CHRONIC PELVIC PAIN

What is Chronic Pelvic Pain?

Chronic pelvic pain is pain felt in the lower abdomen, medically termed as the pelvic region, persisting for 6 months or longer. This pain can vary from intermittent to constant. Sometimes, it may manifest cyclically, such as during menstruation. Certain activities like eating, urinating, or sexual intercourse can trigger chronic pain. In this article, I will discuss in detail the conditions that can cause pelvic pain, as well as the diagnosis and treatment of pelvic pain.

Causes of Chronic Pelvic Pain

Chronic pelvic pain can be attributed to one or multiple diseases. While some of these conditions are related to the reproductive organs, others may involve organs outside the reproductive system, such as the urinary tract, intestines, or even the nervous system. While multiple conditions can be identified as potential causes of some women’s pain, in some cases, no specific cause can be determined.

Pelvic pain can stem from gynecological, gastrointestinal, urological, or musculoskeletal sources.

Gynecological Causes:

Gynecological causes are thought to be responsible for chronic pelvic pain in about 20% of women. The majority of these causes can be summarized as follows:

Endometriosis: Endometriosis is a condition where the tissue that lines the inside of the uterus (endometrium) is found outside the uterus. While some women with endometriosis may have no symptoms, others may experience infertility and pain complaints. For more detailed information, please refer to my article titled “Endometriosis.”

Fibroids: Fibroids are benign growths originating from the muscle layer of the uterus and rarely progress to cancer. While fibroids may be asymptomatic in some women, they can cause chronic pelvic pain, irregular menstruation, or infertility. You can find extensive information in my article titled “Fibroids – Myomas.”

Adenomyosis: Like endometriosis, adenomyosis involves the presence of endometrial tissue outside the uterine cavity, but in this case, it infiltrates the muscular layer of the uterus. This condition can lead to heavy menstrual periods and chronic pelvic pain. It is often associated with endometriosis.

Pelvic Inflammatory Disease: Pelvic inflammatory diseases are typically sexually transmitted infections. Once the genital organs become infected, this condition becomes chronic in about one-third of women, leading to chronic pelvic pain.

Non-Gynecological Causes:

Pain may originate from the digestive system, urinary tract, or pelvic muscles and nerves:

Irritable Bowel Syndrome (IBS): IBS is a digestive system disorder characterized by chronic abdominal pain and abnormal bowel habits (diarrhea, frequent painful bowel movements, and discomfort during defecation) without any identifiable cause.

Interstitial Cystitis (Painful Bladder Syndrome): Interstitial cystitis refers to bladder pain that occurs without any infection. Symptoms typically include frequent urges to urinate and urgent urination.

Diverticulitis: Diverticula are small, bulging pouches that can form in the lining of the digestive system, particularly the colon. Chronic constipation and a low-fiber diet can lead to diverticula. While some diverticula may be asymptomatic, others can become inflamed, leading to diverticulitis. This condition often causes abdominal pain, as well as nausea and vomiting, constipation, diarrhea, and urinary symptoms.

Fibromyalgia: Fibromyalgia is one of the chronic pain disorders affecting the muscles, ligaments, and tendons, which make up the body’s connective tissue. It is characterized by widespread muscle pain (or “myalgia”) and tenderness. Women with fibromyalgia may also experience fatigue, sleep disturbances, headaches, depression, and anxiety. Sometimes, they may face chronic pelvic pain.

Physical or Psychological Abuse: Chronic pain in patients may stem from previous experiences of physical or sexual abuse. Such information is important for your health and can shape your treatment. Therefore, if such a situation exists, you should not hesitate to inform your doctor and seek support.

How is Chronic Pelvic Pain Diagnosed?

Your medical history and a thorough physical examination are crucial steps in approaching a diagnosis. The physical examination should include an evaluation of the abdomen, lower back, hips, and pelvic organs (internal organs in the lower abdomen).

Depending on the results of the physical examination, various laboratory tests may be planned, including a white blood cell count, urine analysis, tests for sexually transmitted infections, and a pregnancy test. Sometimes, if it is suspected that the cause of the pain is related to gynecological issues as mentioned above, opinions and evaluations from other specialties such as a gastroenterologist, urologist, physiotherapist, or psychiatrist may be sought.

Pelvic ultrasound can assist in diagnosis by imaging the female reproductive organs and surrounding structures. It provides information related to the cause of pain, including ovarian cysts (such as chocolate cysts) and fibroids. However, ultrasound is not helpful for pain originating from non-gynecological causes like irritable bowel syndrome, diverticulitis, or painful bladder syndrome. In such cases, additional methods such as endosonography for evaluating the intestinal wall or cystoscopy for evaluating the bladder may be used.

Laparoscopy is a surgical procedure performed under general anesthesia, involving the visualization of the inside of the abdomen through a small incision. Laparoscopic procedures can be helpful in diagnosing some causes of chronic pelvic pain, such as endometriosis and chronic pelvic inflammatory disease.

If laparoscopy reveals abnormalities (such as endometriosis or abnormal tissue areas), these areas can be treated during the procedure, or biopsies may be taken to confirm the diagnosis.

Methods to Alleviate Chronic Pelvic Pain

Various methods are employed to alleviate chronic pelvic pain. The foremost step in treatment is identifying the underlying cause of the pain. Subsequently, both treatments targeting the cause and those aimed at pain relief are implemented. The selected treatments to alleviate pain primarily include medical treatment, physical therapy, nutritional therapy, and surgery.

Lifestyle Changes: Maintaining good posture and regular exercise can help alleviate pelvic pain.

Pain Relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) are helpful in relieving pelvic pain, especially menstrual cramps (dysmenorrhea).

Birth Control Pills: Some birth control pills may be effective in reducing chronic pelvic pain.

Physical Therapy: Acupuncture and nerve stimulation therapies can be beneficial in treating pain caused by dysmenorrhea. Physical therapy, including trigger point therapy, can alleviate muscle pain.

Nutritional Therapy: Vitamin B1 and magnesium can be used to alleviate chronic pelvic pain associated with dysmenorrhea.

Surgery: Surgery is an option for pelvic pain that does not respond to other treatments.