Rehabilitation of the Pelvis and Pelvic Floor

In: Urogenital Pain · 2017 · pp. 143–156 · doi:10.1007/978-3-319-45794-9_9 · W2604699863
book-chapter OA: closed CC0
Full text JSON View on OpenAlex View at publisher
AI-generated summary by claude@2026-06+body, 2026-06-13

Chronic pelvic pain, involving multiple systems, can be treated with physical modalities, medications, psychotherapy, alternative medicine, interventional treatments like nerve blocks, and often requires multidisciplinary plans.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text

This chapter reviews chronic pelvic pain (CPP), including its multifactorial causes across urogenital, gynecological, musculoskeletal, and gastroenterologic systems, and discusses evaluation, diagnosis, and treatment options. It summarizes the use of physical modalities, medications, psychotherapy, and alternative medicine for both specific etiologies and general symptom relief, and it describes common interventional approaches such as superior and inferior hypogastric plexus blocks and the ganglion impar block, noting that multidisciplinary plans can yield better results. A key limitation is that the chapter is narrative/synthesis-focused rather than presenting original trial data, and it does not provide a single standardized treatment protocol. This paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

Read from the paper's body, not the abstract. Not a substitute for reading the paper. No clinical advice. How this works

Full text 8,344 characters · extracted from oa-doi-fallback · 2 sections · click to expand

Abstract

Chronic pelvic pain (CPP) is a vast and complex condition with many potential etiologies. The urogenital, gynecological, musculoskeletal, and gastroenterologic systems are most commonly involved. Timely evaluation, diagnosis, and treatment are important to prevent frustration for both the provider and patient. Physical modalities, medications, psychotherapy, and alternative medicine can be used to treat both specific causes of CPP or to alleviate general symptoms. Commonly used interventional treatments include superior and inferior hypogastric plexus blocks as well as the ganglion impar block. Often, multidisciplinary treatment plans yield superior results. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

