholar
  14. 14.
    Hashim H, Abrams R. Is the bladder a reliable witness for predicting detrusor overactivity? J Urol. 2006;175:191–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Van Kerrebroeck P, Abrams P, Chaikin D, et al. The standardization of terminology in nocturia: report from the standardization subcommittee of the International Continence Society. BJU Int. 2002;90 Suppl 3:11–5.PubMedCrossRefGoogle Scholar
  16. 16.
    Groenendijk PM, Heesakkers JPFA, Ouwerkerk TJ, Lycklama à Nijeholt AAB. Urethral Instability: current pathophysiological concept. Urol Int. 2009;83:125–33.PubMedCrossRefGoogle Scholar
  17. 17.
    Groenebdijk PM, Heesakkers JPFA, Lycklama a Nijeholt AAB. Urethral Instability and sacral nerve stimulation—a better parameter to predict efficacy? J Urol. 2007;178:568–72.CrossRefGoogle Scholar
  18. 18.
    Zu XB, Ye ZQ, Zhou SW, Qi L, Yang ZQ. Chronic prostatitis with non-neurogenic detrusor sphincter dyssynergia: diagnosis and treatment. Zhonghua Nan Ke Xue. 2010;16(2):146–9.PubMedGoogle Scholar
  19. 19.
    Watier A, Rigaud J, Labat JJ. Irritable bowel syndrome, levator ani syndrome, proctalgia fugax and chronic pelvic and perineal pain. Prog Urol. 2010;20(12):995–1002.PubMedCrossRefGoogle Scholar
  20. 20.
    Bernal RM, Pontari MA. Evaluation of chronic pelvic pain syndrome in men: is it chronic prostatitis? Curr Urol Rep. 2009;10(4):295–301.PubMedCrossRefGoogle Scholar
  21. 21.
    •• Nickel JC, Shoskes D. Phenotypic approach to the management of chronic prostatitis/chronic pelvic pain syndrome. Curr Urol Rep. 2009;10(4):307–12. This is an initial report on the UPOINT system for the evaluation of patients with CPPS.PubMedCrossRefGoogle Scholar
  22. 22.
    Shoskes DA, Nickel JC, Kattan MW. Phenotypically directed multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome: a prospective study using UPOINT. Urology. 2010;75(6):1249–53.PubMedCrossRefGoogle Scholar
  23. 23.
    Jensen Mark P, Moore Michael R, Bockow Tamara B, Ehde Dawn M, Engel Joyce M. OTR/L psychosocial factors and adjustment to chronic pain in persons with physical disabilities: a systematic review. Arch Phys Med Rehabil. 2011;92(1):146–60.PubMedCrossRefGoogle Scholar
  24. 24.
    Anderson RU, Orenberg EK, Moery A, et al. Stress induced hypothalamus-pituitary-adrenal axis responses and disturbances in psychological profiles in men with chronic prostatitis/ chronic pelvic pain syndrome. J Urol. 2009;182:2319–24.PubMedCrossRefGoogle Scholar
  25. 25.
    Jensen MP. “Psychosocial approaches to pain management: an organizational framework.” Pain. 2010 Dec 17. [Epub ahead of print]Google Scholar
  26. 26.
    Rodríguez MA, Afari N, Buchwald DS. National Institute of Diabetes and Digestive and Kidney Diseases Working Group on Urological Chronic Pelvic Pain. “Evidence for overlap between urological and nonurological unexplained clinical conditions. J Urol. 2009;182(5):2123–31. Epub 2009 Sep 16.PubMedCrossRefGoogle Scholar
  27. 27.
    Oerlemans S, van Cranenburgh O, Herremans PJ, Spreeuwenberg P, van Dulmen S. Intervening on cognitions and behavior in irritable bowel syndrome: a feasibility trial using PDAs. J Psychosom Res. 2011;70(3):267–77. Epub 2010 Dec 15.PubMedCrossRefGoogle Scholar
  28. 28.
    Subhadra Evans, Laura Cousins, Jennie CI Tsao, Beth Sternlieb, Zeltzer Lonnie K. Protocol for a randomized controlled study of Iyengar yoga for youth with irritable bowel syndrome. Trials. 2011;18:12–5.Google Scholar
  29. 29.
