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OVERVIEW

What is chronic pelvic pain?

Chronic pelvic pain is pain in your pelvic region (the area below your belly button and above your hips) that lasts for at least 6 months. The pain may be steady or it may come and go. It can feel like a dull ache, or it can be sharp. The pain may be mild, or it may be bad enough to interfere with normal daily activities.

SYMPTOMS

Symptoms of chronic pelvic pain

The primary symptom of chronic pelvic pain is the pain itself. How often you feel the pain and the severity differs. It depends on the person and what is causing the pain. A woman may feel it during sex. Another person may feel it only after eating. It may come and go or be present every day.

CAUSES & RISK FACTORS

What causes chronic pelvic pain?

Some of the more common causes of chronic pelvic pain include:

Gynecologic Conditions

• Endometriosis: Endometriosis is when tissue that is similar to that in which lines the uterus grows elsewhere in the body. It can grow on your ovaries, in your pelvis, on your bladder, or in other areas.  When you have your period, this tissue swells and bleeds, just like the lining of your uterus. This is often painful, and scar tissue can form in your pelvic area.
• Pelvic Inflammatory Disease: Pelvic inflammatory disease (PID) is an infection in the female reproductive organs (uterus, fallopian tubes and ovaries). Normally, the cervix (opening to the womb) prevents bacteria in the vagina from spreading up into these organs. However, if the cervix is exposed to a sexually transmitted infection (STI) such as gonorrhea or chlamydia, it becomes infected. This can allow bacteria to travel up into the internal organs, making them inflamed and infected. If this occurs, the woman’s fallopian tubes may be damaged, making it difficult for her to become pregnant.
• Fibroids: Fibroids are benign growths (not cancer) in the muscular wall of the uterus. These growths can be very tiny or as large as a cantaloupe. They are often painful.
• Ovarian remnant: During a complete hysterectomy, the uterus and ovaries are removed. Sometimes a small piece of the ovary gets left behind, and painful cysts can develop.

Other Medical Conditions

• Irritable bowel syndrome: Irritable bowel syndrome (IBS) is a common problem with the intestines. In people with IBS, the intestines squeeze too hard or not hard enough and cause food to move too quickly or too slowly through the intestines.
• Interstitial cystitis: Interstitial cystitis is a chronic bladder problem. People with interstitial cystitis have a bladder wall that is inflamed and irritated (red and sore). This inflammation can scar the bladder or make it stiff. A stiff bladder can’t expand as urine fills it. In some cases, the walls of the bladder may bleed slightly. A few people get sores in the bladder lining.
• Past or present sexual abuse: If you have been the victim of sexual abuse, you are more likely to experience chronic pelvic pain.

DIAGNOSIS & TESTS

How is chronic pelvic pain diagnosed?

Your healthcare provider will ask you questions about your past and present health, and about illness or health-related problems in your family. You may be asked to describe the kind of pain you have, where it is and how strong it is. Tell your healthcare provider anything you can about what causes the pain to get better or worse. They may ask:

• Is the pain related to your menstrual cycle?
• Is it related to bowel movements?
• Does it hurt during urination or sexual activity?
• Have you had an infection?
• Have you had surgery in your pelvic area?

Your healthcare provider may also want to perform some tests to help make the diagnosis.

What types of tests may be performed?

A number of tests can help your healthcare provider find the cause of your pain. Your history and physical exam will help them decide which, if any, tests to do. These may include blood tests, urologic tests or X-rays. In some cases, your healthcare provider may need to perform minor surgery, such as laparoscopy.  Laparoscopy is a procedure in which a thin lighted tube is inserted in the abdomen so the healthcare provider can look at your pelvic organs.

PREVENTION

Whether your chronic pelvic pain can be prevented or avoided depends on what is causing the pain. There are many different causes. Some of them can be prevented. Others cannot be prevented.

Early diagnosis can sometimes prevent chronic pelvic pain. It is important to talk to your healthcare provider r when you begin to feel pelvic pain.

TREATMENT

How is chronic pelvic pain treated?

Treatment depends on your individual problem. Your healthcare provider will help you determine which form of treatment is right for you. Some treatment options include:

• Stopping ovulation (release of eggs from the ovary) with birth control pills or injections
• Use of nonsteroidal anti-inflammatory pain relievers such as ibuprofen (one brand name: Motrin) or naproxen (brand name: Aleve)
• Relaxation exercises, biofeedback (treatment to control emotional states using electronic devices) and physical therapy
• Abdominal trigger point injections. A trigger point is a tender area in the lower wall of the abdomen. Pressure that is put on this area causes pain. Injecting medicine into the trigger point can block this pain.
• Antibiotics
• Psychological counseling

Rarely, surgery is necessary if abnormalities in the pelvis are seen

Living with chronic pelvic pain

Chronic pain is never easy to live with. If traditional methods of pain relief don’t work, there are alternatives. Your healthcare provider can help you find a way to manage your pain. Sometimes, chronic pain responds to a nerve block that can block the pain for an extended period of time. Sometimes physical therapy or weight loss can help. Just know that things aren’t hopeless. Keep exploring pain management options until you find the one that works for you.