Persistent or Chronic Pelvic Pain

PERSISTENT CAUSES OF CHRONIC PELVIC PAIN

WHAT IS CHRONIC PELVIC PAIN?

Chronic pelvic pain is a long-term noncyclical pain in the pelvic region that has lasted for more than six months. Chronic pelvic pain (CPP) can be very painful and debilitating, reduces the quality of life and hinders day to day functioning of women.

WHO DOES CHRONIC PELVIC PAIN AFFECT?

Chronic pelvic pain is a disorder that affects women of ages 15 - 80, across the world. On average, 1 in 7 women reports suffering from chronic pelvic pain during their lifetime.

HOW DOES CHRONIC PELVIC PAIN OCCUR?

The mechanism of chronic pelvic pain is based on the causative factor, which varies from case to case. However, as a general rule, anything that can affect the reproductive organs in a woman, and result in inflammation, enlargement of organs or infection can result in chronic pelvic pain.

PERSISTENT CAUSES OF CHRONIC PELVIC PAIN?

Chronic pelvic pain can be caused by a number of different conditions which include:

  • Pelvic Inflammatory Disease (PID)

  • Pelvic Adhesions

  • Fibroids

  • Endometriosis

  • Adenomyosis

  • Urinary Tract Infection (UTI)

  • Interstitial Cystitis

  • Psychological causes such as depression, substance abuse, anxiety or stress

  • Uterine or cervical cancer

SYMPTOMS OF CHRONIC PELVIC PAIN

Chronic pain that occurs in the region between your hips and belly button (pelvic area) is the primary symptom that is reported in chronic pelvic pain.

Depending on the cause, there may be varying accompanying symptoms such as

  • heavy bleeding,

  • vaginal discharge,

  • burning sensation during urination and

  • more.

These may be present to a varying degree or absent altogether with a patient only reporting constant pain.

TYPES OF CHRONIC PELVIC PAIN

Chronic pelvic pain can either be consistent that is only relieved with medicine or it comes and goes over time. The nature of pain also varies, ranging from a sharp pain to a dull ache.

STAGES OF CHRONIC PELVIC PAIN

The severity of the chronic pelvic pain varies in each case as well, with some women experiencing mild pain and other women experiencing the pain of such severity that they are unable to carry out their daily routine and have to stay in bed.

HOW IS CHRONIC PELVIC PAIN DIAGNOSED?

Due to its chronic nature and symptoms that mimic period pain, chronic pelvic pain sometimes goes undiagnosed for a long while.

Your doctor will suspect chronic pelvic pain if the cause is not immediately obvious and begin by taking a complete medical and gynecological history.

This may involve your doctor

  • performing a complete physical examination, and a

  • pelvic examination

to exclude or confirm the diagnosis.

They will also order certain tests which would include

  • blood pathology,

  • urine analysis for UTIs,

  • pregnancy tests to rule out regular and ectopic pregnancy, and

  • tests to check for Sexually Transmitted Diseases (STDs).

Further tests performed by your doctor could include

  • pelvic ultrasound,

  • abdominal CT or

  • MRI scan and hysteroscopy.

To confirm the diagnosis of chronic pelvic pain may require a joint consultation from a team of specialists which may include

  • your gynecologist,

  • a urologist,

  • a pain specialist and

  • even a psychologist - if the pain is believed to be psychological in nature, after ruling out all other causes.

HOW IS CHRONIC PELVIC PAIN TREATED?

The treatment plan for chronic pelvic pain will be designed by your doctor based on the cause of chronic pelvic pain, your age and general health.

It may include medication, physical therapy, pain management and in certain cases, surgical treatment. A few therapeutic options include:

  • Prescribing oral contraceptive pills

  • Advising use of NSAIDs (Nonsteroidal anti-inflammatory drugs) such as ibuprofen to manage pain

  • Prescribing a course of antibiotics in case of STDs or UTI as the cause of the pain

  • If the cause of CPP is psychological, your doctor may refer you to a psychologist for counselling.

  • If the cause of pain cannot be traced, and the pain is very severe, the doctor may advise surgery to relieve pain. 

Your doctor may also give you guidelines for home-based remedies such as using a hot water bottle, supplements, relieving stress with yoga and meditation, and exercises to relieve pain or reduce its intensity to a manageable level.

In the case of uterine or cervical cancer, your doctor may consult with an oncologist and the treatment may include chemotherapy, radiation therapy and even surgery to treat cancer and manage the chronic pain.

WHAT IF CHRONIC PELVIC PAIN IS UNTREATED

Chronic pelvic pain can be extremely painful and debilitating. If left untreated, the pain can result in emotional burden and economic loss for the patient and lowers their quality of life.

YOUR NEXT STEP

If you have any symptoms of relating to your vaginal bleeding your condition may require further investigation.

We would advise that you see your general practitioner and possibly obtain a referral to see Dr Alexander.

Dr Alexander can offer specialised help, advice on a possible diagnosis, further investigations and suitable treatment. Contact his rooms at www.my-obgyn.com.au