Pelvic Pain

It is estimated that 15% of American women disclose that they have chronic pelvic pain. Four percent of those who do speak with their healthcare provider express that pain is substantial enough to cause them to miss work. And these are only the reported cases. Many more women may be affected by pain, but do not suspect that their condition could potentially be serious.

What Is Pelvic Pain?

Chronic pelvic pain is, in fact, a complex issue. This is because there could be a number of reasons for this symptom. Pain in the pelvic region does not necessarily indicate a gynecologic problem. The reason may lie in the musculoskeletal system, the urologic system, or the gastrointestinal system.

What Classifies as Abnormal Pelvic Pain?

Some pelvic pain is cyclical in nature, meaning that it is related to menstruation. If pain becomes chronic, meaning that it occurs frequently or persists for more than 6 months. Whether pain is constant or coincides with certain events, such as intercourse, urination, bowel movements, or physical activity, or spontaneously appears from time to time, a consultation and exam with a trusted healthcare provider are recommended.

Pelvic Pain Causes

Several factors can contribute to pelvic pain. Some include but are not limited to:

• Pelvic inflammatory disease, or PID. This condition stems from an untreated sexually transmitted infection. It may affect the uterus, ovaries, and tubes of the reproductive system. Chronic pelvic pain affects approximately 30% of women with PID and is directly related to scarring caused by infection.
• Pelvic adhesions. Scar tissue may also form in the bowel, the bladder, the uterus, or other structures as a result of surgery, endometriosis, or other conditions.
• Endometriosis, a condition in which cells that resemble those found in the endometrial lining of the uterus cause inflammation, may lead to pelvic adhesions. Approximately 70% of women with pelvic pain also have endometriosis.
• Uterine fibroids may cause a sensation of uncomfortable pressure.
• Pelvic mass or tumor. The pressure that a growth places on surrounding organs may cause pelvic pain. An ovary may also become twisted by a growth, leading to pain.

Can Pelvic Pain Be Caused by Gas?

Because pelvic pain may originate in one of a number of systems, uncovering the cause may take some time. To begin the diagnostic process, your healthcare provider will conduct a thorough consultation to obtain an accurate medical history. The findings of this initial history and general physical will guide the direction of care. It may be necessary to also consult with a specialist such as a urogynecologist or a gastroenterologist.

How Is the Cause of Pelvic Pain Determined?

The gynecological exam, conducted as an adjunct to medical history, will most likely begin with a pelvic examination. Lab work such as a urinalysis, pregnancy test, and other blood tests may be conducted. Diagnostic labs may include screening for gonorrhea and Chlamydia in some cases.

Radiologic imaging may also be performed to observe internal structures. A pelvic ultrasound may detect fibroids, ovarian cysts, or other pelvic masses. If an initial ultrasound indicates an abnormality, further imaging may be scheduled, such as a CT scan, which obtains various views of the pelvic region, and may be appropriate for diagnosing bladder, colon, or other pelvic masses. MRI imaging can also be beneficial for reaching an accurate diagnosis.

Laparoscopy is another method used to diagnose the cause of chronic pelvic pain. This minimally-invasive procedure achieves two objectives. First, it can reveal the cause of pain, such as adhesions, better than radiologic imaging. Second, laparoscopic surgery can immediately treat abnormalities that are identified.

Will I Need Surgery to Treat Chronic Pelvic Pain?

Not necessarily. Laparoscopy is both a diagnostic tool and a treatment modality. Pelvic pain accounts for one-third of laparoscopies performed. To treat pelvic pain, a healthcare provider may turn to nutritional therapy, physical therapy, medication, or surgery.

• When dysmenorrhea, or pain associated with menstruation, causes pelvic pain, medication to reduce inflammation may be recommended. Magnesium and vitamin B1 may also alleviate this type of pelvic pain. The use of medication does not substitute for medical care obtained to reach an accurate diagnosis for pelvic pain.
• Pelvic pain may be reduced with regular exercise and good posture.
• Physical therapy modalities such as nerve stimulation, acupressure, or acupuncture may facilitate pain relief, as may physical therapy techniques implemented to ease trigger points for muscular pain.
• Outside of diagnostic laparoscopy, surgery may be performed to inhibit nerve signals when conservative therapies do not reach the desired outcome.