Chronic Pelvic Pain Syndrome

Chronic pelvic pain syndrome (CPPS) represents persistent, chronic pain in the pelvic region that cannot be explained by a specific urological, gynaecological, proctological, orthopaedic or internal medicine finding.

CPPS has a reputation of “no one knows what causes it”, “no one knows what it actually is”, “nothing helps”. In fact, however, it is possible to determine causes in most patients, make a clear pathological finding and carry out a (multimodal) treatment that not only helps within a few weeks but, if carried out consistently, makes the recurrences that are so frequent less frequent or prevents them.

What is the cause of chronic pelvic pain syndrome (CPPS)?
In recent years, the understanding of CPPS has increasingly changed so that it is now understood as a multifactorial disease. Muscular tension or dysfunction of the pelvic floor must also be taken into account in the overall assessment of the patient.

Individual muscles of the pelvic floor or the entire pelvic floor can be permanently tense, cramped and shortened. Often they are riddled with painful trigger points that, when palpated, cause the patient’s familiar pain pattern.


How common is CPPS?
CPPS is a very common chronic pain disorder. Figures from the US suggest that it affects between 5 and 15% of the population, women about twice as often as men. It is thus similarly common to chronic back pain. In men under 50 years of age, CPPS (most commonly called chronic abacterial prostatitis) is considered the most common urological diagnosis.

This frequency, and thus its importance for public health, is not very well understood within the general population and medical profession (with the exception of urologists and gynaecologists). The main reason for this is that everything to do with urination, defecation and sexual intercourse is taboo and is embarrassing to disclose and talk about. Also, the different symptoms that lead patients to different specialists make it difficult to perceive patients as a unified group suffering from the same disease.

Learn even more about the treatment of chronic pelvic pain syndrome (CPPS)

The CPPS – a chameleon among pain diseases

The symptoms are very varied. The pain can be constant, but can also last for weeks or months. It can be felt deep in the pelvis, but also in the genitals or perineal region or in the coccyx. Very often, there are also dysfunctions of the bladder, bowel and during sexual intercourse.

Diagnoses which, according to current scientific knowledge, can often be assigned predominantly or completely to CPPS (non-exhaustive list):

Urological pain syndromes

  • Bladder pain syndrome
  • Prostate pain syndrome
  • Urethral pain syndrome
  • Penis pain syndrome
  • Scrotum pain syndrome

Gynaecological pain syndromes

  • Vaginal pain syndrome
  • Vulvar pain syndrome
  • Clitoral pain syndrome
  • Ovarian pain syndrome

Proctological pain syndrome

  • Anorectal pain syndrome
    Neurological pain syndrome

    • Pudendal pain syndrome

    Other commonly used terms

    • Chronic abacterial prostatitis
    • Prostatodynia
    • Orchialgia
    • Epididymitis
    • Urethral syndrome
    • Vulvodynia
    • Vulvavestibulitis
    • Interstitial cystitis
    • Levator ani syndrome
    • Proctalgia fugax
    • Anism
    • Pudendal neuralgia
    • Coccygodynia
    • and others

    Fig. 1: The elongated focus of the therapy source
    reaches different depths in the pelvic floor muscles.

    How is CPPS treated with ESWT?
    Deletion of the trigger points with the piezo shockwave

    The muscles of the pelvic floor line the small pelvis like an internal elastic “basket”. This means that the trigger points (TP) of the pelvic floor are located at very different depths. ELvation Medical and Richard Wolf GmbH have developed a special therapy source for the treatment of the pelvic floor that takes the special anatomy of the pelvic floor into account. Due to the very elongated focal zone of the F10G10 therapy source, TP is reached in all regions of the pelvic floor.

    First, the goal is to center the shockwave on the offending trigger point(s). Shockwaves in the surrounding normal tissue are not felt but when they engage a trigger point it is painful and usually corresponds exactly to the pain the patient is suffering from. Typically, the pain of the trigger point subsides after a few shockwave pulses. Then the therapy source position is adjusted to find the next trigger point which is often only a few millimetres away.

    In subsequent treatments, the trigger point areas are less painfull to the treatment and intensity can usually be increased, which is a sign that the activity of the TP is decreasing and that the therapy is effective.

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