What Causes Chronic Pelvic Pain?

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Chronic Pelvic Pain

Chronic pelvic pain is persistent, non-cyclic pain in the pelvic region that lasts for six months or longer. The pain can be mild or so severe that it disrupts your life, making it difficult to sleep and work. Such chronic pain can be intermittent or steady, dull or sharp. For some women the pain is conditional, meaning it happens in a specific situation, such as during intercourse or while urinating or when simply sitting down. For others it is constant.

Pelvic pain can have a variety of causes, both physical and psychological.

For example, pelvic pain can be caused by endometriosis, a condition in which tissue from the lining of the uterus grows outside the uterus, leading to painful cysts and bands of scar tissue. It can also be caused by long-term infections in your reproductive organs. Pelvic inflammatory disease, usually caused by sexually transmitted bacteria, can damage the ovaries and the uterus.

Noncancerous uterine growths known as fibroids may cause a sensation of pressure in the lower abdomen. Interstitial cystitis or painful bladder syndrome is a chronic bladder condition in which you feel pain and pressure in the bladder area and frequently need to urinate. It’s not caused by a bacterial infection, like a urinary tract infection, and will not improve with antibiotics. The pain temporarily improves after you empty your bladder.

Some women have chronic kidney stones, small pebble-like masses that develop in the urinary tract. These masses can block the tubes that normally easily expel urine from the kidneys. Treating kidney stones is mainly focused on managing symptoms.

Irritable bowel syndrome, a chronic disorder that affects the large intestine, causes cramping, bloating, and gas, and may also result in feelings of pain and pressure in your lower abdomen.

In some women, conditions such as fibromyalgia  and chronic fatigue syndrome can lead to pelvic pain.

Chronic pelvic pain can also be caused by problems in muscles, joints, and ligaments in the pelvis region or lower back. Pelvic pain or discomfort is not unusual during pregnancy as hormone known as relaxin allows the pelvic bones to shift to accommodate the baby’s birth process. Pelvic bones are normally in a fixed state but may shift out of alignment, resulting in lower back, hip or pubic pain. A small percentage of women experience such pain after childbirth.

Psychological factors such as depression and post traumatic stress disorder may also play a part in chronic pelvic pain, especially if a woman has a history of sexual or physical abuse. Nearly one half of the women seeking care for chronic pelvic pain have experienced sexual, physical or emotional trauma.

It’s important to see your doctor for any pain that persists, is severe, or interferes with daily activities. When diagnosing the cause of pelvic pain, doctors will first try to rule out any identifiable diseases and treat the cause.

Diagnosing the cause will usually involve blood and urine tests to check for signs of infection, a pregnancy test, and tests for sexually transmitted diseases. If the cause is still not known after these preliminary tests, your doctor may send you for a transvaginal ultrasound, an MRI or a CT scan of your pelvis.

Your doctor may suggest laparoscopy, a minor surgery that involves inserting a thin lighted tube with a camera  to search for possible growths or scar tissue that might be causing the pain.

Treatment for chronic pain depends on identifying the cause. If the pain is caused by a cyst or a tumor, then surgery to remove the growth may be recommended. If the cause is a condition such as irritable bowel syndrome, treatment recommended for that condition may alleviate the associated pain. If the cause is an infection, antibiotics may be prescribed. If the problem is musculoskeletal, physical therapy may help.

If your doctor suspects a psychological cause, behavioral therapy or an antidepressant may be recommended.

It can take a while to narrow down the cause of chronic pelvic pain and it’s not always possible to find one. If a doctor cannot isolate a specific cause for chronic pelvic pain, treatment may include ways to improve your quality of life and offer safe options for pain relief. Options for pain relief range from over-the-counter medications to injections of local anesthetics.

Joan MacDonald
Joan Vos MacDonald has written about health and fitness for newspapers, magazines and websites. She is a member of the National Association of Science Writers and the author of two books on health-related topics, "Tobacco and Nicotine Dangers," for young adults, and "High Fit Home," a design book about fitness and architecture. She lives in upstate New York near her children and grandchildren.

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