Chronic Pelvic Pain

The pelvis is the part located between the abdomen and the legs. This area provides support for the intestines and contains the bladder and reproductive organs; namely the uterus; fallopian tubes and ovaries.

If you feel pain in this region and if it has lasted for 6 or more months; it is called chronic pelvic pain. If you are suffering from this type of pain; see your gynecologist as most of the time; it is associated with gynecological conditions; although few nongynecological conditions may also cause pain in the pelvis.

Dr. Dimple Doshi at Vardaan Hospital; believes prevention is better than cure, and thus apart from the precise treatment guidelines; preventive measures are an essential part of our consultations with the patients who have either had it or want to know more about it.

Gynecological causes:

  1. Endometriosis: The lining inside the uterus is called the endometrium. If it is present outside the uterus; it is called endometriosis. The majority of women with endometriosis have pain and discomfort in the pelvic region.
  2. Uterine fibroids: Fibroids; also called leiomyomas; are noncancerous growths inside the uterus. Big uterine fibroids cause dragging discomfort and pain in the pelvis.
  3. Adenomyosis: In this condition; the endometrial tissue ( the tissue that normally lines inside the uterus ) grows inside the uterine walls. This enlarges the uterus and pain in the pelvis along with heavy periods. This pain becomes severe during periods but may exist even when there is no menstruation.
  4. Pelvic inflammatory disease: It is an infection that is usually transmitted through sexual activity; though it may happen due to appendicitis; tuberculosis or diverticulitis.  It involves the uterus; fallopian tubes; or ovaries. Chronic changes like damage to the reproductive organs happen due to PID leading to chronic pelvic pain.
  5. Adhesions in the pelvis: Adhesions mean the tissues inside the abdomen stick together. This may result from infection or any surgery. Dense adhesions may lead to chronic pelvic pain.

Nongynecological causes like irritable bowel syndrome; painful bladder syndrome; diverticulitis; fibromuscular causes may lead to chronic pelvic pain.

As a number of conditions cause chronic pelvic pain; your gynaecologist examination will be aimed to find out the reasons of chronic pelvic pain so that  you can be given appropriate treatment to improve the quality of life.

  1. Your gynaecologist will ask your medical history; as to how the pain starts; its triggers and how it worsens.  Your history of any health problems and other conditions will also be elicited.
  2. Your gynaecologist will examine your abdomen; back; lower hips and pelvis. Internal pelvic examination also will be done.
  3. You may be asked to do laboratory tests like complete blood counts; urine analysis; tests for sexually transmitted diseases; and a pregnancy test also.
  4. Pelvic ultrasound is a very important tool to look for the causes like ovarian cysts; fibroids; adenomyosis.
  5. Laparoscopy: Laparoscopy is a minimally invasive surgical procedure to diagnosis causes like endometriosis or pelvic inflammatory diseases which are not picked up the standard tests. Laparoscopy is a procedure done under anesthesia . A thin telescope with camera is inserted through a small incision. This allows your surgeon to see inside your abdomen and look at your reproductive organs. 
  1. Managing pain: Chronic pelvic pain can be controlled by analgesics or the routine pain killers.
  2. Treating the underlying cause: If the diagnostic tests like ultrasound or laparoscopy has suggested a specific cause for your symptoms; your gynaecologist will plan your treatment acoordingly.  
  3. Sometimes your nervous system throws an exaggerated response to the pain; so one approach is to start analgesics; anti depressants and anti convulsive medications.
  4. Surgical treatment: A few gynecological causes of pelvic pain can be treated with surgery like some women may benefit from surgery for endometriosis; fibroids; or ovarian cyst. Hysterectomy is a good choice for pain management in women with PID; adenomyosis or fibroids.   

Psychotherapy involves combined involvement of a psychologist; psychiatrist and social workers who can help you cope up with the chronic pain and improve the quality of life.