Chronic pelvic pain in women: focus on the bladder

The 2 major reasons why women of reproductive age seek gynecologic medical care are (1) abnormal bleeding and (2) pelvic pain. The diagnosis and management of abnormal bleeding is usually performed without difficulty by gynecologists; clinicians have a variety of diagnostic tools and therapeutic approaches to managing their patients abnormal bleeding. In contrast the diagnosis and management of chronic pelvic pain (CPP) remains an enigma to many gynecologists. Pelvic pain is generally thought to be of morphologic origin caused by endometriosis adhesions or vulvodynia and managed accordingly. Excluding urinary tract infections gynecologists rarely consider the bladder a source of CPP and yet research is increasingly demonstrating that bladder-origin CPP is far more common than previously thought. It is now estimated that as many as 1 in 4.5 women may have CPP of bladder origin-specifically due to interstitial cystitis (IC). Studies have demonstrated that suspected cases of endometriosis urinary tract infection and vulvodynia among other gynecologic conditions were in fact the consequence of IC. Gynecologists need to be aware that IC can mimic the symptoms of many of the other causes of CPP. (excerpt)