Chronic pelvic pain and the role of pain of bladder origin: changing the paradigm to improve clinical outcomes.

Chronic pelvic pain (CPP) affects more than 9 million women in the United States and results in a considerable medical, social and economic toll on affected women and their families. CPP can have multiple causes, and its diagnosis can be especially problematic for clinicians. Gynecologists who care for such women have historically evaluated and treated this condition with a gynecological perspective, considering nongynecologic causes only in selected and sometimes extreme situations. Indeed, such an approach can lead to extirpative surgery, a situation that frequently fails to reduce or eliminate the pain. More recent work clearly demonstrates the important role of nongynecologic causes of CPP, most notably, pain of bladder origin. This paper reviews the role of the bladder in the diagnosis and treatment of CPP and provides suggestions for integrating the assessment and treatment of CPP of bladder origin into the care provided by gynecologists so as to improve clinical outcomes.