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’s considered chronic if it lasts for at least 6 months. The pain may be steady, or it may come and go. It can feel like a dull ache, or it can be sharp. The pain may be mild, or it may be bad enough to interfere with normal daily activities.

Symptoms of chronic pelvic pain

The primary symptom of chronic pelvic pain is the pain itself. How often you feel the pain and the severity differs. It depends on the person and what is causing the pain. A woman may feel it during sex. Another person may feel it only after eating. It may come and go or be present every day.

What causes chronic pelvic pain?

Some of the more common causes of chronic pelvic pain include:

Gynecologic conditions

• Endometriosis: When tissue that normally grows inside the uterus grows in other parts of the body, it’s called endometriosis. It can grow on your ovaries, in your pelvis, on your bladder, or in other areas. When you have your period, this tissue swells and bleeds, just like the lining of your uterus. This is often painful. Scar tissue can form in your pelvic area.
• Pelvic inflammatory disease: Pelvic inflammatory disease (PID) is an infection in the female reproductive organs (uterus, fallopian tubes, and ovaries). Normally, the cervix (opening to the womb) prevents bacteria in the vagina from spreading to these organs. If the cervix is exposed to a sexually transmitted infection (STI), such as gonorrhea or chlamydia, it becomes infected. This allows bacteria to travel to the internal organs. This can make organs inflamed and infected. When this happens, the woman’s fallopian tubes may be damaged. It causes pain and makes it difficult to become pregnant.
• Fibroids: Fibroids are benign (not cancerous) growths in the muscular wall of the uterus. These growths can be very tiny or as large as a cantaloupe. They are often painful.
• Ovarian remnant: During a complete hysterectomy, the uterus and ovaries are removed. Sometimes a small piece of the ovary gets left behind, and painful cysts can develop.

Other medical conditions

• Irritable bowel syndrome: IBS is a painful problem with the intestines. With IBS, the intestines squeeze too hard or not hard enough. This causes food to move too quickly or too slowly through the intestines.
• Interstitial cystitis: Interstitial cystitis is a chronic bladder problem. People with interstitial cystitis have a bladder wall that is inflamed and irritated (red and sore). This inflammation can scar the bladder or make it stiff. A stiff bladder can’t expand as urine fills it. In some cases, the walls of the bladder may bleed slightly. A few people get sores in the bladder lining.
• Past or present sexual abuse: If you have been the victim of sexual abuse, you are more likely to experience chronic pelvic pain.

How is chronic pelvic pain diagnosed?

Your doctor will ask you questions about your past and present health. He or she will ask about illness or health-related problems in your family. You may be asked to describe the kind of pain you have, where it is, and how strong it is. Tell your doctor anything you can about what causes the pain to get better or worse. He or she may ask:

• Is the pain related to your menstrual cycle?
• Is it related to bowel movements?
• Does it hurt during urination or sexual activity?
• Have you had an infection?
• Have you had surgery in your pelvic area?
• Your doctor may also want to perform some tests to help make the diagnosis.

What types of tests may be performed?

Several tests can help your doctor find the cause of your pain. Your history and physical exam will help him or her decide which, if any, tests to do. These may include blood tests, urologic tests, ultrasound, or X-rays. In some cases, your doctor may need to perform minor surgery, such as laparoscopy. Laparoscopy is a procedure in which the doctor inserts a thin, lighted tube in your abdomen to look at your pelvic organs.

Can chronic pelvic pain be prevented or avoided?

Whether your chronic pelvic pain can be prevented or avoided depends on what is causing the pain. There are many different causes. Some of them can be prevented. Others cannot be prevented.

Early diagnosis can sometimes prevent chronic pelvic pain. It is important to talk to your doctor when you begin to feel pelvic pain.

Chronic pelvic pain treatment

Treatment depends on your individual problem. Your doctor will help you determine which form of treatment is right for you. Some treatment options include:

• Stopping ovulation (the release of eggs from the ovary). This can be done with birth control pills or injections.
• Using nonsteroidal, anti-inflammatory pain relievers. This includes ibuprofen (one brand name: Motrin) or naproxen (brand name: Aleve).
• Relaxation exercises, biofeedback (treatment to control emotional states using electronic devices), and physical therapy.
• Changing posture.
• Regular physical activity.
• Antibiotics
• Counseling

Rarely, surgery is necessary if doctors can see pelvic abnormalities.

Living with chronic pelvic pain

Chronic pain is never easy to live with. If traditional methods of pain relief don’t work, there are alternatives. Your doctor can help you find a way to manage your pain. Sometimes, chronic pain responds to a nerve block that can block the pain for an extended period of time. Sometimes physical therapy or weight loss can help. Just know that things aren’t hopeless. Keep exploring pain management options until you find the one that works for you. You never want to take opioids for chronic pain.

Questions to ask your doctor

• What is the likely cause of my pelvic pain?
• Do I need any tests, such as ultrasound or X-rays?
• What do my test results mean?
• Based on the cause of my pain, what are my treatment options?
• Which of these treatment options do you recommend for me? Why?
• When can I expect relief from my pain?
• Do I need to make any lifestyle changes at home to help relieve my pain?

Resources

National Institutes of Health, Pelvic Pain: Overview

National Institutes of Health, MedlinePlus: Pelvic Pain