Chronic Pelvic pain
What is chronic pelvic pain?
Chronic pelvic pain can be defined as intermittent or constant pain in the lower abdomen or pelvis of a woman persisting for a period of 6 months or more, not occurring exclusively with menstruation or intercourse and not associated with pregnancy.
Chronic pelvic pain can have multiple causes. It can be a symptom of another disease, or it can be a condition on its own.
If your chronic pelvic pain appears to be caused by another medical problem, treating that problem may be enough to eliminate your pain.
However, in many cases it’s not possible to identify a single cause for chronic pelvic pain. In that case, the goal of treatment is to reduce your pain and other symptoms and improve your quality of life.
What are the symptoms?
The symptoms can include severe and steady pain or a dull ache that comes and goes. Sometimes it can be felt as pressure or heaviness deep within your pelvis
In addition, you may experience pain during intercourse, pain while having a bowel movement or urinating or pain when you sit for long periods of time.
Your discomfort may intensify after standing for long periods and may be relieved when you lie down. The pain may be mild and annoying, or it may be so severe that you miss work, can’t sleep and can’t exercise.
What are the causes?
Chronic pelvic pain is a complex condition that can have multiple causes. Sometimes, a single disorder may be identified as the cause.
Some causes of chronic pelvic pain include:
Endometriosis/ Adenomyosis. This is a condition in which tissue from the lining of your womb (uterus) grows outside your uterus or in to the wall of the womb.
Chronic pelvic inflammatory disease. This can occur if a long-term infection, often sexually transmitted, causes scarring that involves your pelvic organs.
Ovarian remnant. After surgical removal of the uterus, ovaries and fallopian tubes, a small piece of ovary may accidentally be left inside and later develop in to painful cysts.
Adhesions or scarring which can form after surgery or infection can cause pain.
Fibroids These noncancerous uterine growths may cause pressure or a feeling of heaviness in your lower abdomen. They rarely cause sharp pain unless they become deprived of a blood supply and begin to degenerate.
Irritable bowel syndrome can be a cause of pelvic pain and pressure.
Painful bladder syndrome (interstitial cystitis). This condition is associated with recurring pain in your bladder and a frequent need to urinate. You may experience pelvic pain as your bladder fills, which may improve temporarily after you empty your bladder.
Tension in your pelvic floor muscles. Spasms or tension in the pelvic floor muscles can lead to recurring pelvic pain.
Prolapse of the womb. It usually causes dragging sensation.
Psychological factors. Depression, chronic stress or a history of sexual or physical abuse may increase your risk of chronic pelvic pain. Emotional distress makes the pain worse, and living with chronic pain contributes to emotional distress. These two factors often become a vicious cycle.
What tests are required?
Since many different disorders can cause pelvic pain, a detailed history and assessment, is required to reach a diagnosis.
Pelvic exam. This can reveal signs of infection, abnormal growths or tense pelvic floor muscles. It may be useful for assessment of any localised tender spots.
Lab tests. You may need screening for infections, such as chlamydia or gonorrhoea. Blood tests and urinalysis may also be needed.
Ultrasound. This procedure is especially useful for detecting masses or cysts in the ovaries, uterus or fallopian tubes.
Other imaging tests. Additional tests may be needed like abdominal X-rays, computerized tomography (CT) scans or magnetic resonance imaging (MRI) to help detect abnormal structures or growths.
Laparoscopy. 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.
What treatment options are available?
The goal of treatment is to reduce symptoms and improve quality of life. If a specific cause is found, treatment will focus on that cause. However, if a cause can’t be identified, treatment will focus on managing your pain and other symptoms. For many women, the optimal approach involves a combination of treatments.
Pain relievers. Over-the-counter pain remedies, such as Aspirin and Ibuprofen may provide partial relief from your pelvic pain.
Hormonal treatment. Women with cyclical pain are offered a therapeutic trial using hormonal treatment for a period of 3–6 months before having a diagnostic laparoscopy. Ovarian suppression can be an effective treatment for cyclical pain associated with endometriosis. The effect can be achieved with the combined oral contraceptive, progestogens, danazol or GnRH analogues, all of which are equally effective but have differing adverse effect profiles. The levonorgestrel-releasing intrauterine system (Mirena) could also be considered.
Women with IBS are offered a trial with antispasmodics. You will be encouraged to amend your diet to attempt to control symptoms.
Antibiotics. If an infection is the source of your pain, you may be prescribed antibiotics.
Antidepressants. Some types of antidepressants can be helpful for chronic pain. Tricyclic antidepressants, such as amitriptyline seem to have pain-relieving as well as antidepressant effects. They may help improve chronic pelvic pain even in women who don’t have depression.
To correct an underlying problem that causes chronic pelvic pain,
Laparoscopic surgery. Adhesions can be released and endometriosis can be treated laparoscopically. If the pain is attributed to ovarian cysts or fibroids, these can be removed laparoscopically in majority of the cases.
Hysterectomy. In rare complicated cases, you may be recommended removal of your uterus (hysterectomy), fallopian tubes (salpingectomy) or ovaries (oophorectomy). There are important health consequences to having this procedure.
Nonpharmacological modalities such as transcutaneous nerve stimulation, acupuncture and other complementary therapies may be helpful for some women. Dietary modification may also relieve pain.
Stretching exercises, massages and other relaxation techniques may improve your chronic pelvic pain.
Chronic pain can also cause anxiety and stress, which in turn may worsen your pain. Relaxation techniques can help release tension, reduce pain, calm emotions and induce sleep. Many techniques can be learned on your own, such as meditation and deep breathing.