Causes of Chronic Pelvic Pain Syndrome

There are many etiologies and pathogenesis of chronic pelvic pain syndrome(CPPS), which is more likely to be the cascade amplification effect under the initial inducer. CPPS is the result of the interaction of mental factors, immune disorders, neurological disorders, and endocrine disorders.

 

1. Peripheral visceral pain

 

In the early stage of CPPS, there may be inflammation or infection. The change of peripheral tissue leads to the increase of sensitivity of receptors, which enlarges the incoming harmful stimulation signals. The increased release of chemical neurotransmitters results in the change of many neurotransmitter receptors, the decrease of a threshold value or the increase of sensitivity to external stimulation, and there is continuous pain in the peripheral organs without pathology.

 

2. Central sensitization

 

Many of the pathogenesis of CPPS is based on the central nervous system, which is closely related to sensory, functional, behavioral, and psychological changes. The changes in protein activity, protein transcription level, and structure in the process of neural connection are involved in the process of central sensitization. 

 

Repeated stimulation of pain afferent fibers increases intracellular calcium concentration, reduces the excitation threshold of secondary neurons, and more signals are transmitted to higher centers. 

 

Calcium ion can enhance the phosphorylation of amino acids under the action of kinase, change the protein structure, reduce the threshold of channel opening, extend the channel opening time, and enlarge the role of stimulation in these neurons. Central sensitization can be produced by slight physical (touch) or visceral (bladder urine storage) stimulation.

 

3. Psychological and neural regulation

 

Pain is not only related to the activation of complex sensory impairment but also an emotional response. Pain is an unpleasant feeling and emotional experience associated with actual or potential tissue damage. The psychological process that affects emotions, thoughts, and behaviors is a network, not a specific area. Many areas closely related to psychological activities, interact with the aqueduct of the midbrain, which affects the transmission of pain at the spinal level.

 

All kinds of psychological processes can affect the nerve regulation of pain at a higher level, and can also adjust the response to the harmful information. In a short period of time, this kind of psychological regulation may reduce harmful stimulation. 

 

If exposed to this stimulation for a long time, it will enhance through a long period of time, which will lead to the long-term easy perception of chronic visceral pain stimulation and enhance the sensitivity of the sensory stimulation. Depression may be a consequence, not a cause of persistent pain.

 

 

4. Sexual behavior

 

No matter male or female pelvic pain will lead to sexual dysfunction, the reasons are multifaceted and interactive, which may be related to the combination of depression, antidepressant use, marital relationship, and other factors. Pain can affect a person's self-esteem, affect people's ability to get pleasure from sex and sexual relations. Pelvic pain can affect sexual response, hinder freedom of movement, and male functional problems can also affect their sexual partners.

 

Pain reverses sexual arousal, causing weakness of the penis in men or stopping the secretion of synovial fluid in women. Chronic pain can reduce the frequency of sexual activity and sexual satisfaction, but also reduce the satisfaction of the relationship between husband and wife. A study in the UK showed that 73% of chronic pain patients had pain-related and varying degrees of sexual function problems.

 

In China, 1768 patients with prostate pain syndrome (PPS) had a general prevalence of sexual dysfunction of 49%. Premature ejaculation and ED were the most common. In Italy, Turkey, and Finland, the incidence of ED was 27.4%, 15.2%, and 43%, respectively, and the prevalence of sexual dysfunction was high. Patients who suffer from sexual, physical, or emotional abuse are more likely to develop CPPSsymptoms.

 

5. Pelvic floor function and chronic pelvic pain

 

The pelvic floor is composed of muscle and fascia. It has three functions: support, contraction, and relaxation. The relationship between pelvic pain and the dysfunction of pelvic floor muscles, especially the overactivity of pelvic floor muscles, is cause and effect. The dysfunction of the pelvic floor caused by the central nervous system may be one of the main mechanisms of chronic pelvic pain. 

 

There are trigger points in myofascial, which are high-stress points on hypermyofasciae. They are closely related to pain and have the characteristics of pain when stretching muscles. The trigger point aggravates the pain when the pressure increases, continues, or repeatedly contracts. The deformity of buttocks or lower limbs, sexual abuse, trauma, abnormal movement or sexual activity, repeated infection and surgical operation can lead to the increased stress of myofascial trigger point, which is the susceptible factor of pain.

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