Chronic Pelvic Pain

Chronic pelvic pain affects about 1 in 7 women. Find out what causes it and how to treat it.

Women who have experienced pelvic pain for six months or longer may be diagnosed with chronic pelvic pain syndrome. The first step to a proper diagnosis is to visit your healthcare provider and begin a frank discussion of your symptoms.

In the United States, it’s estimated that chronic pelvic pain affects about 1 in 7 women and roughly 10 percent of referrals to gynecologists are for pelvic pain.

Sometimes, chronic pelvic pain is a symptom of another underlying previously undiagnosed condition or can actually be a condition on its own. For instance, pain can be coming from a gynecological condition such as fibroids or endometriosis or from a condition of the bowels or urinary tract. In some cases, it may be myriad of problems that result in pelvic pain.

The symptoms of pelvic pain can vary but are generally situated in the pelvic region of the abdomen below the belly button and above the hipbones. The pain may be a dull ache or severe and steady pain. The pelvis can feel heavy or have a sensation of pressure.

The pain can be intermittent or constant. Sometimes the pain can feel like cramping. Often times, the pain will be exacerbated with sexual intercourse, urinating, or bowel movements. For some, prolonged periods of sitting may intensify the pain.

Reporting these types of symptoms can help your healthcare provider try to systematically narrow in on what may be the underlying cause of pelvic pain. Some of the more common causes of chronic pelvic pain includes: fibroids, endometriosis, chronic pelvic inflammatory disease or PID, ovarian cysts, interstitial cystitis, irritable bowel syndrome or IBS, urinary tract infections, pelvic congestion syndrome, musculoskeletal issues and psychological factors.

Of course, some women may suffer from one or more of these conditions thus complicating the diagnosis. If your symptoms seem to be more related to gastrointestinal issues, you may be referred to a gastroenterologist who can begin the evaluation.

If your symptoms seemed to point more to a gynecological or urinary condition, you may need to be evaluated by a gynecologist who specializes in female reproductive organs. One of the most common gynecological causes of pelvic pain is endometriosis.

This condition involves uterine tissue that grows outside of the uterus and will respond to menstrual cycles causing possible scarring and adhesions that will result in pain. A gynecologist will perform a pelvic exam and may order an ultrasound or MRI to further pinpoint a diagnosis.

If these tests are pointing to endometriosis, a gynecologic surgeon may perform a laparoscopy to get a conclusive diagnosis. A laparoscopy is when a laparoscope, which is a thin surgical instrument with a tiny camera on the end, is inserted into the abdomen through a small incision, and the surgeon visually explores the internal organs, such as the uterus, fallopian tubes, bladder, ovaries, and bowels to find scarring and lesions of endometriosis.

Many times, the surgeon will be able to remove the endometriosis during the procedure, and hopefully this can alleviate the pain after a period of recovery.

Another common gynecological condition that causes pelvic pain is uterine fibroids, and again a laparoscopy can be used to make a definitive diagnosis. If the fibroids are small enough they may be removed during the procedure or may require additional medical treatment or possibly a hysterectomy (removal of the uterus) if not responsive to treatment.

Sexually transmitted bacteria cause pelvic inflammatory disease or PID, which is an infection of the female reproductive organs, such as the vagina, uterus, fallopian tubes, and ovaries. Blood tests, urinalysis, ultrasound, and possibly a laparoscopy may be needed to accurately diagnose PID.

Treatment involves taking a course of antibiotics and temporary abstinence of sexual intercourse. Treatment also involves treatment of sexual partner to avoid a reoccurrence.

Diseases of the urinary tract that may cause pelvic pain may include recurrent urinary tract infections that will be treated with antibiotics and may require prophylactic treatment to keep infections at bay.

Interstitial cystitis or IC is a condition of painful bladder often accompanied by the sometimes frequent and urgent need to urinate. The exact cause of IC is unknown, and often it’s diagnosed only after ruling out other known urinary conditions. It is much more common in women than men and may be worsened by menses and sexual intercourse.

Many times IC is treated medically with medications, bladder training, or pelvic physical therapy, and sometimes a procedure called bladder instillation that introduces various medications into the bladder for a short time before being expelled.

The treatment protocol varies by patient, but some require weekly treatments over months and then receive maintenance treatments to keep the symptoms from reoccurring. In rare cases, IC may need to be treated with surgery.

Sometimes, a clear cause of chronic pelvic pain may elude a succinct diagnosis, and a healthcare provider may evaluate a patient for possible psychological factors.

The physical manifestation of pain may have an underlying psychological cause such as depression or prior physical or sexual abuse. As with many chronic pain conditions, emotional anxiety and stress will intensify the pain and make treatment more difficult.

Chronic pelvic pain can be challenging to diagnose but is certainly treatable. With the proper healthcare provider and perseverance, chronic pelvic pain can be managed and treated to bring relief to many women who suffer from its grip.

Timothy J. Hardy, M.D.

Dr. Timothy Hardy, M.D. has been practicing medicine in the community for many years. He received his medical degree from Eastern Virginia Medical School and founded his own practice, Atlantic OB-GYN, in 1990, where he has been providing women with exceptional care ever since. Website: www.atlanticobgyn.com
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