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Chronic pelvic pain in women
Chronic pelvic pain is persistent pain that lasts for six months or longer. Pelvic pain is in the abdomen below the navel. Around 4-16% of women with chronic pelvic pain are curable when found specific causes. Often, they are unexplained or accompanied by more than one factor.
The pain does not necessarily correlate with the menstrual cycle. Another cause could be how the central nervous system processes the pain signal. A heightened response to the pain signals can make you more sensitive than otherwise.
What causes chronic pelvic pain in women?
Chronic pelvic pain in women can result from many conditions, including gynecologic, gastrointestinal, urologic, musculoskeletal, and body-wide disorders.
Gynecologic causes
20 % of women with chronic pelvic pain have gynecologic origins, including:
- Endometriosis occurs when uterine lining endometrial-like tissue is present at sites outside of its natural location or extending into the uterine muscles causing the uterus to swell and enlarge, leading to painful menstruation. If it's on the ovaries or anywhere in the pelvis, it's a chocolate cyst which could be anywhere in the pelvis. Some cases of endometriosis may be asymptomatic, whereas others may experience menstrual pain, discomfort, heavy menstrual bleeding, or infertility.
- Uterine fibroids (benign growths in the uterus): Almost half of the women have this condition but around 25% experience pelvic pain, heavy menstruation, and infertility.
- Pelvic inflammatory disease (PID) is a female reproductive organ infection that can be a complication of a sexually transmitted disease or abdominal infection. PID can cause chronic pelvic pain and infertility.
Non-gynecologic causes
These are related to digestive, urinary, and muscular causes of pelvic nerve irritation.
- Irritable bowel syndrome is common and causes altered bowel habits with frequent loose stools and chronic abdominal pain.
- Bladder pain syndrome and interstitial cystitis (BPS/IC) denote chronic bladder pain without infection. BPS/IC can cause urinary frequency and urgency.
- Abdominal pain
- Pudendal neuralgia
- Traumatic experiences such as sexual or physical abuse can be associated with chronic pain. People having childhood instability, anxiety, poor pelvic exam experience, stress, distress, or depression can develop chronic pelvic pain.
What are the symptoms of chronic pelvic pain in women?
When you have pelvic pain, you may develop other accompanying signs and symptoms, such as:
- Symptoms in the reproductive system
- Menstrual pain
- Bleeding or discharge from the vagina
- Symptoms in the urinary tract
- Painful urination, urinary frequency
- Symptoms in the gastrointestinal tract
- Bloating
- Rectal bleeding
- Pain during intercourse
- Diarrhea or constipation
- Other symptoms
- Chills or fever
- Pain in the hip or groin
When to see a doctor?
- When you have severe, unrelenting chronic pelvic pain
- When you have mild pelvic pain, but are accompanied by other symptoms, consult a doctor for proper diagnosis and treatment.
Seek immediate medical attention if you have the following symptoms:
- Sharp, sudden, or severe pelvic pain or discomfort
- Blood in stools or urine
- Fever
- Unable to stand up straight
How is chronic pelvic pain diagnosed?
It can be hard to pinpoint the cause of chronic pelvic pain because it can be more than one condition.
- History and physical examination. Your doctor will ask about your past and current health problems and check your lower abdomen and pelvis and perform a pelvis exam.
- Laboratory tests such as pregnancy tests, vaginal cultures for sexually transmitted diseases, urinalysis, and other blood tests
- Pelvic ultrasound can help detect pelvic anomalies such as ovarian endometriosis and uterine fibroids.
- Laparoscopy can diagnose endometriosis and chronic pelvic inflammatory disease. It is helpful when the cause is elusive, or the treatment outcome is not optimal.
- Lower GI endoscopy to examine your colon and rectum
- Abdominal and pelvic X-rays or CT scans.
How is chronic pelvic pain treated?
If the provider identifies the underlying cause of chronic pelvic pain, treatment of its cause should cure the pain. If not, direct the treatment toward pain palliation.
- Pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol, antidepressants, anticonvulsive medications, or muscle relaxants.
- Pelvic floor exercise can relieve muscle tightness in the abdomen, lower back, hips, and thighs and help with abdominal myofascial pain syndrome or pelvic floor pain.
- Acupuncture.
- Biofeedback and relaxation techniques.
- Nerve stimulator.
- Local anesthetic injected into the pain trigger point
Home remedies
- Pain relievers.
- Warm compress.
- Relax to reduce stress and tension.
- Quit smoking. Tobacco use can cause pain and inflammatory nerves.
- Exercise can increase blood flow and relieve pain.
However, if you are beset with chronic pelvic pain, you should see a doctor for a proper diagnosis and treatment.
