Chronic Pelvic Pain

Chronic pelvic pain is any pain in the pelvic region that usually lasts six months or more. The pain can be either continuous or intermittent. It can be a dull ache or it can be sharp and cramping, and it ranges from mild and annoying to pain so intense that it interferes with work, sleep, exercise, and other activities of daily life.

The pain may be especially bad during sexual intercourse or when performing certain motions, like having a bowel movement or sitting down. The discomfort may increase after standing for long periods, and lying down may provide relief.

Gynecologic problems, gastrointestinal disorders, and urologic conditions can cause chronic pelvic pain. Psychological factors can also contribute to the pain.

Some causes of chronic pelvic pain include:

  • Endometriosis. This is a condition in which tissue from the lining of the uterus grows outside of the uterus. This can lead to scar tissue (adhesions) and pain during intercourse or menstruation.
  • Spasms or tension of the muscles in the pelvis.
  • Chronic pelvic inflammatory disease (PID). PID, which is caused by sexually transmitted diseases, can cause scarring in the organs of the pelvis if left untreated.
  • Pelvic congestion syndrome. Caused by enlarged, varicose-type veins around the uterus and ovaries, pelvic congestion syndrome most often causes a dull ache.
  • Ovarian remnant synndrome. During a complete hysterectomy—surgical removal of the uterus, ovaries and fallopian tubes—a small piece of ovary may be left in the body, which can later develop into a painful mass. This conditions is associated with cyclic pelvic 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 nutrients and begin to die (degenerate).
  • Irritable bowel syndrome. Symptoms associated with irritable bowel syndrome — bloating, constipation, or diarrhea — can be a source of uncomfortable pelvic pain and pressure.
  • Bladder Pain Syndrome/Interstitial Cystitis: A need to urinate often and bladder pain are the main symptoms of this condition. The pain usually gets worse as the bladder fills with urine, and is relieved by urination.
  • Psychological factors. Depression, chronic stress, or a history of sexual or physical abuse may increase the risk of developing chronic pelvic pain. Emotional distress can make pain worse, and living with chronic pain can cause emotional distress. These two factors frequently get locked into a vicious cycle.

Because there can be many causes of chronic pelvic pain, your doctor will conduct a physical examination and will take a complete health history to pinpoint the cause. Possible tests or exams your doctor might suggest include:

  • Pelvic examination. This can reveal signs of infection, growths or cysts, or tense muscles in the pelvis.
  • Cultures. A laboratory analysis of cell samples from your cervix or vagina may detect sexually transmitted infections, such as chlamydia and gonorrhea.
  • Ultrasound. This test uses high-frequency sound waves to produce precise images of structures within your body.
  • Ultrasound, abdominal X-rays, computerized tomography (CT) scans, or magnetic resonance imaging (MRI) can help detect abnormal structures or growths.
  • Laparoscopy. During this procedure, the doctor is able to view the inside of the abdomen through a small scope. Laparoscopy is especially useful in detecting endometriosis and chronic pelvic inflammatory disease.

Finding the underlying cause of chronic pelvic pain can be a long process, and in many cases, a clear explanation may never be found. Treatment will depend on the cause of the discomfort.

If your doctor can pinpoint a specific underlying cause, treatment will focus on eliminating that particular cause. However, if the doctor cannot identify any particular cause, treatment will focus on managing your pain.

Medications

Depending on the underlying cause, your doctor may recommend a number of medications to treat your condition, including:

  • Pain relievers. Over-the-counter pain remedies, such as aspirin, ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others), may provide partial relief from your pelvic pain. Sometimes a prescription pain reliever may be necessary. However, pain medication alone cannot usually solve chronic pain.
  • Hormone treatments. If pain occurs during a specific point in the menstrual cycle, hormones such birth control pills may be prescribed.
  • Antibiotics. If the pain is caused by an infection, the doctor may prescribe antibiotics.
  • Antidepressants. Antidepressants can help the patient deal with the depression and anxiety that often accompanies chronic pain. Some antidepressants also directly relieve pain in addition to improving mood.

Therapies

Your doctor may recommend specific therapies or procedures as a part of your treatment for chronic pelvic pain. These treatments may include: nerve blocks, physical therapy, surgery, transcutaneous nerve stimulation, psychological counseling, acupuncture, and physical therapy may be prescribed to help alleviate or control pain.

What about Research Studies for this condition?

We are currently participating in a national multi-center study trying to understand more about Chronic Pelvic Pain, with the goal of eventually developing more effective therapies.  You can find out more about this study here.