Description

Chronic pelvic pain is pain in the area below your bellybutton and between your hips that lasts six months or more.

Chronic pelvic pain can have more than one cause. It can be a symptom of another disease, or it may be a condition in its own right.

If your chronic pelvic pain appears to be caused by another health condition, treatment of that problem can get rid of the pain.

But the tests may not be able to find a cause for chronic pelvic pain. In that case, the goal of treatment is to relieve pain and other symptoms. That could make your quality of life better.

Symptoms

You may feel chronic pelvic pain in different parts of your pelvic area, instead of in a single place. You could describe the pain in one or more of the following ways:

  • Serious and constant.
  • The pain that comes and goes.
  • Deaf.
  • Sharp pains or cramps.
  • Pressure or heaviness deep within the pelvis.

The pain may also occur:

  • During the sex.
  • While defecating or urinating.
  • When sitting or standing for a long time.

Chronic pelvic pain can be mild. Or may be so severe that miss work and can't sleep, or exercise.

Other symptoms may include:

  • An urgent or frequent need to urinate.
  • The abdominal distension.
  • Upset stomach.
  • Constipation or diarrhea.

When to see a doctor

In general, consult your health care professional if the pain disrupts your daily life or if your symptoms seem to get worse.

Causes

Chronic pelvic pain is a complex health problem. Sometimes, the tests may find that a single disease is the cause. In other cases, the pain may come from more than one medical condition. For example, you could have endometriosis and interstitial cystitis, which play a role in the chronic pelvic pain.

Some of the causes of chronic pelvic pain include:

  • The Endometriosis. This is a disease in which the tissue lining of the uterus grows outside of the uterus. Can cause pain or infertility.
  • Muscle and bone problems. Health problems affecting the bones, joints, and connective tissues that can lead to pelvic pain that keeps coming back. These issues include fibromyalgia, tension in the muscles of the pelvic floor, swelling of the pubic joint, or a hernia.
  • The nerve injury. Injured or trapped nerves of the pelvis or the lower part of the stomach can lead to ongoing pelvic pain. Nerve problems can occur after surgery in the lower part of the stomach, such as having a c-section. Or long-lasting pain may result after injury to a nerve in the pelvis called the pudendal nerve of repetitive activities, such as cycling, horse riding or sitting for long periods of time. This condition is called neuralgia of the pudendal.
  • Chronic pelvic inflammatory disease. This can happen if a long-term infection, often spread through sex, it causes the formation of scar tissue that involves the organs of the pelvis.
  • Ovarian remnant. After surgery to remove one or both ovaries, a small piece of ovary may be left on the inside by mistake. Later, these tissue debris, can form cysts painful.
  • The fibroids. These growths inside, or attached to the uterus are not cancer. But they can cause pressure or a feeling of heaviness in the lower abdomen or back. Rarely, they can cause acute pain.
  • The Irritable bowel syndrome. Symptoms associated with the irritable bowel syndrome — bloating, constipation or diarrhea can be a source of pelvic pain and pressure.
  • Painful bladder syndrome. This is also called interstitial cystitis. This related to pain in the bladder that keeps coming back. Also tied to a frequent need to urinate. You may have pain in the pelvis such as the bladder fills. The pain may get better for a while after emptying the bladder.
  • Pelvic congestion syndrome. Enlarged, varicose veins, type of veins around the uterus and ovaries can cause pelvic pain.
  • The Mental health risk factors. The depression, the long-term stress, or a history of physical or sexual abuse may increase the risk of chronic pelvic pain. The emotional distress can make the pain worse. And long-term pain may be the fuel of the distress. These two factors often become a vicious circle.

Risk factors

Many conditions are linked to chronic pelvic pain. To have more of a condition that causes pain in the pelvis, such as endometriosis and fibroids increases your risk. A history of physical or sexual abuse can also increase the risk.

Diagnosis

To find out what is causing your chronic pelvic pain, your health care team will ask about your symptoms. Also you will be able to respond to questions about the health conditions that you and your blood relatives, such as parents and siblings, have had in recent years.

Your health care team may ask you to keep a journal of your pain and other symptoms. This can help to describe the impact that the pain has on your daily life.

You may also need tests or examinations, such as:

  • Pelvic exam. This can be found symptoms of the disease, unusual growths or tense the muscles of the pelvic floor. Your health care professional checks for the areas that feel soft. Speak up if you feel any pain during this test, especially if it feels like the pain that I've had lately. And if the test makes you anxious, you may ask your health care professional to stop at any time.
  • The laboratory tests. These can be checked by diseases such as chlamydia or gonorrhea. You may also need a blood test to measure your blood cells or a urine test to detect an infection of the urinary tract.
  • Ultrasound. This test uses sound waves to create images of tissues, organs, and other parts inside the body. You can help find tumors or cysts in the ovaries, the uterus or the fallopian tubes.
  • Other imaging tests. You might need a computed tomography (CT) or magnetic resonance imaging (MRI). These imaging tests can help find growths or out of the ordinary, the structures inside the body.
  • The laparoscopy. During this surgery, a small cut is made in the stomach area. A thin tube with a small camera is placed through the cut. The camera allows your surgeon to look at the pelvic organs and check for unusual fabrics or infections. This procedure can help to find and treat problems such as endometriosis and chronic pelvic inflammatory disease.

