This systematic review addresses the pathophysiology, diagnostic evaluation, and treatment of several chronic pain syndromes affecting the pelvic organs: chronic proctalgia, coccygodynia, pudendal neuralgia, and chronic pelvic pain. Chronic or recurrent pain in the anal canal, rectum, or other pelvic organs occurs in 7% to 24% of the population and is associated with impaired quality of life and high health care costs. However, these pain syndromes are poorly understood, with little research evidence available to guide their diagnosis and treatment. This situation appears to be changing: a recently published large randomized, controlled trial by our group comparing biofeedback, electrogalvanic stimulation, and massage for the treatment of chronic proctalgia has shown success rates of 85% for biofeedback when patients are selected based on physical examination evidence of tenderness in response to traction on the levator ani muscle--a physical sign suggestive of striated muscle tension. Excessive tension (spasm) in the striated muscles of the pelvic floor appears to be common to most of the pelvic pain syndromes. This suggests the possibility that similar approaches to diagnostic assessment and treatment may improve outcomes in other pelvic pain disorders.

The clinical syndrome of chronic prostatitis ranges from well-defined chronic bacterial infections to poorly defined chronic pelvic pain syndrome (CPPS), previously referred to as "prostatodynia" or "abacterial prostatitis." Faced with the obscure nature of the disease, its protracted course, and the poor response to oral medication, urologists have considered alternative routes of drug administration. We review the indications and outcomes of local drug infiltration (intraprostatic antibiotic and zinc, intrasphincteric botulinum toxin A, pudendal nerve blocks) and discuss their potential use and benefit in the treatment of chronic prostatitis syndromes.