Chronic Pelvic Pain

What is chronic pelvic pain?

Chronic pelvic pain is pain in your pelvic region (the area below your belly button and above your hips). It is considered chronic when it has lasted for at least 6 months.

Pelvic pain can present as a dull ache or sharp pain, it may be constant or intermittent and may be mild or severe enough to interfere with activities of daily living.

What are the causes of pelvic pain?

There are many causes of chronic pelvic pain but some of the more common causes include;

Gynaecologic conditions

  • Endometriosis – tissue that is normally found in the uterus grows outside the uterus, such as on the ovaries, in the pelvis, on the bladder, or in other areas. During menstruation (period), this tissue bleeds, just like the lining of the uterus. This causes pain and can also cause scar tissue to form between the internal organs.
  • Pelvic inflammatory disease – this is an infection in the female reproductive organs (uterus, fallopian tubes, and ovaries).
  • Fibroids – these are benign (not cancerous) growths in the muscular wall of the uterus. The growths can range from very small to very large.
  • Ovarian remnant
  • Polyps
  • Cysts – cysts on the ovary can cause pain
  • Cancers in the pelvic area
  • Miscarriage
  • Ectopic pregnancy
  • Adhesions inside the pelvis and belly – Adhesions are bands of scar tissue occurring between organs inside the abdomen. They can be caused by previous surgery, Caesarean sections, or some infection inside the pelvis. Adhesions can be divided by laparoscopic surgery, allowing internal organs to move freely again.

Other medical conditions

  • Irritable bowel syndrome
  • Interstitial cystitis – patients with interstitial cystitis have a bladder wall that is inflamed and irritated. This inflammation can scar the bladder or render it stiff and unable to expand normally.
  • Pelvic congestion syndrome

What investigations are there for chronic pelvic pain?

In order to determine the cause of the pelvic pain, your doctor will first take a full history and perform an examination. Based on this your doctor will be able to recommend a variety of treatments that are best for you.

One or more of the following may be recommended;

  • Blood tests
  • Abdominal ultrasound
  • Transvaginal ultrasound
  • CT scan
  • MRI
  • Laparoscopy
  • Cystoscopy

What are the treatments for chronic pelvic pain?

The treatment for chronic pelvic pain depends on the cause. Your doctor will help you decide which treatment is right for you. Treatment options include;

  • Using nonsteroidal anti-inflammatory painkillers, such as ibuprofen or naproxen.
  • Stopping ovulation with birth control pills or injections.
  • Antibiotics
  • Relaxation exercises
  • Psychological counselling
  • Surgery

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