Chronic Pelvic and Abdominal Pain

  • Joslyn Gober
  • Melanie Howell
  • Sovrin M. Shah
  • Kimberly A. Sackheim


Patients suffering from chronic abdominal and pelvic pain syndromes can be very complicated and difficult to diagnose and treat. These patients often end up visiting numerous physicians and undergo an abundance of tests and imaging prior to their physician establishing an accurate diagnosis. Unfortunately, some of the patients undergo unnecessary surgical interventions and continue to have their pain syndrome afterwards. It is important to listen to these patients, establish a proper and detailed history, physical examination, and assure they have had all acute and surgical pathologies ruled out prior to proceeding. Chronic abdominal and pelvic pain can be disabling and drastically effect a patient’s quality of life.


Cholecystitis Chronic endometriosis Functional gastrointestinal disorder Inguinal neuralgia Interstitial cystitis Irritable bowel syndrome Pancreatitis Pelvic floor abnormalities Pelvic trigger points Pelvic venous congestion Prostatitis Pudendal neuralgia 



Complete blood count


Computed tomography


Diabetic ketoacidosis


Interstitial cystitis


Gastroesophageal reflux disease








Left lower quadrant


Left upper quadrant


Manual muscle testing


Magnetic resonance imaging


Nonsteroidal anti-inflammatory drugs


Pelvic inflammatory disease






Right lower quadrant


Right upper quadrant






Urine culture


Urinary tract infection


  1. 1.
    Howard F. Causes of chronic pelvic pain in women. In: Barbieri RL, editor. UpToDate. UpToDate, Inc. Accessed 4Jan 2014.Google Scholar
  2. 2.
    Vincent K, Moore J. Pelvic pain in females. In: Fishman SM, Ballantyne JC, Rathmell JP, editors. Bonica’s management of pain. 4th ed. New York: Lippincott, Williams & Wilkins; 2009. p. 925–38.Google Scholar
  3. 3.
    Singh, Manish K. Chronic Pelvic Pain in Women Clinical Presentation. 2012.
  4. 4.
    Howard F. Treatment of chronic pelvic pain in women. In: Barbieri R, editor. UpToDate. UpToDate, Inc. Accessed 4 Jan 2014.Google Scholar
  5. 5.
    Bonder J, Rizzo JR, Chowdhury N, Sayegh S. Musculoskeletal pelvic pain and pelvic floor dysfunction. In: Sackheim K, editor. Rehab clinical pocket guide: rehabilitation medicine. New York: Springer; 2013. p. 467–85.CrossRefGoogle Scholar
  6. 6.
    Hanno P, Dmochowski R. Status of international consensus on interstitial cystitis/bladder pain syndrome/painful bladder syndrome: 2008 snapshot. Neurourol Urodyn. 2009;28(4):274–86.CrossRefPubMedGoogle Scholar
  7. 7.
    Hanno PM, Landis JR, Mathews-Cook Y, Kusek Jr NL. The diagnosis of interstitial cystitis revisited: lessons learned from the National Institutes of Health Interstitial Cystitis Database study. J Urol. 1999;161(2):553–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Driscoll A, Teichman JM. How do patients with interstitial cystitis present? J Urol. 2001;166(6):2118–20.CrossRefPubMedGoogle Scholar
  9. 9.
    Anderson RU, Wise D, Sawyer T, Chan C. Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. J Urol. 2005;174(1):155–60.CrossRefPubMedGoogle Scholar
  10. 10.
    FitzGerald MP, Anderson RU, Potts J, Payne CK, Peters KM, Clemens JQ, Kotarinos R, Fraser L, Cosby A, Fortman C, Neville C, Badillo S, Odabachian L, Sanfield A, O’Dougherty R, Halle-Podell R, Cen L, Chuai S, Landis JR, Mickelberg K, Barrell T, Kusek JW, Nyberg LM. Urological Pelvic Pain Collaborative Research Network. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological pelvic pain syndromes J Urol. 2009;182(2):570–80.PubMedGoogle Scholar
  11. 11.
    Foster Jr HE, Hanno PM, Nickel JC, Payne CK, Mayer RD, Burks DA, Yang CC, Chai TC, Kreder KJ, Peters KM, Lukacz ES, FitzGerald MP, Cen L, Landis JR, Propert KJ, Yang W, Kusek JW, Nyberg LM. Interstitial Cystitis Collaborative Research Network. Effect of amitriptyline on symptoms in treatment naïve patients with interstitial cystitis/painful bladder syndrome J Urol. 2009;183(5):1853–8.Google Scholar
  12. 12.
    Holm-Bentzen M, Jacobsen F, Nerstrom B, Lose G, Kristensen JK, Pedersen RH, Krarup T, Feggetter J, Bates P. Barnard. A prospective double-blind clinically controlled multicenter trial of sodium pentosanpolysulfate in the treatment of interstitial cystitis J Urol. 1987;138(3):503–7.PubMedGoogle Scholar
  13. 13.
