Chronic Pelvic Pain

Chronic pelvic pain is described as abdominal pain that is not associated with menstrual cramps occurring six months or more. Approximately 15-20% of women experience chronic pelvic pain. Often the cause is undiagnosed or misdiagnosed.

Causes
Chronic pelvic pain can have many different underlying causes, and not all of them are gynecological. Interestingly, the nerves that signal “pain” from the pelvic organs to the brain are all bundled closely together as they enter the spinal cord. Thus, the brain cannot always distinguish an exact location of the pain. It could be coming from the uterus, the fallopian tubes or the ovaries, or it could be coming from the bladder, the intestines or the internal abdominal muscles. For this reason it is sometimes difficult to determine the underlying cause of chronic pelvic pain. Sometimes a team of specialists that includes a gynecologist, a urologist, a gastroenterologist and a physical therapist may be needed to pinpoint the root of pain.

Gynecologic causes of chronic pelvic pain include adhesions (scar tissue), endometriosis, previous damage due to surgery or infections, interstitial cystitis (IC), and pelvic congestion syndrome.

In contrast, pain caused by ovarian cysts and ectopic pregnancies is usually acute (sudden and piercing).

Diagnosis
One of the best means of identifying the cause of chronic pelvic pain is laparoscopy, a technique that allows the physician to view the pelvic organs including the uterus, fallopian tubes, ovaries, intestines, appendix, gallbladder and liver. This firsthand visual inspection can uncover problems such as endometriosis, pelvic infection, adhesions, ovarian cysts and ectopic pregnancies, as well as inflammation or infection of the appendix, intestines or gallbladder. Once the cause is known, an appropriate treatment can be determined.  Interstitial cystitis (IC) can be diagnosed in the office by a sample test called KCI test.

References

  1. American College of Obstetricians and Gynecologists. Gynecological Problems: Pelvic Pain. 2006. www.acog.org/publications/patient_education.pdf/bp099.cfm.
  2. American Society for Reproductive Medicine. Pelvic Pain: A Guide for Patients. Patient Information Series 1997. www.asrm.org/patients/patientbooklets/pelvicpain.pdf.
  3. Parker WH. A Gynecologist’s Second Opinion. (c)2003; A Plume Book; Published by the Penguin Group, New York, NY.
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Last updated on Nov 17, 2017
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