References

Green IC, Cohen SL, Finkenzeller D, et al. Interventional therapies for controlling pelvic pain: what is the evidence? Curr Pain Headache Rep. 2010;14:22–32. Mathis SD, Kuppermann M, Liberman RF, et al. Chronic pelvic pain: prevalence health related quality of life, and economic correlates. Obstet Gynecol. 1996;87(3):321–7. Garry R. Diagnosis of endometriosis and pelvic pain. Fertil Steril. 2006;86:1307–9. Reiter RC, Gambone JC. Demographic and historic variables in women with idiopathic chronic pelvic pain. Obstet Gynecol. 1990;75:428–32. Berger MY. Chronic abdominal pain in children. BMJ. 2007;334:997–1002. Stein SL. Chronic pelvic pain. Gastroenterol Clin N Am. 2013;42:785–800. International Pelvic Pain Society – Pelvic pain assessment form. http://www.pelvicpain.org/docs/resources/forms/History-and-Physical-Form-English.aspx. Dwarkasing RS, Schouten WR, Geeraedts TE, et al. Chronic anal and perianal pain resolved with MRI. AJR Am J Roentgenol. 2012;200(5):1034–41. Zondervan KT, Yudkin PL, Vessey MP, et al. Chronic pelvic pain in the community: symptoms, investigations, and diagnoses. Am J Obstet Gynecol. 2001;164:1149. Rao SS, Paulson J, Mata M, et al. Clinical trial: effects of botulinum toxin on levator ani syndrome – a double-blind, placebo controlled study. Aliment Pharmacol Ther. 2009;29:985–91. Mazza L, Formento E, Fonda G. Anorectal and perineal pain: new pathophysiological hypothesis. Tech Coloproctol. 2004;8:77–83. Shin JH, Howard FM. Management of chronic pelvic pain. Curr Pain Headache Rep. 2011;15:377–85. Hogston P. Irritable bowel syndrome as a cause of chronic pain in women attending a gynaecology clinic. Br Med J. 1987;294(6577):934–5. Clemons JL, Arya LA, Myers DL. Diagnosing interstitial cystitis in women with chronic pelvic pain. Obstet Gynecol. 2002;100:337–41. Farquhar C. Endometriosis. Endometriosis Br Med J. 2007;334:249–53. Patijn J, Janssen M, Hayek S, et al. Coccygodynia. Pain Pract. 2010;10(6):554–9. Janicki TI. Chronic pelvic pain as a form of complex regional pain syndrome. Clin Obstet Gynecol. 2003;46(4):797–803. Potts JM. Therapeutic options for chronic prostatitis/chronic pelvic pain syndrome. Curr Urol Rep. 2005;6(4):313–7. Howard FM, Perry CP, Carter JE, et al. Pelvic pain diagnosis and management. Philadelphia: Lippincott Williams & Wilkins; 2000. ISBN 0-7817-1724-8. Newman DK. Pelvic floor muscle rehabilitation using biofeedback. Urol Nurs. 2014;34(4):193–202. Poterucha TJ, Murphy SL, Rho RH, et al. Topical amitriptyline-ketamine for treatment of rectal, genital, and perineal pain and discomfort. Pain Physician. 2012;15(6):485–8. Kroenke K, Krebs EE, Bair MJ. Pharmacotherapy of chronic pain: a synthesis of recommendations from systematic reviews. Gen Hosp Pyschiatry. 2009;31:206–19. Van Ophoven A, Hertle L. Long-term results of amitriptyline treatment of interstitial cystitis. J Urol. 2005;174:1837–40. Dawson TE, Jamison J. Intravesical treatments for painful bladder syndrome/interstitial cystitis. Cochrane Database Syst Rev. 2007;4:CD006113. Cervigni M, Natale F, Natasa L, et al. A combined intravesical therapy with hyaluronic acid and chondroitin for refractory painful bladder syndrome/interstitial cystitis. Int Urogynecol J. 2008;19:943–7. Toft BR, Nordling J. Recent developments of intravesical therapy of painful bladder syndrome/interstitial cystitis: a review. Curr Opin Urol. 2006;16:268–72. American Urological Association Guideline. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome. 2014. https://www.auanet.org/education/guidelines/ic-bladder-pain-syndrome.cfm. Plancarte R, Amescua C, Patt RB, et al. Superior hypogastric plexus block for pelvic cancer pain. Anesthesiology. 1990;73:236–9. de Leon-Casasola OA, Kent E, Lema MJ. Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Pain. 1993;54(2):145–51. Ghoneim AA, Mansour SM. Comparative study between computed tomography guided superior hypogastric plexus block and the classic posterior approach: a prospective randomized study. Saudi J Anaesth. 2014;8(3):378–83. Mishra S, Bhatnagar S, Rana SP, et al. Efficacy of the anterior ultrasound-guided superior hypogastric plexus neurolysis in pelvic cancer pain in advanced gynecological cancer patients. Pain Med. 2013;14(6):837–42. Plancarte R, de Leon-Casacola OA, El-Helaly M, et al. Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Reg Anesth. 1997;22:562–8. Schutz DM. Inferior hypogastric plexus blockade: a transsacral approach. Pain Physician. 2007;10(6):757–63. Foye P, Buttaci C, Stitik T. Successful injection for coccyx pain. Am J Phys Med Rehabil. 2006;85(9):783–4. Johnston PJ, Michalek P. Blockade of the ganglion impar (walther), using ultrasound and a loss of resistance technique. Prague Med Rep. 2012;113(1):53–7. Wemm Jr K, Saberski L. Modified approach to block the ganglion impar (ganglion of Walther). Reg Anesth. 1995;20(6):544–5. Ahmed DG, Mohamad MF, Mohamad SA. Superior hypogastric plexus combined with ganglion impar neurolytic blocks for pelvic and/or perineal cancer pain relief. Pain Physician. 2015;18:E49–56. Whitemore KE, Payne CK, Diokno AC, et al. Sacral neuromodulation in patient with interstitial cystitis: a multicenter clinical trial. Int Urogynecol J. 2003;14:305–9. Seigel S, Paszkiewicz E, Kirkpatrick C, et al. Sacral nerve stimulation in patient with chronic intractable pelvic pain. J Urol. 2001;166:1742–5. Everaert K, Devulder J, De Muynk M, et al. The pain cycle: implications for the diagnosis and treatment of pelvic pain syndromes. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12:9–14. Peters KM, Killineger KA, Boguslawski BM, et al. Chronic pudendal neuromodulation: expanding available treatment options for refractory urologic symptoms. Neurourol Urodyn. 2010;29(7):1267–71. Bolash R, Vrooman B. Chapter sympathetic blocks for chronic abdominal pain. In: Kapural L, editor. Chronic abdominal pain: an evidence based, comprehensive guide to clinical management. New York: Springer; 2015. p. 143–52. Scott-Warren JT, Hill V, Rajasekaran A. Ganglion impar blockade: a review. Curr Pain Headache Rep. 2013;17:306. Reissing ED, Brown C, Lord MJ, et al. Pelvic floor muscle functioning in women with vulvar vestibulitis syndrome. J Psychosom Obstet Gynecol. 2005;26(2):107–13. Carrico DJ, Peters KM. Vaginal diazepam use with urogenital pain/pelvic floor dysfunction. Urol Nurs. 2011;31(5):279–84. Crisp CC, Vacarro CM, Estanol MV, et al. Intra-vaginal diazepam for high-tone pelvic floor dysfunction: a randomized placebo-controlled trial. Int Urogynecol J. 2013;24(11):1915–23. Rogalski MJ, Kellog-Spadt S, Hoffman AR, et al. Retrospective chart review of vaginal diazepam suppository use in high-tone pelvic floor dysfunction. Int Urogynecol J. 2010;21(7):895–9. Author information Authors and Affiliations Corresponding author Editor information Editors and Affiliations Rights and permissions Copyright information © 2017 Springer International Publishing Switzerland About this chapter Cite this chapter Ramsook, R.R., Nampiaparampil, D.E., Mogilevksy, M. (2017). Rehabilitation of the Pelvis and Pelvic Floor. In: Sabia, M., Sehdev, J., Bentley, W. (eds) Urogenital Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-45794-9_9 Download citation DOI: https://doi.org/10.1007/978-3-319-45794-9_9 Published: Publisher Name: Springer, Cham Print ISBN: 978-3-319-45792-5 Online ISBN: 978-3-319-45794-9 eBook Packages: MedicineMedicine (R0)

Text is read by the "Ask this paper" AI Q&A widget below. Extraction quality varies by source — PMC NXML preserves structure cleanly, OA-HTML may include some navigation residue, and OA-PDF can have broken hyphenation. The publisher copy (via DOI) is the canonical version.

My notes (saved in your browser only)

Ask this paper AI returns verbatim quotes from the full text · source: oa-doi-fallback

Answers must be backed by verbatim quotes from this paper's full text. Hallucinated quotes are dropped automatically; if no verbatim passage answers the question, we say so. How this works

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (47)

Source provenance

openalex
last seen: 2026-06-10T17:14:06.276822+00:00
License: CC0 · commercial use OK