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Pelvic PainPlease Login to watch the video...
These materials are for your general information and are not a substitute for medical advice. You should contact your physician or other healthcare provider with any questions about your health, treatment, or care. Chronic pelvic pain is pain that occurs below the umbilicus (or belly button) that lasts for at least six months. It may or may not be associated with menstruation. Chronic pelvic pain is not a disease, rather, it is a symptom that may be caused by several different conditions. WHAT CAN CAUSE CHRONIC PELVIC PAIN? — A variety of gynecologic, gastrointestinal, and systemic disorders, can cause chronic pelvic pain. Gynecologic causes — Some of the gynecologic causes of pelvic pain include: Endometriosis — The tissue lining the inside of the uterus is called the endometrium. Endometriosis is a condition in which endometrial tissue is also present outside of the uterus. Some women with endometriosis have no symptoms, while others experience marked discomfort and pain and may have problems with fertility. Other causes — Some of the more common non-gynecologic causes of chronic pelvic pain include: Irritable bowel syndrome — Irritable bowel syndrome is a gastrointestinal condition characterized by chronic abdominal pain and altered bowel habits (such as loose stools, more frequent bowel movements with onset of pain, and pain relieved by defecation) in the absence of any specific cause. HOW IS THE CAUSE OF CHRONIC PELVIC PAIN IDENTIFIED? — Because a number of different conditions can cause chronic pelvic pain, it is sometimes difficult to pinpoint the specific cause. A thorough history and a physical examination of the abdomen and pelvis are essential components of the diagnostic work-up. Laboratory tests, including a white blood cell count, urinalysis, tests for sexually transmitted infections, and a pregnancy test may be performed. The lab results may suggest causes of pelvic pain such as infection or pregnancy. Some diagnostic procedures may also be helpful in identifying the cause of chronic pelvic pain. For example, a pelvic ultrasound examination is very good at detecting pelvic masses, including ovarian cysts (sometimes caused by ovarian endometriosis) and uterine fibroids. A surgical procedure called a laparoscopy may be helpful in diagnosing some causes of chronic pelvic pain such as endometriosis and chronic pelvic inflammatory disease. At laparoscopy, a flexible tube with a special fiberoptic lens is inserted through a small incision just below the umbilicus. Through the tube, or laparoscope, the surgeon can visualize the contents of the abdomen, especially the reproductive organs. If the laparoscopy reveals a normal pelvis, the physician can then focus the diagnostic and treatment efforts on non-gynecologic causes of pelvic pain. HOW IS GYNECOLOGIC PELVIC PAIN TREATED? — Chronic pelvic pain due to a gynecologic condition is often treated medically. In some cases, however, surgery may be the treatment of choice. Medical treatment — Medication may be prescribed once laboratory and imaging tests suggest the pain is due to a gynecologic condition. Drugs that may be used include: Nonsteroidal anti-inflammatory medications such as ibuprofen If these medications are not effective in treating the pain, the woman is sometimes referred to a medical practice specializing in pain management. Pain services frequently utilize multiple treatment modalities including acupuncture and behavioral and relaxation feedback therapies. Nerve stimulation devices or injection of tender sites with anesthetic agents may also be used. Psychological counseling may be offered to help women manage the pain. Pain services can also be helpful in treating women who have become dependent on narcotics for pain management. Surgical treatment — A few causes of gynecologic pelvic pain can be treated surgically. For example, some women may benefit from surgical removal of their endometriosis. Uterine fibroids can be excised (a procedure called myomectomy) or removed as a consequence of hysterectomy (surgical removal of the uterus). Hysterectomy may alleviate chronic pelvic pain, especially when it is due to uterine disorders such as adenomyosis or fibroids. However, pain can persist even after hysterectomy, particularly in younger women (those less than 30) and in women with a history of chronic pelvic inflammatory disease. Obviously, hysterectomy is not a good choice for the management of chronic pelvic pain in women who have not completed their family. Surgery to cut some of the nerves in the pelvis has also been studied as a treatment for chronic pelvic pain. However, the effectiveness of this approach has not yet been demonstrated. WHERE TO GET MORE INFORMATION — Your doctor is the best resource for finding out important information related to your particular case. Not all patients with chronic pelvic pain are alike, and it is important that your situation is evaluated by someone who knows you as a whole person. National Library of Medicine (http://www.nlm.nih.gov/medlineplus) The American College of Obstetricians and Gynecologists 1. Mathias, SD, Kuppermann, M, Liberman, RF et al. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol 1996; 87:321. source: uptodate.com  |
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