Chronic Pelvic Pain (Women)

Chronic pelvic pain is pelvic pain that persists for more than six months.

The pain is not confined to a particular area, it is rather diffused. It can either be a condition in itself or an indication of some other medical conditions.

It is often difficult to pinpoint the cause of pelvic pain. If the cause of your pelvic pain is identified, it is managed by treating the cause.

If the cause is not identified, doctors aim to manage your pain. 

You may experience following signs and symptoms of Chronic pelvic pain in women:

• Excruciating and steady or mild and intermittent pain (pain comes and goes)
• Dull and diffused or piercing pain
• Tension or heaviness in pelvis

You may also have also experience pain:

• during sexual intercourse
• while urinating or evacuating bowel
• after sitting for a long period of time

The pain is exaggerated if you stand for a long period. Lying can relive your pain. Severe pain can interfere with your daily activities.

When to see a doctor?

Visit your doctor if your symptoms worsen or if pain interrupts your daily activities.

There are several conditions that can cause chronic pelvic pain women. Sometimes, a definitive may not be identified. Psychological factors can worsen your pain.

Chronic pain in itself may exacerbate your pain. Your pelvic pain may be caused by:

• Endometriosis: The tissues lining your uterus (womb) grow outside the uterine cavity. These tissues, just like the ones in uterus, thicken, break down and bleed each month but collect in your abdomen instead of exiting through your vagina. They may form painful cyst and scar tissue.

• Tension in your pelvic floor muscles: Cramp or tension of the muscle in the pelvis can lead to chronic pelvic pain.

• Chronic pelvic inflammatory disease: It is a prolonged painful infection of your reproductive organs, mostly transmitted by sexual contact. It can cause scarring of your pelvic organs.

• Ovarian remnant: Portion of ovary left behind during surgery of uterus, ovaries and fallopian tubes (complete hysterectomy), can develop into painful cysts.

• Fibroids: Non-cancerous growths of uterus, fibroids can cause tension or sensation of heaviness in your lower abdomen. Poorly supplied fibroids may begin to die which caused a sharp pain.

• Irritable bowel syndrome: Irritable bowel syndrome symptoms, such as bloating, constipation or diarrhea, can result in pelvic pain.

• Painful bladder syndrome (interstitial cystitis): It is characterized by severe inflammation in bladder and frequents needs to urinate. Bladder filling may cause pelvic pain which may be relieved after emptying.

• Psychological factors: Depression, chronic stress or a history of sexual or physical abuse increases risk of chronic pelvic pain. Emotional stress of a chronic pain in itself can worsen your pain.

• Pelvic congestion syndrome: Enlarged, varicose-type veins around your uterus and ovaries are likely to cause pelvic pain.

Chronic pelvic pain in women is diagnosed by performing several tests.

Your doctor may refer you to a gynecologist (a specialist in women's health), a gastroenterologist (a specialist in digestive system problems), a urogynecologist (a specialist in urinary and gynecologic problems) or a physical therapist (a specialist in musculoskeletal problem).

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful. List out all the symptoms.
Write down your key medical information. Write down the names of all your medications, vitamins or supplements. Ask a friend or family member to accompany you during the visit.

Make a list of the questions to ask your doctor. Some typical questions can be

• What could be possible causes of my symptoms?
• What tests do I need?
• Are there any additional tests that I need?
• What will be your treatment approach to improve my symptoms?
• What will be the duration of treatment?
• When can I feel better?
• Should I see a specialist?

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor. Your doctor might ask you typical questions like:

• When did the pain begin and how frequent is it?
• How severe is your pain and how long does it last?
• Can you locate your pain and does it occur mostly on the same site?
• Can you describe your pain?
• Is your pain intermittent or constant?
• Do you experience pain during urination or a bowel movement?
• Is your pain affected by menstrual cycle?
• Does anything improve or worsen your pain?
• Is any of your activities affected by pain?
• Do you feel down, depressed or hopeless?
• Have you undergone pelvic surgery or been pregnant?
• Have you received treatment for a urinary tract or vaginal infection?

