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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.

CAUSES & RISK FACTORS

What are possible causes of chronic pelvic pain?

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

Gynecologic Conditions

• Endometriosis: Endometriosis is a problem with the lining of the uterus. Tissue from the lining of the uterus moves through the fallopian tubes and gets 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.
• 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.

• 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 (a procedure in which a thin lighted tube is inserted in the abdomen so the healthcare provider can look at your pelvic organs).

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

QUESTIONS TO ASK YOUR HEALTHCARE PROVIDER

• What is the likely cause of my pelvic pain?
• Do I need any tests, such as ultrasound or X-rays?
• What do my test results mean?
• Based on the cause of my pain, what are my treatment options?
• Which of these treatment options do you recommend for me? Why?
• When can I expect relief from my pain?
• Do I need to make any lifestyle changes at home to help relieve my pain?