Chronic Pelvic Pain - Possible Causes of Chronic Pelvic Pain

Chronic Pelvic Pain

Pelvic pain that persists for longer than 6 months is considered chronic pelvic pain. According to American Congress of Obstetricians and Gynecologist (ACOG) publications, it is estimated that 15-20 % of women aged 18-50 years of age experience chronic pelvic pain that may persist for more than one year. It is generally located below your belly button and between your hips. Chronic pelvic pain may be physically and mentally distressing and impact quality of life and activities of daily living. The pain can be constant and experienced on a daily basis or can come and go. It is described as severe and steady, dull, sharp, achy, or a pressure and heaviness within the genitopelvic region.

Chronic pain can impact work, and social commitments and impact relationships. There are many causes of chronic pelvic pain; however for some women no definitive cause can be located. Treatment is usually directed at controlling the local disease, if present, and decreasing the pain symptoms. Common causes of chronic pelvic pain include:

  • Reproductive causes (vaginitis, sexual transmitted infections, pelvic inflammatory diseases, Gonorrhea, Chlamydia, endometriosis, adhesions from surgery, uterine fibroids, and adenomyosis)
  • Gastrointestinal (chrones, inflammatory bowel disease, irritable bowel syndrome, diverticulitis or cancer)
  • Urinary (chronic urinary infection, interstitial cystitis (IC) kidney or urethral stones).

ACOG advises that interstitial cystitis may affect as many as 38-85% of women who seek care for chronic pelvic pain and it is associated with urinary frequency, urgency and pain. These women typically have negative urine cultures.

A comprehensive evaluation and assessment by a health care professional is important to help diagnosis the origin of the pelvic pain. Physical examination, blood laboratory testing, pelvic ultrasound and other advanced testing, including cystoscopy, laparoscopy, and colonoscopy, may be warranted. Consultations to other sub specialists who work with the gastrointestinal system or the urinary system may be warranted.  Not finding a cause does not rule out the existence of pain, and pain management techniques should be offered to the patient. Sexual assault and abuse has been linked to chronic pelvic pain. According to ACOG patient educational materials, approximately one half of women who report chronic pelvic pain may also have a history of sexual abuse or assault.

Treatment for chronic pelvic pain may include medications to control pain, antibiotics for infections, physical therapy, surgery and nutritional support. Psychological counseling may be necessary for women and their partners who are suffering from chronic pelvic pain.



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