What is Chronic Pelvic Pain?
Chronic pelvic pain refers to pain in the region below the navel and between the hips (suprapubic or lower abdominal region) that last for over six months. It can be a condition or a symptom of a variety of other diseases such as irritable bowel syndrome, non-specific chronic fatigue syndromes, and mental health disorders.
Chronic pelvic pain can cause significant distress and impact one’s quality of life. As with any chronic pain problem, it can be difficult to determine when to see a doctor. However, if your symptoms worsen or when it starts to disrupt daily activities, consult a doctor for proper evaluation and treatment.
What are the symptoms of Chronic Pelvic Pain?
The main symptom of chronic pelvic pain is persistent pain in the pelvic area that lasts for at least six months. The type, frequency, and intensity of pain vary among affected individuals.
The pain can be described as severe and steady, intermittent, dull aching, sharp pain, or feeling of heaviness deep in the pelvis. In addition, pelvic pain may be experienced during or following activities such as sexual intercourse, urinating or bowel movement, or sitting for a long period of time.
You should see a doctor if you experience any of the bothersome symptoms related to pelvic floor dysfunction, such as a change in evacuation and voiding effort. Although urinary and faecal incontinence are not life-threatening, they can worsen over time and result in more discomfort
What causes Chronic Pelvic Pain?
Chronic pelvic pain is a complex condition and the causes are often multifactorial. It can be a manifestation of other underlying medical conditions or a standalone condition by itself. The more common causes are related to the gynaecological, gastrointestinal, musculoskeletal, urological, psychological, and neurological systems.
Gynaecological causes
- Endometriosis: It is a condition where tissue that normally lines the inside of the uterus grows outside the uterus. The pain varies with the menstrual cycle but typically intensifies towards the period and slowly declines during menstruation.
- Chronic pelvic inflammatory disease: It is an infection of the female reproductive organs, including the uterus, fallopian tubes, and ovaries. The disease may take the form of adhesions or modification in the behaviour of the nerves, leading to or contributing to pelvic pain.
- Pelvic adhesions: Peritoneal adhesions might cause pelvic pain, especially with stretching movements or organ distension.
Gastrointestinal causes
- Irritable bowel syndrome: It is the most common cause of pain in women of reproductive age that arises from the bowel. It is a functional disease that results in pain which is relieved by defecation.
Musculoskeletal causes
- Mechanical pelvic pain: Pelvic pain can result from pregnancy or trauma. It may arise from the joints or associated muscle spasms. The pain varies with different movements and postures and may worsen towards the end of the day.
- Pelvic pain posture: This is a condition that arises mainly due to abnormal posture. Poor posture due to a sedentary lifestyle or otherwise may result in muscle tension and strain on joints and ligaments, leading to pain.
Urological causes
- Interstitial cystitis: It is an inflammatory condition not caused by infection and is characterised by pain and bladder symptoms. The pain intensifies as the bladder fills and is relieved by passing urine.
Neurological causes
- Nerve entrapment: Nerves that are trapped in scar tissue or fascia may result in pain in the scar area or in the distribution of the nerve. The pain tends to be sharp in nature and may worsen by specific movements.
- Neuropathic pain: Neuropathic pain refers to pain that results from a damaged nerve rather than damaged tissue. Damaged nerves may act abnormally leading to altered sensation.
What can I expect during my first consultation?
The first consultation generally begins with taking a detailed medical history to understand your condition better. This involves questions regarding your symptoms and pain mapping to assess the location of the pain. Any association between pain and menses, urination, bowel movement, and sexual activity will be recorded as well.
A physical examination may also be performed, including a pelvic exam. Your urologist may suggest other imaging tests and exams to rule out other underlying reproductive, urologic, and gastrointestinal conditions.
How is Chronic Pelvic Pain diagnosed?
After getting a detailed medical history, various physical examinations may be carried out to identify tissues, nerves, or organs that give rise to the pain symptoms in order to determine the underlying cause.
Tests for chronic pelvic pain include a pelvic examination, lab tests, ultrasound, magnetic resonance imaging, and laparoscopy.
- Pelvic examination — The pelvic exam is conducted by inserting a single finger into the pelvic area to identify structures related to focal tenderness. The pelvis is also examined for any trigger points, vaginal discharge, and pelvic organ prolapse.
- Laboratory tests — Lab tests will include full blood count, erythrocyte sedimentation rate, etc.
- Ultrasound — Pelvic ultrasonography is performed to exclude any anatomic abnormalities. Transvaginal ultrasonography can help to detect any pelvic masses and adenomyosis.
- Magnetic resonance imaging (MRI) — MRI of the pelvis may be used to detect the abnormality detected on ultrasonography.
- Laparoscopy — It is a surgical procedure done under general anaesthesia and may be useful to confirm endometriosis or pelvic adhesions.
- Urinalysis — A urinalysis assessment can be done to determine if the pelvic pain is caused by a urinary tract infection or sexually transmitted disease.
Can Chronic Pelvic Pain be cured?
There is limited evidence for curative treatment of chronic pelvic pain. However, there are various treatment options available that can help to reduce and manage pain effectively. The prognosis for chronic pelvic pain is often poor due to its complexity but the treatment of the underlying causes can lead to improvement in quality of life.
How is Chronic Pelvic Pain treated?
The treatment for chronic pelvic pain largely depends on the cause of the pain, its intensity and frequency. A holistic treatment approach is best. Some of these are:
Medications
- Pain relievers — Over-the-counter pain-relieving medications such as non-steroidal anti-inflammatory drugs (NSAIDs) may help to provide adequate relief from pelvic pain and are generally well tolerated.
- Hormone treatment — For cases where pelvic pain coincides with a certain phase of the menstrual cycle, birth control pills and other hormonal medications may help to relieve pelvic pain.
- Antibiotics — If the cause of pelvic pain is due to infections, taking antibiotics may help to relieve the pain.
Therapies
- Physical therapy —Stretching, massage, and other relaxation techniques such as acupuncture and acupressure can help to relieve specific muscle tightness. Pelvic floor physical therapy can be considered when there is pelvic floor tenderness.
- Neurostimulation — This treatment involves blocking nerve pathways so that the pain signal will not be able to reach the brain. Neuromodulation of sacral nerves may also be useful in relieving pain.
- Trigger point injections — A numbing local corticosteroid can be injected into painful spots, also known as trigger points, to ease pain and discomfort.
- Neurotoxin injection— When injected into the bladder, intravesical neurotoxin has been used to reduce pain for patients.
Behavioural interventions
Maintaining good posture and regular exercise may help to reduce pelvic pain. Somatocognitive therapy, a mixture of psychotherapy and physiotherapy, can help to promote awareness of the body and develop coping strategies to release muscular pain.
Surgery
Surgical interventions such as laparoscopic surgery and hysterectomy may be helpful to treat underlying conditions that cause pelvic pain. Laparoscopic surgery is commonly performed for endometriosis which has been shown to improve pain.
Summary
Chronic pelvic pain can be a disabling condition that has a negative impact on quality of life and overall function. The causes of chronic pelvic pain are often difficult to identify and manifest due to other underlying medical conditions such as interstitial cystitis.
If you experience chronic pain, along with other urological symptoms, please schedule an appointment for a proper diagnosis and treatment.
