Pelvic pain in women refers to pain in the lowest part of the abdomen and pelvis, the area below the bellybutton and between the hips. It tends to be long lasting, sometimes six months or longer.
Chronic pelvic pain can be a symptom of another disease, or it can be an independent condition. The cause of chronic pelvic pain is often hard to find. If the source of the chronic pelvic pain can be found, treatment focuses on that cause.
Some women never receive a specific diagnosis that explains their pain. But that doesn't mean the pain isn't real and treatable. If no cause can be found, treatment focuses on managing the pain.
Chronic pelvic pain has many different characteristics. Symptoms may include:
- Pain that comes and goes,
- Severe and steady pain,
- Dull aching,
- Sharp pains or cramping,
- Pressure or heaviness deep within the pelvis.
In addition, pain may be experienced during intercourse, pain while having a bowel movement or urinating and pain when sitting for long periods of time.
The pain may be mild and annoying, or it may be so severe that the woman cannot go to work, sleep and exercise.
Several conditions may be the source of chronic pelvic pain. Sometimes, it may develop for no apparent reason and without any definitive source or cause. In addition, psychological factors may contribute to the pain such as emotional distress that may result from dealing with pain over a long period of time.
Some causes of chronic pelvic pain include:
- Tension in the pelvic floor muscles,
- Chronic pelvic inflammatory disease,
- Ovarian remnant,
- Irritable bowel syndrome,
- Painful bladder syndrome,
- Psychological factors,
- Pelvic congestion syndrome.
Risk factors for pelvic pain that becomes chronic include:
- Past pelvic inflammatory disease.
- Physical or sexual abuse in the past,
- Past radiation treatment or surgery of the abdomen or pelvis.
- History of depression. Pain and depression seem to be related.
- Alcohol or drug abuse.
- Something abnormal in the structure of the female organs.
- Pregnancy and childbirth that put stress on the back and pelvis, such as delivery of a large baby, a difficult delivery, or a forceps or vacuum delivery.
A wide range of complications are possible, mostly in the acute period. Surgical complications are generally managed surgically. Patients with primarily drug-seeking behaviour will often demonstrate global pain in all areas and will refuse all management options that do not include narcotics.
Failure to manage chronic pain is the most common complication and the most difficult to manage. Even with an optimal medical evaluation and management, some patients will still have intractable, cryptogenic pain.
The treatment will focus on eliminating the cause behind the chronic pelvic pain. However, if the cause can't be found, treatment will focus on managing the pain. Depending on the cause, the doctor may recommend a number of medications to treat the condition, such as pain relievers, hormone treatments, antibiotics and antidepressants.
To correct an underlying problem that causes chronic pelvic pain, a surgical procedure, such as laparoscopy and hysterectomy may be recommended.
A combination of treatment approaches and a pain rehabilitation program are possible.
Early diagnosis and treatment of pelvic pain may help keep the pain from becoming chronic.
One cause of chronic pelvic pain is pelvic inflammatory disease. The risk of getting this disease can be lowered by practicing safer sex by using condoms correctly.