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Understanding Chronic Pelvic Pain: Causes, Symptoms, and Treatment

chronic pelvic pain

Introduction

Living with pelvic pain for months—or even years—can be emotionally exhausting and physically limiting. Many women silently tolerate discomfort, thinking it is “normal” or something they must learn to live with. Chronic pelvic pain is not normal, and more importantly, it is treatable once the underlying cause is identified. With the right evaluation and a compassionate, step-by-step approach, most women experience significant relief.

What is chronic pelvic pain?

Chronic pelvic pain (CPP) is defined as persistent pain in the lower abdomen or pelvis lasting for six months or more. The pelvis lies between the abdomen and the legs and contains important organs such as the uterus, ovaries, fallopian tubes, bladder, bowel, and pelvic floor muscles.

The pain may be:

  • Continuous or intermittent

  • Mild, dull, dragging, or sharp

  • Related or unrelated to periods

  • Worse during intercourse, urination, or bowel movements

In my clinical experience, chronic pelvic pain is often multifactorial—meaning more than one cause may coexist.

Endometriosis

Endometrial tissue grows outside the uterus, leading to inflammation, scarring, and pain—often severe during periods or intercourse.

Uterine fibroids

Large or degenerating fibroids can cause a heavy, dragging pelvic discomfort and pressure.

Adenomyosis

When endometrial tissue grows into the uterine muscle, the uterus enlarges and causes severe menstrual pain and chronic pelvic ache.

Pelvic inflammatory disease (PID)

Chronic infection or damage to the uterus, tubes, or ovaries—often due to sexually transmitted infections or tuberculosis—can lead to long-term pain.

Pelvic adhesions

Bands of scar tissue form after infections or surgeries, causing organs to stick together and generate pain.

Ovarian cysts and adnexal masses

These can stretch the ovarian capsule or cause torsion, leading to persistent pain.

Pelvic congestion syndrome

Dilated pelvic veins cause a dull, aching pain, usually worse after standing for long periods.

Pelvic cancers

Cancers of the uterus, ovaries, or cervix may present with chronic pelvic pain in advanced stages.

Effects of pelvic radiation therapy

Radiation for cancer can cause long-term tissue damage and fibrosis, resulting in chronic pain.

Gastrointestinal causes

  • Irritable bowel syndrome (IBS)

  • Chronic constipation

  • Inflammatory bowel disease

  • Diverticulitis

Urological causes

  • Painful bladder syndrome

  • Interstitial cystitis

  • Recurrent urinary tract infections

Musculoskeletal causes

  • Pelvic floor muscle spasm

  • Fibromuscular pain syndromes

  • Herniated lumbar disc

Neurological causes

  • Nerve entrapment due to endometriosis or fibrosis

  • Nerve injury after surgery, childbirth, or trauma

Psychological and emotional factors

  • Chronic stress or depression

  • History of physical or emotional trauma

  • Pain amplification due to long-standing untreated pain

Dr. Dimple Doshi’s Tip:
Chronic pain affects both the body and the mind—addressing both is essential for lasting relief.

Because chronic pelvic pain has many possible causes, a thorough and structured evaluation is crucial.

Your assessment may include:

  • Detailed medical and menstrual history
  • Understanding pain triggers, duration, and relieving factors
  • Physical examination of the abdomen, pelvis, hips, and lower back
  • Internal pelvic examination
  • Blood tests, urine tests, STI screening, and pregnancy test (if relevant)
  • Imaging such as pelvic ultrasound, CT scan, or MRI
  • Diagnostic laparoscopy, a minimally invasive procedure that allows direct visualization of pelvic organs—especially useful for diagnosing endometriosis, adhesions, and PID

Treatment is always individualized and depends on the underlying cause.

Pain control

  • Simple analgesics or pain modulators to improve daily functioning

Treating the root cause

  • Antibiotics for infections
  • Hormonal therapy for endometriosis or adenomyosis
  • Targeted medical treatment for IBS or bladder conditions

Nerve-related pain management

  • Selected antidepressants or anticonvulsants to reduce nerve hypersensitivity

Surgical treatment

  • Laparoscopic excision of endometriosis
  • Adhesiolysis
  • Fibroid removal
  • Hysterectomy in severe, selected cases

Psychological support

  • Counseling or psychotherapy
  • Multidisciplinary care involving psychologists and pain specialists

In my practice, combining medical treatment with lifestyle and emotional support gives the best long-term results.

Q1. Can chronic pelvic pain go away on its own?

Ans. Rarely. Most cases need evaluation and targeted treatment.

Q2. Is chronic pelvic pain always gynecological?

Ans. No. Bladder, bowel, muscle, nerve, and psychological causes are equally common.

Q3. Can lifestyle changes help?

Ans. Yes. Stress management, physiotherapy, dietary changes, and exercise often reduce pain.

Q4. Is laparoscopy necessary for all women?

Ans. No. It is advised when non-invasive tests do not provide answers.

Conclusion

Chronic pelvic pain can deeply affect a woman’s physical health, emotional well-being, relationships, and work life. The good news is that you do not have to live with it. With timely diagnosis, a holistic evaluation, and personalized treatment, chronic pelvic pain is manageable and often significantly reversible.

At Vardaan Hospital, Goregaon West, Mumbai, I focus on identifying the true cause of pelvic pain rather than masking symptoms. If you have been struggling with persistent pelvic discomfort, seeking expert care is the first step toward reclaiming comfort, confidence, and quality of life.

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