Pelvic Pain

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All About Pelvic Pain

What Defines Pelvic Pain?

Pelvic pain is a general term for a whole range of symptoms and diagnoses associated with the lower abdomen, groin, lower back, pelvic and upper thigh areas. Women who complain of pelvic pain may be suffering from any number and degree of problems from severely painful menstruation (acute) to pelvic inflammatory disease (chronic) and from urinary tract infection to fibroids. Pelvic pain complaints may encompass mild to severe cramping, sharp pain in the lower abdomen, back and thighs, mild pelvic pressure, bloating, pain during intimacy or gas pain. Acute pelvic pain may indicate a specific isolated problem, while chronic pelvic pain is defined as any pelvic pain that lasts for more than six months. Pelvic pain in women is as varied as the type and location of pain. Acute pain may be mild for some women, while others experience severe discomfort that can significantly interfere with everyday activities for several days each month.

What Are the Causes of Pelvic Pain?

A physician will rule out pregnancy and cancer, before determining possible causes of pelvic pain. A pelvic exam is essential in eliminating secondary causes of pain such as tumors or ovarian cysts. A pain assessment, which addresses family history, location, menstrual cycle occurrence, radiation and relief or aggravating factors of pain will be performed. Differentiating dysmenorrhea from premenstrual syndrome (PMS) is one elimination step. Pain associated with PMS, for example, is generally related to abdominal bloating rather than lower abdominal cramping pain. PMS symptoms usually begin before the menstrual cycle and resolve shortly after menstrual flow begins.

The onset of menstruation is the most common cause of pelvic pain. Uterine contractions occur during all periods, but in some women these cramps can be frequent and very intense. Primary dysmenorrhea, or pain during menstruation, is described as a mild, dull (cramping) or throbbing pain, that usually centers in the lower mid-abdomen, radiating toward the lower back or thighs. It occurs just before or during menstruation in the absence of other diseases, such as endometriosis, and is caused by normal uterine muscle contractions Pain usually develops within hours of the start of menstruation and peaks as the flow becomes heaviest, during the first day or two of the cycle. Women may experience sharp, intermittent spasms of pain, usually centered in the pubic area, or pain that radiates to the thighs or lower back.

Secondary dysmenorrhea refers to painful periods resulting from pelvic diseases such as endometriosis, fibroid tumors, pelvic inflammatory disease, scarring (adhesions), polyps, ovarian cysts and inflammatory bowel disease. Prostaglandins or hormone-like substances are believed to be responsible for the painful uterine contractions and symptoms of dysmenorrhea.

Diagnosing Pelvic Pain

Diagnosing pelvic pain requires an invasive examination of the cervix, uterus, tubes, ovaries, vagina and rectum for endometriosis, tumors, adhesions, adenomyosis, fibroids, polyps, complications of pregnancy, pelvic infection or inflammation, congenital malformations, appendicitis and gastrointestinal and renal disease. Musculoskeletal problems that may effect pelvic muscle tension should also be considered.

Pain mapping techniques are performed where specific areas inside the pelvis are touched by the physician to learn if they duplicate the chronic pain experienced by the patient.

Hysteroscopy is performed to detect the presence of fibroids, polyps or other causes of pelvic pain (with the exception of cancer). A fiber-optic light source is inserted into the uterus to view and transmit to a video screen.

Some Potential Causes of Pelvic Pain

Fibroids are generally benign (non-cancerous tumors) that occur in the uterus (womb) and distort the uterine wall. These fibroids may inhibit muscle contracture and cause significant cramping. Fibroids may enlarge (grapefruit size) to the point where they outgrow their blood supply and cause a great deal of pain, especially during periods.

Endometriosis is when small implants of uterine lining tissue grow outside of the uterus, causing pain during periods and possibly during intercourse.

Adenomyosis occurs when glands from the uterine lining become embedded in the uterine muscle, causing heavy bleeding and pain during menstrual contractions.

Pelvic adhesions are bands of scar tissue that form and cause internal organs with natural mobility to stick together and cause pain.

Pelvic inflammatory disease (PID) results from an infection (usually a sexually transmitted disease) that frequently leads to adhesions (please see All About Adhesions). Pelvic or abdominal adhesions, e.g., cause 60-70% of small bowel obstructions in adults and are believed to contribute to the development of chronic pelvic pain. Fallopian tube adhesions can lead to increased incidence of ectopic pregnancy in which a fetus develops outside the uterus. Cervical motion tenderness is a common symptom of pelvic inflammatory disease and is usually caused by gonorrhea or Chlamydia.

· Vestibulitis is often a source of pain which originates during sexual penetration from the areas surrounding the entrance to the vagina.

A birth control device, such as an IUD, can cause cramping and backache due to local irritation.

Postpartum endometritis is an example of a pain causing injury to the reproductive tract.

Treatment Options

Surgical evaluation and treatment of specific pain disorders are utilized. Laparoscopic exams are often critical in determining cause(s) and providing treatment for pelvic pain. Women with pelvic adhesions or endometriosis may be treated laparoscopically under general anesthesia in an outpatient setting.

Vaginal ultrasound increases the accuracy of diagnosing pelvic pain and assists in selecting one of the following procedures to treat the cause(s) of pain:

Endometrial resection involves cutting away the inflamed uterine lining
Endometrial ablation is the removal of the uterine lining by using electricity, heat, cold or microwave
Intrauterine resection of polyps and fibroids
Open, vaginal or laparoscopic removal of fibroids
Open, vaginal or laparoscopic hysterectomy or surgical removal of the uterus
Lysis of adhesions

Additional Treatment Options

A heating pad or hot-water bottle placed on the abdomen or lower back, or a hot bath can help relieve pelvic pain.
Hypnosis, yoga and relaxation therapy help reduce the stress that increases pain.
Non-prescription drug usage, such as acetaminophen or ibuprofen, is so predictable in women with primary dysmenorrhea that failure to respond to treatment should raise doubts about the diagnosis. Most patients with primary dysmenorrhea show improvement with this treatment.
Oral contraceptives can ease the pain of dysmenorrhea by lowering muscle contraction-causing hormone levels. Oral contraceptives provide another effective choice for therapy, especially in women desiring birth control.
Changing the body position, e.g. assuming a fetal position, with knees pulled up to the chest, while hugging a heating pad or pillow to the abdomen, can help ease cramps.
Acupuncture
Diet changes/Vitamin supplements
Exercise
Smoking cessation
Aromatherapy
Counseling

Conclusion

A woman’s ability to convey accurate information about the pain she is experiencing can contribute to effective diagnosis, evaluation and treatment by the physician. Successful pain management and reduction should enable a woman to resume her normal life.

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Pelvic Pain

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