Pelvic pain

What Is It ?

Pelvic pain is a symptom that can affect both women and men. The pelvic pain that persists for a period of 3 months or more is considered chronic while less than this duration is considered acute.

Most women, at some time in their lives, experience pelvic pain. As girls enter puberty, pelvic or abdominal pain becomes a frequent complaint. Chronic pelvic pain (CPP) accounts for 10% of all visits to gynecologists. In addition, CPP is the reason for 20 - 30% of all laparoscopies in adults.

Follow-Up

If pelvic pain is severe enough to disrupt your daily life for either a few days a month or for longer amounts of time, if pelvic pain increases overtime or if you have experienced a recent increase in pain, then you should consult the doctor.

Workup should begin with a careful history and examination, followed by a pregnancy test. Some women may also need bloodwork or additional imaging studies and a handful may also benefit from having surgical evaluation. The absence of visible pathology in chronic pain syndromes should not form the basis for either seeking psychological explanations or questioning the reality of the patient’s pain. Instead it is essential to approach the complexity of chronic pain from a psychophysiological perspective which recognises the importance of the mind-body interaction.

Some of the mechanisms by which the limbic system impacts on pain and in particular myofascial pain have been clarified by research findings in neurology and psychophysiology.

Signs and Tests

Keeping a pain journal can help your doctor pinpoint the cause and lets your provider see any patterns that may be associated with your pelvic pain.

To help your physician diagnose the cause of your pelvic pain, it's important that you can answer a few questions:

  • When did the pain begin?
  • Is it constant pain, or does it come and go?
  • How long does the pain last?
  • How severe is the pain?
  • Is it a sharp stabbing pain or a dull ache?
  • Is the pain always in the same place?
  • When do you typically experience pelvic pain?

In your pain journal you should also note:

  • The time of day when pain occurs.
  • The time as it occurs during your monthly cycle.

Whether pain occurs before, during, or after:

  • Eating
  • Urination
  • Bowel movements
  • Sexual intercourse
  • Physical activity
  • Sleeping
Treatment

Many women will benefit from a consultation with a physical therapist, a trial of anti-inflammatory medications, hormonal therapy, or even neurological agents.

Sooner or later, as women, most of us experience some degree of pelvic pain. How we respond to pelvic pain varies; some women are more bothered by pain than others. If pelvic pain is severe enough to disrupt your daily life for either a few days a month or for longer amounts of time, if pelvic pain increases overtime, or if you have experienced a recent increase in pain, you should talk with your health care provider to determine the cause.

There can be many causes of pelvic pain, so be prepared for a long diagnostic process.

Causes

Many times there is more than one reason for pelvic pain and it can be difficult to pinpoint the exact source. It may be necessary for your physician to consider other parts of your body when determining the cause of pelvic pain. Pelvic pain can be caused by problems in the digestive or urinary systems, as well as the reproductive organs. Many different conditions which can cause pelvic pain include:

  • Exaggerated bladder, bowel, or uterine pain sensitivity (also known as visceral pain)
  • Pelvic girdle pain
  • Gynaecologic
    • Dysmenorrhea
    • Endometriosis
    • Müllerian abnormalities
    • Pelvic inflammatory disease 
    • Ovarian cysts
    • Ovarian torsion
  • Abdominal
    • Loin pain hematuria syndrome
    • Proctitis
    • Colitis
    • appendicitis