What is Chronic Pelvic Pain

Pelvic pain is discomfort or pain anywhere in the lower abdominal region (below the belly button). It is considered chronic when the pain is severe, interferes with one’s normal activities, and lasts more than 6 months. The pain may be constant, or it may occur only at certain times such as during menstruation, sexual activity, or urination.

Chronic pelvic pain can be a condition, without any underlying cause. It can also be a symptom of another condition related to the reproductive organs, urinary tract, or bowel. In cases where it is not possible to determine a primary cause, the goal of a treatment plan is to provide pain relief which allows the patient to resume normal activities.

Chronic Pelvic Pain Symptoms

The pain can manifest in several different ways. It may be described as a sharp and stabbing pain, like menstrual cramps. It may otherwise be described as dull and aching, comparative to an upset stomach. Some women experience it as a feeling of pressure or heaviness in the pelvis. The symptoms may happen intermittently or remain a constant source of discomfort.

Pain that is intermittent may happen during intercourse, when using the bathroom, when lifting something heavy, or after sitting or standing for a long period of time.

There may be other symptoms associated with the pain, such as vaginal discharge, fever, nausea/vomiting, or dizziness.

Causes of Chronic Pelvic Pain

There are several different conditions that could be linked to chronic pelvic pain. Additionally, there could be more than one contributing factor to the pain, or it may be difficult to pinpoint an exact cause.

Some of the conditions leading to chronic pelvic pain include:

• Adenomyosis: A condition where endometrial tissue (tissue which lines the uterus) grows into the uterine wall. It can cause pain and heavy bleeding.
• Endometriosis: A common gynecological condition where endometrial tissue grows in areas outside of the uterus, such as on the ovaries or inside the bladder. Women with this condition can suffer from excessive menstrual cramps and pain during intercourse.
• Interstitial Cystitis: This chronic condition, most common in women, is also known as painful bladder syndrome, and can be mistaken for a urinary tract infection (UTI). It can cause pressure, bladder pain, and sometimes pelvic pain.
• Pelvic Adhesions: Scar tissue from prior surgeries or other conditions, such as endometriosis or pelvic inflammatory disease, can cause chronic pelvic pain.
• Pelvic Inflammatory Disease (PID): PID is an infection of the reproductive organs, often caused by a sexually transmitted disease such as chlamydia and gonorrhea. Pain can linger even after the infection is resolved. `
• Pelvic Organ Prolapse: Most found in women after childbirth, prolapse happens when the muscles and ligaments supporting the pelvic organs weaken. This loss of support causes the pelvic organs, such as the bladder or uterus, to sag or drop into the vagina. It can cause pressure, discomfort, or pain.
• Uterine Fibroids: Noncancerous growths from the uterine wall which can cause pelvic pressure or pain, as well as abnormal vaginal bleeding.

Chronic Pelvic Pain Diagnosis

For women experiencing chronic pain, it can be hard to know when to call the doctor. If the pain lasts longer than six months, the pain increases, or it interferes with your daily activities, you should reach out to your provider. They will conduct a thorough physical examination that will include a pelvic exam. They will also gently examine the outside of your abdomen to help determine the location of the pain and tenderness. If the pain is acute, they will ask questions to rule out conditions that would require immediate action, such as an ectopic pregnancy or appendicitis.

After considering your symptoms and health history, your doctor may order further tests before giving you a diagnosis. These may include:

• Blood tests: Lab work may be ordered to check for pregnancy, signs of an infection, or kidney stones.
• Colonoscopy: This can help detect changes in the intestinal tract and help determine causes of abdominal pain.
• CT (computed tomography) scan: This type of imaging test can show details of the internal organs beyond those of a normal x-ray.
• Cystoscopy: A thin tube with a camera is inserted in the urethra, allowing your doctor to examine the bladder for sources of pain.
• Pelvic MRI (magnetic resonance imaging): This noninvasive procedure provides detailed images of soft tissue and evaluates some organ functions.
• Pelvic ultrasound: This type of test uses sound waves to give a visualization of the uterus, vagina, fallopian tubes, and ovaries. It can assist in diagnosing cysts, masses, and certain types of inflammation or infection.
• Laparoscopy: During this procedure, a surgeon uses a thin lighted tube with a video camera to look at the organs in the abdominal area. It requires a small incision near your belly button.