How should I approach the assessment and management of a patient presenting with chronic pelvic pain?

Assessment:

• Offer a person-centred assessment to identify factors contributing to the chronic pelvic pain and how it affects the patient's life, involving the patient actively in discussions and shared decision making.
• Take a detailed history including symptoms related to pelvic floor dysfunction (urinary incontinence, bowel symptoms, sexual dysfunction), and consider relevant comorbidities or recent childbirth.
• Conduct a focused clinical examination and investigations to exclude secondary causes such as pelvic masses, neurological disease, urinary tract infection, medication side effects, diabetes, cancer, fistula, inflammatory bowel or bladder conditions, and endometriosis.
• Consider digital information sources to support patient understanding and self-management.
• Recognise that chronic pelvic pain may be due to chronic primary pain (no clear underlying cause) or chronic secondary pain (with an identifiable cause), and these can coexist. Re-evaluate diagnosis over time if symptoms change.

Management:

• Develop a collaborative management plan with the patient, considering multidisciplinary input including physiotherapists, continence advisors, and specialist pelvic floor teams.
• Consider referral to specialist services if endometriosis is suspected, or if complex pelvic floor dysfunction is present, ensuring access to multidisciplinary pain management and specialist imaging.
• Provide tailored information and support, including symptom diaries for conditions like endometriosis, and involve family or partners if the patient agrees.
• Use non-surgical management strategies such as pelvic floor muscle training, behavioural interventions, medication review, and community-based multidisciplinary team support.
• Ensure ongoing review and adjustment of the care plan, recognising the long-term nature and psychosocial impact of chronic pelvic pain.

These approaches align with NICE guidelines on chronic pain, pelvic floor dysfunction, and endometriosis management, ensuring a comprehensive, person-centred, and multidisciplinary approach to chronic pelvic pain assessment and management ¹,²,³.