    Rovner E, Propert KJ, Brensinger C, Wein AJ, Foy M, Kirkemo A, Landis JR, Kusek JW, Nyberg LM. Treatments used in women with interstitial cystitis data base (ICDB) study experience. The Interstitial Cystitis Data Base Study Group Urology. 2000;56(6):940–5.Google Scholar
  14. 14.
    Chong M, Hester J. Pharmacotherapy for neuropathic pain with special reference to urogenital pain. In: Baranowski A, Abrams P, Fall M, editors. Urogenital pain in clinical practice. New York: Informa Healthcare; 2008.Google Scholar
  15. 15.
    Welk BK, Teichman JM. Dyspareunia response in patients with interstitial cystitis treated with intravesical lidocaine, bicarbonate, and heparin. Urology. 2008;71(1):67–70.CrossRefPubMedGoogle Scholar
  16. 16.
    Ottem DP, Teichman JM. What is the value of cystoscopy with hydrodistention for interstitial cystitis? Urology. 2005;66(3):494–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Peters KM, Konstandt D. Sacral neuromodulation decreases narcotic requirements in refractory interstitial cystitis. BJU Int. 2004;93(6):777–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Giannantoni A, Porena M, Costantini E, Zucchi A, Mearini A, Mearinin E. Botulinum A toxin intravesical injection in patients with painful bladder syndrome: 1-year followup. J Urol. 2008;179(3):1031–4.4.CrossRefPubMedGoogle Scholar
  19. 19.
    Hughes OD, Kynaston HG, Jenkins BJ, Stephenson TP, Vaughton KC. Substitution cystoplasty for intractable interstitial cystitis. Br J Urol. 1995;76(2):172–4.CrossRefPubMedGoogle Scholar
  20. 20.
    Mears Jr EM. Prostatitis. Med Clinic North Am. 1991;75(2):405–24.Google Scholar
  21. 21.
    Nickel JC. Practical approach to the management of prostatitis. Tech Urol. 1995;1(3):162–7.PubMedGoogle Scholar
  22. 22.
    Pewitt EB, Schaeffer AJ. Urinary tract infection in urology, including acute and chronic prostatitis. Infect Dis Clin North Am. 1997;11(3):623–46.CrossRefPubMedGoogle Scholar
  23. 23.
    Nickel JC. Effective office management of chronic prostatitis. Urol Clin North Am. 1998;25(4):677–84.CrossRefPubMedGoogle Scholar
  24. 24.
    Nickel JC, Sorensen R. Transurethral microwave thermotherapy of nonbacterial prostatitis and prostatodynia: initial experience. Urology. 1994;44(3):458–60.CrossRefPubMedGoogle Scholar
  25. 25.
    Ignacio EA, Intervent S. Radiol. Dec. 2008;25(4):361–8.Google Scholar
  26. 26.
    Moynihan, Leah K. Treatment of myofascial pelvic pain syndrome in women. In: Brubaker L, editor. UpToDate. UpToDate, Inc. Accessed 4 Jan 2014.Google Scholar
  27. 27.
    Fishman, M., Aronson, M., Chacko, M. Chronic abdominal pain in children and adults: Approach to evaluation. In: Middleman A, Ferry G, Drutz J, editors. UpToDate. UpToDate, Inc. Accessed 21 Feb 2014.Google Scholar
  28. 28.
    Fishman, M., Aronson, M. Differential Diagnosis of abdominal pain in adults. In: Fletcher, R., editor. UpToDate. UpToDate, Inc. Accessed 21 Feb 2014.Google Scholar
  29. 29.
    Fishman, M., Aronson, M. History and physical examination in adults with abdominal pain. In: Fletcher R, editor. UpToDate. UpToDate, Inc. Accessed 21 Feb 2014.Google Scholar
  30. 30.
    Zakko S, Afdhal N. Acute cholecystitis: pathogenesis, clinical features, and diagnosis. In: Chopra S, editor. UpToDate. UpToDate, Inc. Accessed 21Feb 2014.Google Scholar
  31. 31.
    Freedman S. Clinical manifestations and diagnosis of chronic pancreatitis in adults. In: Whitcomb D, editors. UpToDate. UpToDate, Inc. Accessed 21 Feb 2014.Google Scholar
  32. 32.
    Wald A. Clinical manifestations and diagnosis of irritable bowel syndrome in adults. In: Talley N, editor. UpToDate. UpToDate, Inc. Accessed 21 Feb 2014Google Scholar
  33. 33.
    Drossman D. The functional gastrointestinal disorders and the Rome III process. Gastroenterology. 2006;130(5):1377–90; Review.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Joslyn Gober
    • 1
  • Melanie Howell
    • 2
  • Sovrin M. Shah
    • 3
  • Kimberly A. Sackheim
    • 2
  1. 1.Nova Southeastern University College of Osteopathic MedicineFort LauderdaleUSA
  2. 2.Department of Rehabilitation MedicineNew York University Langone Medical CenterNew YorkUSA
  3. 3.Department of Urology Female Pelvic Medicine and Reconstructive SurgeryIcahn School of Medicine at Mount SinaiMount Sinai Beth IsraelNew YorkUSA

Personalised recommendations