    Murphy AB, Macejko A, Taylor A, Nadler RB. Chronic prostatitis: management strategies. Drugs. 2009;69(1):71–84.PubMedCrossRefGoogle Scholar
  30. 30.
    Shi H, Cheng L, Zheng X, Tu L. Study of effects and mechanism of phytosterols on chronic a bacterial prostatitis. Zhongguo Zhong Yao Za Zhi. 2010;35(22):3033–7.PubMedGoogle Scholar
  31. 31.
    Yuan SY, Qin Z, Liu DS, Yin WQ, Zhang ZL, Li SG. “Acupuncture for chronic pelvic pain syndromes (CPPS) and its effect on cytokines in prostatic fluid.” 2011 Jan; 31(1):11–4.Google Scholar
  32. 32.
    Touma NJ, Nickel JC. Prostatitis and chronic pelvic pain syndrome in men. Med Clin North Am. 2011;95(1):75–86. Epub 2010 Oct.PubMedCrossRefGoogle Scholar
  33. 33.
    Murphy AB, Nadler RB. Pharmacotherapy strategies in chronic prostatitis/chronic pelvic pain syndrome management. Expert Opin Pharmacother. 2010 Jun;11(8):1255–61.Google Scholar
  34. 34.
    Warren JW, Howard FM, Cross RK, Good JL, Weissman MM, Wesselmann U, et al. Antecedent nonbladder syndromes in case-control study of interstitial cystitis/painful bladder syndrome. Urology. 2009;73(1):52–7.PubMedCrossRefGoogle Scholar
  35. 35.
    Papandreou C, Skapinakis P, Giannakis D, Sofikitis N, Mavreas V. “Antidepressant drugs for chronic urological pelvic pain: an evidence-based review.” Adv Urol. 2009; 2009:797031. Epub 2010 Feb 14.Google Scholar
  36. 36.
    Pontari MA, Krieger JN, Litwin MS, et al. Pregabalin for the treatment of men with chronic prostatitis/chronic pelvic pain syndrome: a randomized controlled trial. Arch Intern Med. 2010;170(17):1586–93.PubMedCrossRefGoogle Scholar
  37. 37.
    Rigaud J, Riant T, Delavierre D, Sibert L, Labat JJ. Somatic nerve block in the management of chronic pelvic and perineal pain. Prog Urol. 2010;20(12):1072–83. Epub 2010 Oct 20.PubMedCrossRefGoogle Scholar
  38. 38.
    Rigaud J, Delavierre D, Sibert L, Labat JJ. Sympathetic nerve block in the management of chronic pelvic and perineal pain. Prog Urol. 2010;20(12):1124–31.PubMedCrossRefGoogle Scholar
  39. 39.
    Calabrò RS, Gervasi G, Marino S, Mondo PN, Bramanti P. Misdiagnosed chronic pelvic pain: pudendal neuralgia responding to a novel use of palmitoylethanolamide. Pain Med. 2010;11(5):781–4. Epub 2010 Mar 22.PubMedCrossRefGoogle Scholar
  40. 40.
    Labat JJ, Delavierre D, Sibert L, Rigaud J. Symptomatic approach to chronic pudendal pain. Prog Urol. 2010;20(12):922–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Robert R, Labat JJ, Riant T, Louppe JM, Lucas O, Hamel O. Somatic perineal pain other than pudendal neuralgia.” Neurochirurgie. 2009 Oct; 55(4–5):Google Scholar
  42. 42.
    Lapeyre E, Kuks JB, Meijler WJ. Spasticity: revisiting the role and the individual value of several pharmacological treatments. NeuroRehabilitation. 2010;27(2):193–200.PubMedGoogle Scholar
  43. 43.
    FitzGerald MP, Anderson RU, Potts J, et al. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. J Urol. 2009;182(2):570–80.PubMedCrossRefGoogle Scholar
  44. 44.
