Chronic Pelvic Pain
1 in 3 women of child-bearing age experiences chronic pelvic pain.
Chronic pelvic pain is discomfort that occurs in the lower abdomen (below the belly button) for at least six months. There are many factors that can cause this pain and your symptoms may be different from someone else with this condition. That’s why it’s important to work with the right pelvic health specialist to develop a care plan for you.
Understanding Chronic Pelvic Pain
Your pelvic pain symptoms may be uniquely different from someone else suffering from chronic pelvic pain. Patients who suffer from pelvic pain often experience (and describe) symptoms like:
- Pain over the entire pelvic area rather than a single spot
- Severe and steady pain or intermittent pain (it comes and goes)
- Dull aching pain or sharp pains/cramping
- Pressure or heaviness deep within the pelvis
- Pain in the back of the abdominal wall, lower back and/or buttocks
- Pain during or after intercourse
- Pain while having a bowel movement or urinating
- Pain when sitting or standing for long periods of time
- Pain so severe that they miss work, can’t sleep or engage in physical activity like exercise.
Because a number of different conditions can cause chronic pelvic pain, it is sometimes difficult to pinpoint the specific cause. A variety of gynecologic, gastrointestinal, neurologic, urologic, musculoskeletal and body-wide disorders can cause chronic pelvic pain in women, including:
- Menstrual cramps: severe cramping before or during menstruation
- Endometriosis: a condition in which the tissue that normally lines the uterus grows on the ovaries, bladder or other organs
- Pelvic Congestion Syndrome: (also known as nutckracker syndrome) is enlarged, varicose-type veins around your uterus and ovaries may result in pelvic pain.
- Uterine Fibroids: noncancerous, firm, compact tumors made of smooth muscle cells and fibrous connective tissue, that grow in the uterus
- Cancers of the reproductive organs: cancer that starts in a woman's reproductive organs—cervical, ovarian, uterine, vaginal and vulvar. If cancer is found during an evaluation, you will be referred to a gynecologist-oncologist (a physician who specializes in diagnosing and treating cancers that are located on a woman’s reproductive organs) for further evaluation and treatment.
- Pelvic floor disorder (PFDs): a group of conditions that affect the pelvic floor—the muscles, ligaments and connective tissue in the lowest part of the pelvis. The pelvic floor supports pelvic organs including the bowel, bladder, uterus, vagina, and rectum. The pelvic floor prevents these organs from falling down or out of a woman’s body.
- Abdominal myofascial pain (trigger points): pain that originates from the muscles of the abdominal wall due to myofascial pain. This common type of pain occurs when the muscles in the abdominal wall, pelvic floor and lower back aren’t working properly, are too sensitive or contract too much. Often there are small localized areas of abnormal tenderness of the abdominal muscles that are called trigger points.
- Interstitial cystitis: an inflammation of the bladder that may cause urinary urgency or pelvic pain. If this condition is found to be the cause of pelvic pain, the patient is referred to a urologist.
- Musculoskeletal problems: conditions affecting your bones, joints and connective tissues (musculoskeletal system). Fibromyalgia, pelvic floor muscle tension, inflammation of the pubic joint (pubic symphysis) or hernia can cause pelvic pain.
- Psychological factors: depression, chronic stress or a history of sexual or physical abuse may increase your risk of chronic pelvic pain. Emotional distress makes pain worse, and living with chronic pain contributes to emotional distress.
To help correctly diagnosis the cause of your pelvic pain, one of several examinations or procedures may be performed:
- History and physical examination: A thorough history and a physical examination of the abdomen and pelvis may be needed for an accurate diagnosis.
- Pelvic exam: A pelvic exam can reveal signs of infection, abnormal growths or tense pelvic floor muscles. The doctor will check for areas of tenderness. Let your doctor know if you feel any discomfort during this exam, especially if the pain is similar to the pain you've been experiencing.
- Pelvic ultrasound: Some diagnostic procedures, including a pelvic ultrasound examination, may also be helpful in identifying the cause of chronic pelvic pain. Pelvic ultrasounds are generally accurate in detecting pelvic masses, ovarian cysts or ovarian endometriosis and uterine fibroids.
- X-ray: Electromagnetic energy used to produce images of bones and internal organs onto film.
- Computed tomography (CT or CT scan): This is an imaging test that uses X-rays and a computer to make detailed images of the body. A CT scan shows details of the bones, muscles, fat, organs and any abnormalities that may not show up on an ordinary X-ray.
- Magnetic resonance imaging (MRI): A noninvasive procedure that produces a two-dimensional view of an internal organ or structure.
- Laparoscopy: A minor surgical procedure in which a laparoscope, a thin tube with a lens and a light, is inserted into an incision in the abdominal wall. The laparoscope allows your doctor to view your pelvic organs and check for abnormal tissues or signs of infection. This procedure is especially useful in detecting endometriosis and chronic pelvic inflammatory disease.
There are multiple possible treatments, surgical and nonsurgical, for chronic pelvic pain. The goal of treatment is to reduce symptoms and improve quality of life. Because of the many causes of pelvic pain, it’s important to find a board-certified, fellowship-trained gynecologist who specializes in treating chronic pain and minimally invasive gynecologic surgery. For many women, the optimal approach involves a combination of treatments:
- Medications: Depending on the cause, your doctor may recommend a number of medications including pain relievers, hormone treatments, antibiotics and neuromodulating medications (includes some anti-depressants and anti-seizing medications).
- Physical therapy: Stretching exercises, massage and other relaxation techniques may improve your chronic pelvic pain. A physical therapist can assist you with these therapies and help you develop coping strategies for the pain.
- Trigger point injections: If your doctor finds specific points where you feel pain, you may benefit from having a numbing medicine injected into those painful spots (trigger points). The medicine, usually a long-acting local anesthetic, can block pain and ease discomfort.
- Psychotherapy: It may be helpful to talk with a psychologist or psychiatrist if your pain is intertwined with depression, sexual abuse, a personality disorder or other mental/behavioral condition. There are different types of psychotherapy, such as cognitive behavioral therapy and biofeedback, which can help you develop strategies for coping with the pain.
- Surgery: To correct an underlying problem that causes chronic pelvic pain, your doctor may recommend a surgical procedure.
- Laparoscopic surgery: Less invasive surgeries are performed laparoscopically. Your surgeon inserts a slender viewing instrument (laparoscope) through a small incision near your navel and inserts instruments to view and remove tissue through one or more additional small incisions.
- Hysterectomy: In rare complicated cases, and after discussing benefits and risks, your doctor may recommend removal of your uterus (hysterectomy), fallopian tubes (salpingectomy) or ovaries (oophorectomy).
Talk to a specialist; call 567-585-0240 to request an appointment today.