Chronic pelvic pain syndrome (CPPS) is a long-term condition that causes persistent pain in the pelvic region lasting more than six months. The pain can be sharp, dull, burning, or cramping—and it often disrupts daily activities, emotional well-being, and overall quality of life.

CPPS affects about 10% of people, most commonly those with a uterus, though anyone can develop the condition. Because the pain can stem from many different causes, diagnosis and treatment often require a multidisciplinary team—including primary care providers, physical therapists, and mental health specialists.

Common Symptoms

CPPS symptoms vary depending on where the pain originates. For some, it affects the uterus, bladder, prostate, intestines, or pelvic floor muscles. Others experience widespread discomfort across the entire pelvic area.

Typical symptoms include:

  • Persistent dull, sharp, burning, or electrical pain in the pelvic region

  • Pain not related to menstrual cramps

  • Abdominal bloating or fullness

  • Discomfort during bowel movements

  • Pain during or after sex

  • Trouble sleeping due to pain

  • Frequent urge to urinate or difficulty urinating

  • Constipation or diarrhea

  • Emotional symptoms such as depression and anxiety

Many people with CPPS also live with co-occurring conditions, such as fibromyalgia, endometriosis, or irritable bowel syndrome (IBS), which can make pain worse.

Possible Causes

The exact cause of CPPS remains unclear, but research suggests it can result from multiple factors, including:

  • Pelvic surgery (for example, up to 20% of people report pain six months after a cesarean section)

  • Underlying conditions like endometriosis or pelvic inflammatory disease (PID)

  • Trauma history, including sexual or physical abuse, which may alter how the brain processes pain

  • Central sensitization, a process in which the nervous system becomes overly sensitive to pain signals

In many cases, no single cause is found. Instead, pain develops from a combination of physical, hormonal, and emotional factors that interact over time.

How Chronic Pelvic Pain Is Diagnosed

Because there is no specific test for CPPS, diagnosis involves ruling out other possible conditions first. Many cases go undiagnosed because symptoms can overlap with other disorders like urinary tract infections or gastrointestinal issues.

Your healthcare provider may begin by asking about your medical history, pain patterns, stress levels, and lifestyle. They may also recommend several tests, such as:

  • Physical exam: Checks tenderness in the pelvic area

  • Imaging scans: Ultrasound, MRI, or X-ray to look for abnormalities

  • Laparoscopy: A minimally invasive surgery to examine internal organs

  • Endoscopy: Used to view the colon or bladder for possible disease

  • Blood and urine tests: To rule out infections

  • Neurological exams: To assess nerve function

  • Mental health screenings: To evaluate the impact of trauma, anxiety, or depression

  • Diagnostic nerve blocks: To identify which nerves are involved in the pain

Accurate diagnosis is often a gradual process that requires collaboration between specialists.

Treatment Options

Because CPPS is complex and individualized, treatment usually combines medical care, physical therapy, and psychological support. The goal is to relieve pain, treat any underlying causes, and improve overall functioning.

Surgery

If an underlying condition like endometriosis, uterine fibroids, or adenomyosis contributes to pain, surgery—such as a laparoscopy—may help.

Medications

Doctors may prescribe one or more of the following:

  • Over-the-counter pain relievers (NSAIDs or acetaminophen)

  • Opioid medications (used cautiously and under medical supervision)

  • Hormone therapy (for pain linked to menstrual cycles)

  • Neuropathic pain drugs like gabapentin or tricyclic antidepressants

  • Botulinum toxin injections to relax pelvic muscles and ease pain

Other Therapies

A combination of non-surgical therapies can also be effective, including:

  • Pelvic floor physical therapy: Helps relax and strengthen pelvic muscles

  • Cognitive-behavioral therapy (CBT): Addresses the emotional and psychological aspects of chronic pain

  • Biofeedback or relaxation training: Helps manage stress and pain responses

Because every patient’s pain profile is unique, your provider will personalize your treatment plan to your symptoms and medical history.

Preventing Chronic Pelvic Pain Syndrome

Since the causes of CPPS are complex, there’s no guaranteed way to prevent it. However, certain actions may lower the risk or severity:

  • Seek early treatment for acute pain or infections to prevent long-term sensitization.

  • Manage underlying conditions such as PID, endometriosis, or IBS before they worsen.

  • Prioritize emotional health: Address trauma, stress, and anxiety early through therapy or counseling.

Timely medical attention and proactive care can help minimize pain and protect long-term pelvic health.

Related Conditions

People with CPPS may also experience one or more of the following:

  • Endometriosis

  • Pelvic inflammatory disease (PID)

  • Interstitial cystitis (painful bladder syndrome)

  • Fibromyalgia

  • IBS (Irritable Bowel Syndrome)

  • Depression

  • Anxiety

  • Post-traumatic stress disorder (PTSD)

Living With Chronic Pelvic Pain Syndrome

Chronic pelvic pain can interfere with sleep, work, relationships, and intimacy. The constant discomfort often leads to frustration and emotional distress—but with early diagnosis and comprehensive care, many people can regain control and live fulfilling lives.

If you suspect CPPS, don’t ignore the symptoms. Discuss your pain with a healthcare provider and seek multidisciplinary treatment. Pain may be invisible, but it’s real—and help is available.