    Anderson RU, Sawyer T, Wise D, et al. Painful myofascial trigger points and pain sites in men with chronic prostatitis/chronic pelvic pain syndrome. J Urol. 2009;182(6):2753–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Westesson KE, Shoskes DA. Chronic prostatitis/chronic pelvic pain syndrome and pelvic floor spasm: can we diagnose and treat? Curr Urol Rep. 2010;11(4):261–4.PubMedCrossRefGoogle Scholar
  46. 46.
    •• Anderson RU, Wise D, Sawyer T, Glowe P, Orenberg EK. “Six-Day Intensive Treatment Protocol for Refractory Chronic Prostatitis/Chronic Pelvic Pain Syndrome Using Myofascial Release and Paradoxical Relaxation Training.” J Urol. 2011 Feb 18. This is the first long-term report on the Stanford Protocol. Google Scholar
  47. 47.
    Chiarioni G, Nardo A, Vantini I, Romito A, Whitehead WE. Biofeedback is superior to electrogalvanic stimulation and massage for treatment of levator ani syndrome. Gastroenterology. 2010;138(4):1321–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Gottsch HP, Yang CC, Berger RE. A pilot study of botulinum toxin A for male chronic pelvic pain syndrome. Scand J Urol Nephrol. 2011;45(1):72–6.PubMedCrossRefGoogle Scholar
  49. 49.
    Marinkovic SP, Gillen LM, Marinkovic CM. ”Minimum six-year outcomes for interstitial cystitis treated with sacral neuromodulation.” Int Urogynecol J Pelvic Floor Dysfunct. 2010 Sep 17.Google Scholar
  50. 50.
    van Wunnik BP, Govaert B, Leong R, Nieman FH, Baeten CG. Patient experience and satisfaction with sacral neuromodulation: results of a single-center sample survey. Dis Colon Rectum. 2011;54(1):95–100.PubMedCrossRefGoogle Scholar
  51. 51.
    Dudding TC. Future indications for sacral nerve stimulation. Colorectal Dis. 2011;13 Suppl 2:23–8.PubMedCrossRefGoogle Scholar
  52. 52.
    Kim JH, Hong JC, Kim MS, Kim SH. Sacral nerve stimulation for treatment of intractable pain associated with cauda equina syndrome. J Korean Neurosurg Soc. 2010;47(6):473–6. Epub 2010 Jun 30.PubMedCrossRefGoogle Scholar
  53. 53.
    Peters KM, Killinger KA, Boguslawski BM, Boura JA. Chronic pudendal neuromodulation: expanding available treatment options for refractory urologic symptoms. Neurourol Urodyn. 2010;29(7):1267–71.PubMedCrossRefGoogle Scholar
  54. 54.
    Lee SW, Liong ML, Yuen KH, Leong WS, Khan NK, Krieger JN. “Validation of a sham acupuncture procedure in a randomized, controlled clinical trial of chronic pelvic pain treatment.” Acupunct Med. 2011 Jan 18.Google Scholar
  55. 55.
    Lee SH, Lee BC. Electroacupuncture relieves pain in men with chronic prostatitis/chronic pelvic pain syndrome: three-arm randomized trial. Urology. 2009;73(5):1036–41.PubMedCrossRefGoogle Scholar
  56. 56.
    Zimmermann R, Cumpanas A, Miclea F, Janetschek G. Extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome in males: a randomized, double-blind, placebo-controlled study. Eur Urol. 2009;56(3):418–24.PubMedCrossRefGoogle Scholar
  57. 57.
    Fenton BW, Palmieri PA, Boggio P, Fanning J, Fregni F. A preliminary study of transcranial direct current stimulation for the treatment of refractory chronic pelvic pain. Brain Stimul. 2009;2(2):103–7. Epub 2009 Feb 28.PubMedCrossRefGoogle Scholar
  58. 58.
    Marx S, Cimniak U, Beckert R, Schwerla F, Resch KL. Chronic prostatitis/chronic pelvic pain syndrome. Influence of osteopathic treatment—a randomized controlled study. Urologe A. 2009;48(11):1339–45.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.University of TennesseeKnoxvilleUSA

Personalised recommendations