Chronic pelvic pain

Chronic Pelvic Pain Syndrome (CPPS) is a one-way ticket… to hell.

There’s no other way to describe what a patient goes through — suffering from severe pain in the pelvis, perineum, or genitals — only to hear a doctor say the brilliant phrase: “The pain is all in your head.”
In other words, you're either lying or mentally ill.

In over 20 years of medical practice, I’ve never understood why any kind of pain should be dismissed. Even if it’s psychosomatic, the person is still experiencing real pain.
And the worst part? In almost every case, the cause of the pain can be identified — and treated.
Because it’s not just the bladder, bowel, or prostate that can hurt in the pelvic region.
There are also muscles, fascia… and the true royals — NERVES.
Nerves that can indeed be damaged and cause truly excruciating pain syndromes.

Pain. Agonizing, constant or intermittent, aching, burning, or shooting, unrelated to physical exertion, sudden in onset, and worst of all — not responding to usual painkillers.

Some of these patients cannot even be offered to sit on a chair — for them, it is torture. Others easily lose their temper at the mere mention of the words “prostatitis” or “hemorrhoids” — each of them has a folder full of treatment records for these conditions. All without any effect…

There are no doctors these patients haven’t seen. It seems there are no tests they haven’t undergone. And every single one of them has, at least once, heard the phrase, “This pain is all in your head.” As if the person is to blame for having pain.

And then what? Depression. Severe depression — a constant companion of patients with chronic pelvic pain. Every second patient we see has already lost hope of recovery from chronic pelvic pain syndrome.

Important to Know!

Diagnosing the causes — and consequently providing the correct treatment for pelvic pain — is not the responsibility of any single doctor: urologist, gynecologist, or neurologist. Only a multidisciplinary team with clear understanding and experience in this issue can achieve success and relieve the pain.

Causes of Pelvic Pain

There is a vast range of causes for chronic pelvic pain syndrome, many of which simply fall outside the expertise of narrow specialists. Let’s take a look at a small portion of them:

Pelvic Organ Prolapse

Essentially, the stretching of nerve fibers leads to pain.

Neuropathies of the Pelvic Nerves

Damage to nerve trunks, for example the pudendal nerve.

Myofascial Pelvic Pain

Development of chronic muscle spasms.

Endometriosis of the pelvic nerves

Nerve involvement by endometriotic nodules

Pathologies of the Coccyx and Joints

Causing excruciating bone pain

Varicose Veins of the Pelvis

“A common problem that is rarely diagnosed.”

This is just a small portion of the causes that lead to severe pain symptoms in the pelvic area. Please note: each of the examples listed requires a specialist who is knowledgeable not only in their own field but also in chronic pelvic pain syndrome (CPPS).

We’ve built just such a team of specialists at Dilanyan Clinic. Each member has an in‑depth understanding of pelvic pain within their own field and can determine which additional specialist the patient needs.

A good doctor is someone who knows the remedies for certain ailments or, if the illness is unclear, calls upon those who can help the patient.

— Jean de La Bruyère

What can be done about pelvic pain that isn’t a symptom or consequence of any disease—such as inflammation, cancer, or an acute injury? In those cases, the pain is explainable and understandable. It’s an entirely different matter when the underlying condition has been treated or hasn’t been identified at all, yet the painful sensations persist.

Diagnosis of Chronic Pelvic Pain

I insist that every patient who comes to my clinic be informed that, in the pelvis—besides the prostate, vagina, bladder, and rectum—there are other structures as well, such as muscles, fascia, and entire networks of nerves.

O. E. Dilanyan

There is no single protocol for diagnosing pelvic pain. It is always a personalized course of action, designed specifically for you.

To choose the most appropriate and truly necessary investigations, the physician will take a detailed history and review your symptoms, as well as examine all the diagnostic tests you’ve already undergone. Sometimes this process takes up to an hour.

Treatment of Chronic Pelvic Pain

Conservative Methods

Physiotherapy

Biofeedback Therapy

Therapeutic and Diagnostic Nerve Blocks

Osteopathy

Reflexotherapy

Localized Pain Treatment

Surgical Methods

Selection of appropriate medication for pain relief and nerve tissue recovery.

Targeted treatment of affected muscles, fascia, and nerves to restore their normal function.

Biofeedback: enables the patient to learn how to properly relax a specific painful muscle, for example.

They play a major role in diagnosing nerve trunk pathologies and are sometimes used as a treatment method.

Manual therapy targeting muscle groups and joints to eliminate the causes of their dysfunction.

Stimulation of active points on the human body, which in many cases successfully alleviates pain.

Treatment of the “painful area” using various methods: injection of medications under ultrasound guidance, dry needling, botulinum toxin therapy, PRP and PRGF therapy, and work with “trigger” points.

Surgical procedures aimed at nerve decompression or freeing nerve trunks from endometriosis. This also includes radiofrequency ablation and pain neuromodulation.

How can I make an appointment with a urologist

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