Find the cause of the chronic pelvic pain can take time. A clear reason for the pain may never be found. Talk openly with your health care team during this process. Work together to find a treatment plan that helps you live well with as little pain as possible.

Treatment

With chronic pelvic pain, the goal of treatment is to relieve symptoms and make your quality of life better.

If your health care professional may find a specific cause, the treatment is focused on that cause. If a cause cannot be found, the focus of treatment is to control pain and other symptoms. You may need more than one treatment.

Drugs

Depending on the cause, certain medications may be used to treat chronic pelvic pain, such as:

  • Pain relievers. Medicines that you can buy without a prescription may relieve some of your pain. These include aspirin, ibuprofen (Advil, Motrin IB, others) and acetaminophen (Tylenol, others). Sometimes you may need a stronger prescription to relieve the pain. But the pain medication only rarely gets rid of the chronic pain.
  • The hormonal treatments. Some people find that the days when you have pelvic pain may coincide with a phase of your period. When this is the case, birth control pills or other hormonal medications can help relieve pelvic pain.
  • Antibiotics. If a disease caused by bacteria is the source of your pain, you may need antibiotics.
  • Antidepressants. Some types of medications used to treat depression can also be useful for chronic pain. These are the tricyclic antidepressants, such as amitriptyline, nortriptyline (Pamelor), and others. Also included are inhibitors of the reuptake of serotonin and norepinephrine, such as duloxetine (Cymbalta) and venlafaxine (Effexor XR). They can help to relieve chronic pelvic pain, even if you don't have depression.
  • Muscle relaxants. Medications such as cyclobenzaprine (Amrix) can help to relax the muscles associated with pelvic pain.

Other therapies

In addition to medications, other treatments may be helpful for chronic pelvic pain. These may include:

  • The physical therapy.For some people, physical therapy can manage the chronic pelvic pain. May involve more useful training stretches and relaxation techniques and getting a massage. You can also include procedures that treat the pain. For example, a physical therapist can find rigid areas in the tissues that are associated with the pelvic pain. The therapist can then stretch and put pressure on these areas to loosen up. This is called myofascial release. Sometimes, physical therapists with specific pain points with a medical device called a transcutaneous electrical nerve stimulation. This sends low-voltage electrical currents to the nerves nearby. The physical therapists you can also use a technique of psychology called biofeedback. This helps you to be aware of the areas where the muscles are tense, so that you can learn to relax these areas. Some people also get relief of the pain of a procedure called dry needling. The therapist places of very thin needles in and around the stiff, sensitive areas tied to pain called trigger points.
  • Stimulation of the spinal cord. This is also called neuromodulation. The treatment involves implanting a device that blocks the nerve pathways, so that the pain signal may not reach the brain. It may be useful, depending on the cause of your pelvic pain.
  • Trigger point injections. Trigger points are tight, sensitive points in the body. Injections of anesthetic may help block the pain in these places.
  • Talk therapy.Some people with chronic pelvic pain also have a mental health condition, such as depression, anxiety or a personality disorder. Others have duration of a sexual trauma or emotional abuse. Talk therapy with a psychologist or a psychiatrist can help both your body and mind. You can relieve stress and help you learn ways to cope with the pain. A type of psychotherapy that can help is the so-called cognitive-behavioral therapy. This means learning to be aware of the negative thoughts and bad. Sex therapy may also help. A therapist teaches couples how to have sex without pain, and can help relieve pelvic pain.

The physical therapy. For some people, physical therapy can manage the chronic pelvic pain. May involve more useful training stretches and relaxation techniques and getting a massage. You can also include procedures that treat the pain.

For example, a physical therapist can find rigid areas in the tissues that are associated with the pelvic pain. The therapist can then stretch and put pressure on these areas to loosen up. This is called myofascial release.

Sometimes, physical therapists with specific pain points with a medical device called a transcutaneous electrical nerve stimulation. This sends low-voltage electrical currents to the nerves nearby.

The physical therapists you can also use a technique of psychology called biofeedback. This helps you to be aware of the areas where the muscles are tense, so that you can learn to relax these areas.

Some people also get relief of the pain of a procedure called dry needling. The therapist places of very thin needles in and around the stiff, sensitive areas tied to pain called trigger points.

