Treatment For Chronic Pelvic Pain

By Allen A. Farsaii, MD

Chronic pelvic pain is a relatively common condition in both men and women. In women, it is more common in the young to middle age group and is associated with a variety of voiding symptoms such as frequent urination, pain during voiding, and burning sensations. It occurs day or night, and is estimated to affect 10 to 15 million people.
Interstitial cystitis (IC) is now believed to have a mild form that results in occasional bladder pain, pain during intercourse, or severe constant bladder pain that is relieved after urination. Although the vast majority of this group does not have a urinary tract infection, there is a temporary disappearance of symptoms after any course of antibiotics.
In men, the primary cause is chronic prostatitis. In some cases, difficult to treat chronic prostatodynia is the cause. Although rare, interstitial cystitis should always be considered in difficult to treat cases. Failure to do so results in disappointed and discouraged patients who are desperate for relief.
Before treating chronic pelvic pain, especially for difficult cases, other important causes must be ruled out. A PSA and digital prostate exam must be performed for men and a bladder biopsy for women is appropriate if cancer in situ or endometriosis is suspected.
Treatment options for interstitial cystitis include installing DMSO in the bladder for several weeks, oral medication (pentosan polysulfate sodium), behavioral treatment and antichlinergics. Lifestyle changes such as diet, change of climate, etc. can also play an important role.