Chronic Pelvic Pain


Chronic pelvic pain is a common problem for women. It is defined as any pain felt either in lower abdomen or in the back which could be associated with cyclical periods or can be present all through the month. There are a wide variety of conditions that could lead to pelvic pain. Pelvic pain is considered “chronic” if it lasts for six months or more, or if it fails to respond to treatment.  It is often difficult to treat. 
We offer consultative services to women with chronic pelvic pain, including those with painful menstrual periods, undiagnosed chronic pelvic pain, and pain after hysterectomy. This is done using a multidisciplinary approach. Due to the complex nature of chronic pelvic pain, these conditions need detailed evaluation sometimes even several counselling sessions to completely relieve women with this distressing issue.

When do you consider that you are suffering from chronic pelvic pain

Chronic pelvic pain may present as severe and continuous pain; often dull aching with intermittent sharp cramping pain. One can feel pressure or heaviness deep within the pelvis. Pain during intercourse or cyclical bleeding or  while having a bowel movement or urinating can also be treated as chronic pelvic pain. The pain may be mild or incapicitating and so severe that one misses work, can't sleep and can't exercise

What can cause paelvic pain?

  • Endometriosis  (hyperlink to page on endometriosis) Can have both cyclical or non cyclical pain.
  • Tension & Stress- The pelvic floor and lower back muscles go into a spasm giving a  feeling of heaviness in pelvis especially by evening.
  • Chronic pelvic inflammatory disease. Long standing infection, often sexually transmitted, causes inflammation and scarring of pelvic organs.
  • Fibroids. These benign uterine growths can  cause pressure or heaviness in pelvis.
  • Irritable bowel syndrome- Bloating, constipation or diarrhea are often associated with pelvic discomfort.
  • Painful bladder syndrome (interstitial cystitis). Often difficult to diagnose, this condition is associated urinary symptoms as well. Pain is felt on full bladder and reduces after one voids urine.
  • Pelvic congestion syndrome. Enlarged, varicose-type veins in pelvismay cause pelvic pain. However, there is no scientific proof for the same.
  • Psychological factors. Depression, Anxiety disorders, stress can cause pelvic pain. Emotional distress makes pain worse, and living with chronic pain contributes to emotional distress, so it's a visciouc cycle.

 

What tests are required to diagnose chroinc pelvic pain?

  • Pelvic exam. Done in Gynecological office provides important clues for the underlying cause of such pain. Infection, abnormal growths or tense pelvic floor muscles can be diagnosed by the same.
  • Pap smear and other tests to rule out pelvic infections. Urine tests to rule out urinary tract infections.
  • Ultrasound. Detects masses or cysts in the ovaries, uterus or fallopian tubes. Endometrioisis and fibroids can also be diagnosed by USG.
  • Laparoscopy- Useful in detecting endometriosis and chronic pelvic inflammatory disease. If any of the above investigations do not reveal the correct diagnosis, Diagnostic Laparoscopy is a good method to diagnose as well as treat the underlying disorders.

How is chronic pelvic pain treated?

Treatment will vary for each patient, and the goal of treatment is to reduce symptoms and improve quality of life.

Medications

  • Pain kilers- Paracetamol, ibuprofen, diclofenac or muscle relaxants can provide relief, however rarely solves the problem of chronic pain.
  • Hormone treatments. Cyclical pain responds to oral contraceptive pills or progesterone treatment. .
  • Antibiotics. Pelvic inflammatory disease responds to antibiotics.
  • Antidepressants. Some types of antidepressants can be helpful for chronic pain. Tricyclic antidepressants have pain-relieving as well as antidepressant effects.

Surgery

Surgical therapy, often through minimally invasive (Laparoscopic or Robotic) techniques, is considered an appropriate option for specific causes of pain

  • Laparoscopic surgery. Pain due to adhesions, endometriosis, pelvic masses or fibroids can be relieved by surgical correction.
  • Hysterectomy. In rare complicated cases, removal of uterus (hysterectomy), fallopian tubes (salpingectomy) or ovaries (oophorectomy) may be recommended.

Our team also works with other pain specialists, including physiotherapists and behavioral therapist. A multi prong approach will help to relieve pain in this complex scenario.




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