Talk therapy. Some people with chronic pelvic pain also have a mental health condition, such as depression, anxiety or a personality disorder. Others have duration of a sexual trauma or emotional abuse. Talk therapy with a psychologist or a psychiatrist can help both your body and mind. You can relieve stress and help you learn ways to cope with the pain.

A type of psychotherapy that can help is the so-called cognitive-behavioral therapy. This means learning to be aware of the negative thoughts and bad. Sex therapy may also help. A therapist teaches couples how to have sex without pain, and can help relieve pelvic pain.

Surgery

Your healthcare provider may suggest surgery to treat a problem that causes chronic pelvic pain. The surgeries include:

  • The laparoscopy. If you have endometriosis, this type of surgery can treat or remove the tissue outside the uterus, causing pain. During the surgery, a slender visualization tool placed through a small incision near the belly button. The painful tissue is removed through one or more small incisions.
  • The hysterectomy. On rare occasions, you may need surgery to remove the uterus, called a hysterectomy. You may also need one or both ovaries. This is called oophorectomy. These surgeries have key consequences for the health. Ask your health professional to explain the benefits and risks in detail.

The pain rehabilitation programs

You can take a combination of treatment approaches before you find what works best for you. If appropriate, you might consider the possibility of introducing a pain in the rehabilitation program.

Lifestyle and home remedies

Long-term pain, can have a big impact on your daily life. When you are in pain, you may have trouble sleeping, exercising, or doing everyday tasks.

Long-term pain can also cause anxiety and stress. And these can make the pain worse.

Relaxation techniques such as meditation and deep breathing can help you to get a bit of relief. They can help to release tension, relieve pain, calm emotions, and help you sleep.

Other lifestyle changes may also help relieve the chronic pelvic pain:

  • Practice good posture.
  • Lose the extra weight. This can decrease the risk of tension in the muscles and joints of the pelvis.
  • Get regular exercise. Do an activity that you enjoy, and a rhythm. Talk with your doctor first if you're working out causes pain.

Alternative medicine

Some research suggests that acupuncture can be helpful for some causes of pelvic pain.

During the acupuncture treatment, tiny needles are placed in the skin at precise points. The relief of pain may come from the release of endorphins, the natural painkillers of the body. But that is only a theory about how acupuncture works. Acupuncture, in general, is a safe treatment.

Talk with your health care team before you try a complementary or alternative therapy.

Preparing for your appointment

It is likely to start by seeing your primary healthcare professional. Or you could see a gynecologist, a physician who is trained to identify and treat conditions that affect the female reproductive health.

Depending on what could be the cause of your pain, you may also need to see one of these providers:

  • A gastroenterologist, which helps people with digestive problems.
  • A urogynecologist, which treats urinary and female reproductive system problems.
  • A physiatrist or physical therapist, who helps people with muscle and skeletal pain.

What you can do

To prepare for your appointment:

  • Make a list of your symptoms. Include any that do not seem to be related to the reason for your appointment.
  • Take note of the key of the medical information. Include any major stresses or recent life changes.
  • Make a list of your medications. List all of the prescription and nonprescription medicines, vitamins, or other supplements you are taking. Include the amount you take, called the dose.
  • The thought of taking a family member or a friend with you. It can be difficult to remember all the information provided during an appointment. Someone who goes with you may remember something that you missed or forgot.
  • Prepare questions to ask the health care professional. This can help you to make the most of your time together.

Some basic questions to ask include:

  • What could be the cause of my symptoms?
  • What tests might I need?
  • If the tests to find the cause of my pain, what types of treatments could help me? If there is not a clear cause is found, what treatment do you suggest?
  • There are lifestyle changes should I make?
  • You should see a specialist?
  • Is there a generic alternative to the medicine you're prescribing?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Feel free to ask questions during your appointment. And tell your health care professional if you don't understand something.

What to expect from your doctor

Your healthcare provider will probably ask some questions. Be prepared to answer questions about the pain itself, such as:

  • When did the pain first start? Has changed over time?
  • How often do you feel the pain? It comes in the form of waves or is it constant?
  • How bad is the pain, and how long it lasts?
  • Where do you feel the pain? It is always in the same place?
  • How would you describe your pain?

You can also expect questions about things that seem to trigger or worsen your pain, such as:

  • Do you feel pain when you urinate or have a bowel movement?
  • Does your period affect your pain?
  • Is there anything that makes your pain better or worse?
  • The pain limit your ability to perform everyday tasks or things that you like?

You will be asked about your health history as well. These questions may include:

  • Have you ever had a pelvic surgery?
  • Have you ever been pregnant?
  • It has arrived the treatment of the urinary tract or vaginal infection?
  • Have you ever been touched against their will?
  • What are the treatments for pelvic pain have you tried so far? How have they worked?
  • Are being treated or have recently been treated for any other health problem?
  • Have you recently been feeling down, depressed or hopeless?
Symptoms and treatment of Chronic pelvic pain