Chronic Pelvic Pain
Chronic pelvic pain is a common problem for women. It is defined as any pain felt either in lower abdomen or in the lower back which could be associated with cyclical periods or can be present all through the month.
There are a wide variety of conditions that could lead to pelvic pain. Pelvic pain is considered chronic if it lasts for six months or more, or if it fails to respond to treatment. It is often difficult to treat.
It needs detailed evaluation and many times a multidisciplinary approach.
When do you consider that you are suffering from chronic pelvic pain
Chronic pelvic pain can present as mild dull aching or severe which can be continuous pain or only during menstrual cycles. One can feel pressure or heaviness deep within the pelvis. Pain during intercourse or cyclical bleeding or while having a bowel movement or urinating can also be treated as chronic pelvic pain. The pain may be incapacitating and so severe that one misses work, can’t sleep and can’t exercise
What can cause pelvic pain?
- Endometriosis –Can have both cyclical or non cyclical pain.
- Tension & Stress- The pelvic floor and lower back muscles go into a spasm giving a feeling of heaviness in pelvis especially by evening.
- Chronic pelvic inflammatory disease- Long standing infection, often sexually transmitted, causes inflammation and scarring of pelvic organs.
- Fibroids- These benign uterine growths can cause pressure or heaviness in pelvis.
- Irritable bowel syndrome- Bloating, constipation or diarrhoea are often associated with pelvic discomfort.
- Painful bladder syndrome (interstitial cystitis)- Often difficult to diagnose, this condition is associated urinary symptoms as well. Pain is felt on full bladder and reduces after one voids urine.
- Pelvic congestion syndrome- Enlarged, varicose-type veins in pelvis can cause pelvic pain.
- Psychological factors- Depression, Anxiety disorders, stress can cause pelvic pain. Emotional distress makes pain worse, and living with chronic pain contributes to emotional distress, so it’s interrelated.
What tests are required to diagnose chroinc pelvic pain?
- Pelvic exam- Done in Gynecological office provides important clues for the underlying cause of such pain. Infection, abnormal growths or tense pelvic floor muscles can be diagnosed by the same.
- Urine tests to rule out urinary tract infections.
- Ultrasound- Detects masses or cysts in the ovaries, uterus or fallopian tubes. Endometrioisis and fibroids can also be diagnosed by USG.
- Laparoscopy- Useful in detecting endometriosis and chronic pelvic inflammatory disease. If any of the above investigations do not reveal the correct diagnosis, Diagnostic Laparoscopy is a good method to diagnose as well as treat the underlying disorders.
How is chronic pelvic pain treated?
Treatment will vary for each patient, and the goal of treatment is to reduce symptoms and improve quality of life.
Medications
Hormone treatments
Antibiotics
Antidepressants
Pain kilers- Paracetamol
Surgery
Surgical therapy, often through minimally invasive (Laparoscopic or Robotic) techniques, is considered an appropriate option for specific causes of pain