Chronic Pelvic Pain

(Pelvic Pain, Chronic)
  • Definition

    Pelvic pain is located between the belly button and the hips and groin. If it lasts for six months or more it is called chronic pelvic pain. It is often difficult to figure out what is the source of the pain. Pelvic pain can be caused by problems in the:
    • Female reproductive organs
    • Intestines
    • Nerves
    • Bladder
    • Prostate
    Male Pelvis Organs
    Male pelvis lateral
    Includes bladder, prostate (under bladder), and the colon.
    © 2011 Nucleus Medical Media, Inc.
  • Causes

    Chronic pelvic pain can be caused by a wide variety of conditions.
    • Gynecological conditions
      Female Pelvis Organs
      Female pelvis lateral
      From left to right: the bladder, uterus, and colon. Nerves are shown in yellow.
      © 2011 Nucleus Medical Media, Inc.
    • Psychological conditions, such as depression, or a history of physical or sexual abuse
    • Neuromuscular conditions
      • Pudendal neuralgia
      • Muscle pain
      • Nerve pain
      • Lower back pain
      • Joint and bone pain
      • Muscle strain
  • Risk Factors

    Having one of the conditions listed above increases your chance of having chronic pelvic pain. Other factors may include:
    • Miscarriage
    • Cesarean section
    • Alcohol or drug abuse
    • Heavy menstrual flow
  • Symptoms

    Symptoms may include:
    • Constant pain or dull ache in pelvic area
    • Pain that comes and goes
    • Pain that ranges from mild to severe
    • Pain with certain activities
    • Pelvic heaviness
    • Urge to defecate hits suddenly and intensely
  • Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may be asked to keep a pain journal to help your doctor diagnose the pain. You will be asked to write down when your pain occurs, how it feels, and how long it lasts. Your doctor may recommend tests to confirm or rule out specific diagnoses.
    Tests may include:
    • Blood and urine tests
    • Cultures and swabs
    • Tests for sexually transmitted diseases (STDs)
    • Laparoscopy—a thin, lighted tube inserted into the abdomen to look for infection or disease
    • Cystoscopy—a thin, lighted tube inserted into the bladder to look for abnormalities
    • Sigmoidoscopy—a thin, lighted tube inserted into the rectum to look for abnormalities
    • Intravenous pyelography—type of x-ray that uses dye to look at the kidneys; used to look for damage or disease
    Imaging tests to see inside body structures:
  • Treatment

    Talk with your doctor about the best treatment plan for you. Options include:
    Medications
    Chronic pelvic pain is treated based on what caused it:
    • Antibiotics if an infection is present or possible
    • Nonsteroidal anti-inflammatory drugs (NSAIDs) to treat pain and reduce inflammation
    • Opioid pain relievers
    • Antidepressants
    • Antiseizure medications
    • Birth control pills
    Complementary Therapies
    The following have been used to treat pelvic pain:
    The following have been used to treat pelvic pain:
    Interventional Approaches
    In some cases interventional approaches, including nerve blocks, may be used.
    Psychological Counseling
    Managing stress through counseling is helpful to many women with chronic pelvic pain.
    Surgery
    There are numerous causes of pelvic pain. Many are treated with surgery. The type of surgery depends upon the specific problem.
  • Prevention

    Preventing chronic pelvic pain depends on the condition causing it. Some causes are not preventable.
    STDs cause many conditions that result in chronic pelvic pain. Use latex condoms every time you have sexual intercourse, and minimize the number of sex partners you have.
  • RESOURCES

    The American Congress of Obstetricians and Gynecologists http://www.acog.org

    The International Pelvic Pain Society http://www.pelvicpain.org

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

    The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org

    References

    Chronic pelvic pain. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/chronic-pelvic-pain.html. Updated January 2011. Accessed June 11, 2013.

    Chronic pelvic pain. The American Congress of Obstetricians and Gynecologists website. Available at: http://www.acog.org/~/media/For%20Patients/faq099.pdf?dmc=1&ts=20130611T1540053024. Accessed June 11, 2013.

    Chronic pelvic pain. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated June 7, 2012. Accessed June 11, 2013.

    Chronic pelvic pain. The International Pelvic Pain Society website. Available at: http://www.pelvicpain.org/pdf/Patients/CPP%5FPt%5FEd%5FBooklet.pdf. Accessed June 11, 2013.

    Levy BS. The complex nature of chronic pelvic pain. J Fam Pract. 2007 Mar;56(3 Suppl Diagnosis):S16-17.

    Reiter RC. Evidence-based management of chronic pelvic pain. Clin Obstet Gynecol. 1998;41(2):422-435.

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