Pelvic Pain Diagnosis & Treatment

Pelvic pain in women is pain experienced in the lowest part of the abdomen and pelvis, specifically the region below the bellybutton and between the hips.  Organs within the pelvis include the ovaries, uterus, bowel, and bladder. In addition, pain may come from pelvic bones near these organs, or from the surrounding nerves, blood vessels, joints, or muscles.  Therefore, it is safe to say that there are many different causes of pelvic pain which often make this type of pain hard to diagnose.  Pelvic pain is considered chronic if the pain lasts 6 months or more.  Pelvic pain symptoms vary widely in severity and nature and may include pain that is described as one of the following: intermittent, steady/non-stop, severe, mild, dull/ aching, pressure/heaviness, cramping, or sharp.  Pelvic pain may also be experienced during sexual intercourse, while sitting down, while urinating, or during a bowel movement.

Again, pelvic pain can often be difficult to diagnose as there exists a plethora of possible causes.  Chronic pelvic pain may be a symptom of another condition or disease, or it can be a condition in and of itself.  Some possible causes of pelvic pain include:

• Pelvic Inflammatory Disease (PID): PID is a uterine infection caused by bacteria that travels from the vagina or cervix into the uterus.  Cases of PID are commonly a result of a sexually transmitted disease such as gonorrhea or chlamydia.  PID may become chronic if a long-term infection causes scarring that affects the organs within the pelvis.  PID symptoms may include lower abdomen/pelvic pain, abnormal vaginal bleeding, vaginal discharge, and/or fever.

• Fibroids: Fibroids are common, non-cancerous, benign tumors that develop in or on a woman’s uterus.  While most fibroids are in fact asymptomatic, some can expand to large sizes and may causes symptoms such as pelvic pain, lower back pain, irregular bleeding, heavy periods, painful menstruation, urinary urgency, lower abdominal pressure/heaviness, or painful intercourse.  Degenerative changes in a fibroid occur when it becomes deprived of its blood supply and starts to die.  This process of degeneration or shrinking can cause sharp pelvic pain.

• Endometriosis: Endometriosis is a common medical condition that occurs when the tissue that lines the uterus (endometrium) grows beyond or outside of the uterus.  Normally, the endometrium sheds each month during the menstrual cycle.  However, with endometriosis the misplaced tissue (which reacts to the menstrual cycle just as the endometrium does by breaking down and bleeding every month) is unable to exit the body through the vagina.  Therefore, the endometrium tissue that is outside of the uterus still breaks down, detaches, and bleeds, but is unable to leave.  This can cause a host of painful issues including: pain during menstruation, pain during intercourse, internal bleeding, inflammation of surrounding areas, dysmenorrhea, menorrhagia, chronic lower back or pelvic pain, painful bowel movements or urination, nausea/vomiting, intermenstrual bleeding, scar tissue formation, bowel issues, painful cysts, and fibroid bands.

• Ovarian Cyst: An ovarian cyst is a fluid filled sac which develops in an ovary.  The majority of these cysts are benign/non-cancerous and asymptomatic.  Ovarian cysts vary in size and can grow to be as large as a grapefruit or as small as a pea.  If symptomatic, ovarian cysts can cause issues such as irregular bleeding, pelvic pain, and/or abdominal swelling.  Pain may also occur if an ovarian cyst ruptures or twists (torsion).  Also, should ovarian remnant tissue remain after a complete hysterectomy, this can also result in the growth of painful cysts.

There are many other possible causes for pelvic pain including irritable bowel syndrome, interstitial cystitis, pelvic muscle tension, etc.  Psychological issues such as stress, past sexual trauma, depression, and emotional distress can also contribute to chronic pelvic pain.

Treatment of pelvic pain depends on the whether or not a specific diagnosis can be identified.  If the physician is able to pinpoint the cause (such as those mentioned above) and source of the pelvic pain, treatment focuses on eradicating that cause.  In some cases, there is no obvious cause that can be found and the patient never receives a specific diagnosis.  In these cases, the treatment focuses on managing the patient’s pelvic pain.  Depending on the cause of the pain (or lack of diagnosis), a physician may treat pelvic pain with medication (i.e. hormone treatments, antidepressants, pain relievers, antibiotics), surgery (i.e. laparoscopic, hysterectomy), pain management therapies (i.e. exercise, physical therapy, psychological counseling, pain blocking/trigger point injections), or in more extreme cases, spinal cord stimulation (neurostimulation).

If you are experiencing Pelvic Pain, please contact our office to schedule an appointment with one of our skilled providers.

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