Chronic Pelvic Pain

Chronic pelvic pain (CPP) refers to pain in the lower abdomen, pelvis, or perineum that lasts for six months or longer. Unlike pain from an injury or short-term infection, CPP often persists for 6 months or more, and its intensity may fluctuate over time. Some people experience pain daily, while others notice flare-ups that come and go.

Both women and men can be affected. In men, CPP may show up as persistent pain in the prostate, bladder, bowel or pelvic muscles — this may sometimes be called chronic prostatitis / chronic pelvic pain syndrome (CPPS). In women, CPP may also be linked to conditions such as endometriosis, painful periods, or pelvic floor dysfunction after childbirth.

At SGH, we recognise that CPP is not simply a single-disease condition. It is a complex experience that requires careful evaluation and personalised care.

Why Does Chronic Pelvic Pain Happen?

The pelvis is one of the busiest parts of the body. It houses the bladder, bowel, uterus, ovaries, prostate, blood vessels, and nerves, supported by many muscles of the pelvic floor. Because of this complexity, pain may originate from one organ, several systems, or even the way these systems interact.

Possible contributors include:

• Urological conditions such as bladder pain syndrome, urinary infections, chronic prostate problems, or voiding dysfunction.
• Gynaecological conditions such as endometriosis, ovarian cysts, pelvic inflammatory disease, or painful periods.
• Colorectal and digestive conditions such as irritable bowel syndrome (IBS), constipation, piles, or inflammatory bowel disease.
• Pelvic floor and musculoskeletal issues, including overactive or tight muscles, hip or lower back problems, nerve entrapment, or central sensitisation where the nervous system becomes more sensitive to pain.
• Psychological and emotional influences, since stress, anxiety, and past trauma can heighten pain and affect coping.

Most patients have more than one contributing factor, which is why CPP can be difficult to diagnose and treat.

How Does CPP Affect Daily Life?

CPP affects far more than just the pelvis. Because this region is central to movement, digestion, urination, and sexual activity, symptoms can spill over into many parts of daily life:

• Physical health: fatigue, sleep disturbance, and reduced mobility.
• Bladder and bowel function: urgency, frequency, or difficulty emptying.
• Sexual health: pain during intercourse, erectile dysfunction, or reduced sexual confidence.
• Mental health: frustration, anxiety, or depression.
• Relationships and work: strain on intimacy, missed workdays, or reduced productivity.

For many patients, CPP is not just a medical condition, but a quality-of-life condition.

Our Approach at SGH: Multidisciplinary Team-Based Care

At Singapore General Hospital, our Pelvic Floor Disorders Service brings together specialists from across disciplines to provide comprehensive care for CPP. This team-based model ensures that patients receive holistic support without needing to navigate multiple clinics on their own.

Our team includes:

• Urologists – assessing bladder and urinary causes.
• Gynaecologists – evaluating endometriosis, hormonal factors, or adhesions.
• Colorectal surgeons & gastroenterologists – managing bowel-related contributors.
• Pelvic floor physiotherapists – providing targeted rehabilitation to optimise muscle function and relieve tension.
• Chronic pain specialists – guiding medications, injections, or neuromodulation.
• Psychologists and counsellors – addressing the emotional toll of long-term pain.
• Specialised nurses – including advanced practice, continence, and stoma nurses to support day-to-day management.

Our team meets on a regular basis to discuss and coordinate the treatment and care of patients who have CPP.

Diagnosis involves ruling out different causes and understanding how they interact.

At SGH, investigations may include:

• A thorough medical history and physical examination
• Imaging such as ultrasound or CT scans
• Endoscopy (looking inside the bladder or bowel)
• Laparoscopy (keyhole surgery to check for endometriosis or adhesions)
• Pelvic floor muscle assessment by a physiotherapist

Equally important, our specialists explore lifestyle, stress, and emotional wellbeing, since these strongly influence pain experiences.

There is no single cure for CPP, but many strategies can provide meaningful relief. Treatment at SGH is highly individualised and may involve:

Medical and surgical care

• Pain-relief medication, including targeted treatment for nerve-related pain
• Hormonal therapy for endometriosis
• Antibiotics where infection is proven
• Selected surgeries (e.g. endometriosis excision, nerve decompression, bladder procedures for interstitial cystitis)

Pelvic floor physiotherapy and rehabilitation

• Muscle relaxation and retraining techniques
• Breathing and posture optimisation
• Gentle, progressive exercise programmes
• Manual therapy and biofeedback

Pain and nerve-focused treatments

• Extracorporeal shockwave therapy (ESWT) for local pain and discomfort
• Local nerve blocks or trigger point injections
• Neuromodulation to reduce nerve hypersensitivity
• Comprehensive pain management strategies

Lifestyle and self-care

• Diet adjustments for bladder and bowel health
• Bladder training and bowel management strategies
• Sleep optimisation and stress reduction practices

Psychological support

• Counselling or psychotherapy to build coping skills
• Cognitive behavioural therapy (CBT)
• Mindfulness and relaxation strategies
• Treatment of associated anxiety or depression

Seeking Help at SGH

If you have pelvic pain that has lasted more than a few months and is interfering with your daily life, it may be time to seek help.

You do not need to manage chronic pelvic pain alone. With early assessment, team-based care, and tailored treatment, many patients find meaningful relief and renewed confidence.