The source of pelvic pain is diagnosed by ruling out the disorders that are likely to cause pelvic pain. Tests may include:

• Pelvic exam: During pelvic exam, your doctor feels the pelvic region to determine the area of tenderness. Tell your doctor if you feel pain during examination and whether the pain is similar to which you are experiencing. Pelvic exam helps in determining signs of infection, abnormal growths or the muscles which are tightened.

• Cultures: Sample of cells from your cervix or vagina are tested for infections, such as Chlamydia or gonorrhea.

• Ultrasound: Sound waves are used to obtain images of your internal body structures.

• Other imaging tests: X-rays, computerized tomography (CT) scans or magnetic resonance imaging (MRI) can be used to detect any abnormalities.

• Laparoscopy: A laparoscope (a thin tube that is attached with small camera) is inserted inside your abdomen through a small incision made in your abdomen to detect abnormal tissues or signs of infection in your pelvis. Most often, laparoscopy is used for diagnosis of endometriosis and chronic pelvic inflammatory disease.

The source of chronic pelvic pain may not be found or it may take time. Your doctor plans your treatment to improve your quality of life and minimize distress.

Finding the underlying cause of chronic pelvic pain can be a long process, and in some cases, a clear explanation may never be found. With patience and open communication, however, you and your doctor can develop a treatment plan that helps you live a full life with minimal discomfort.

Your pelvic pain can be managed by treating the underlying cause, if detected. If no cause id identified, treatment is focused at controlling your pain.

Medications used for pelvic pain may include:

• Pain medications: Over-the-counter pain killers, such as aspirin, ibuprofen or acetaminophen, may reduce your pelvic pain. In certain circumstances, you may need prescription pain killer.

• Hormone treatments: Oral contraceptive pill or other hormone containing medications can provide relief from cyclic pain that occurs during certain phases of menstruation or hormonal changes.

• Antibiotics: Antibiotics are prescribed to treat underlying infection.

• Antidepressants: Tricyclic antidepressants, such as amitriptyline, nortriptyline and others, relieve pain and mood lifting effects.

• Therapies: Your doctor may recommend following therapies for chronic pelvic pain:
  • • Physical therapy: Different stretching exercises, massage, heat and cold application to your pelvic region and other relaxation techniques can provide relief. You may also learn exercises that strengthen your pelvic muscles. Sometimes physical therapists use transcutaneous electrical nerve stimulation (TENS) in which electrodes placed on the area of pain deliver electrical impulses to nearby nerve pathways. TENS works possibly by blocking the pain signals.
    • Neurostimulation (spinal cord stimulation): In spinal cord stimulation, a device that generates electrical impulses are kept below the skin which block the nerve pathways transmitting pain signals.
    • rigger point injections: Your doctor may inject local anesthetics (numbing medicine) to certain painful site.

• Counseling: Depression, sexual abuse, marital issues or a family crisis can worsen your pain. Counseling can be an important part of your treatment strategy.

• Surgery: You might need to undergo surgery to treat the underlying medical condition. Some of them include:
  • •  Laparoscopic surgery: During surgery, your doctor inserts laparoscope (a thin tube attached with camera) and other instruments (for removal of endometrial tissues) through small cuts made in your abdomen. It is commonly used for endometriosis.

• Hysterectomy: If you are beyond childbearing age and have pelvic pain, your doctor might suggest removal of uterus (hysterectomy) and ovaries (oophorectomy).

• Pain rehabilitation programs: Your doctor may recommend combination of treatments to treat your pelvic pain. You may join a pain rehabilitation program and learn various pain management techniques.

You may consider using following alternative remedies for chronic pelvic pain in womem after consulting your doctor:

• Relaxation techniques: Deep breaths and stretching exercises can relieve your pain.
• Acupuncture: Tiny needles are inserted into your skin at specific points, which is said to release endorphins, your body's natural pain relievers. Endorphins reduce your pain. However, its efficacy is yet to be established.

Lifestyle modifications are necessary in order to cope with chronic pelvic pain in women.

Chronic pain hampers various aspects of your life including sleep. The pain is often exacerbated by emotional distress.

Stress management techniques help to lower the level of stress as well reduce the pain exacerbated by stress.

Meditation, deep breathing, exercising and getting enough sleep help to manage your stress.