• Chronic Pelvic Pain

    (Pelvic Pain, Chronic)

    Definition

    Pelvic pain is located between the belly button and hips. If it lasts for six months or more it is called chronic pelvic pain. It is often difficult to figure out what is the source of the pain. Pelvic pain can be caused by problems in the:
    • Female organs
    • Intestines
    • Nerves
    • Bladder
    • Prostate (in men)
    • Retroperitoneal space (space between the diaphragm and pelvis)
    Male Pelvis Organs
    Male pelvis lateral
    Includes bladder, prostate (under bladder), and the colon.
    © 2011 Nucleus Medical Media, Inc.
    If you have chronic pelvic pain, it’s important to see your doctor.

    Causes

    Chronic pelvic pain can be caused by a wide variety of conditions, including:
      Psychological conditions
      • Depression
      • History of being abused (physically or sexually)

    Risk Factors

    These factors increase your chance of chronic pelvic pain. Tell your doctor if you have any of these risk factors:
    • Pelvic girdle syndrome
    • Pelvic inflammatory disease
    • History of sexual abuse
    • History of pelvic surgery
    • History of pelvic radiation therapy

    Symptoms

    Since there are many causes of chronic pelvic pain, symptoms can vary. Tell your doctor if you have any of these:
    • Constant pain
    • Pain that comes and goes
    • Dull achiness
    • Pelvic heaviness
    • Pressure
    • Mild pain
    • Severe pain
    • Pain with certain activities
    • Rectal urgency (urge to defecate hits suddenly and intensely)

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may be asked to keep a pain journal to help your doctor diagnose the pain. You will be asked to write down when your pain occurs, how it feels, and how long it lasts.
    Once the source of your pain is identified, you may be referred to a specialist. Pelvic pain is best diagnosed and treated in a specialized clinic by a team of specialists.
    Tests may include the following:
    • X-rays —test that uses radiation to form an image; used to look at for abnormalities in the pelvis
    • MRI scan —test that uses magnetic waves to form an image; used to look for abnormalities in the pelvis
    • CT scan —type of x-ray that uses computer to form an image; used to look for abnormalities in the pelvis
    • Laparoscopy —a thin, lighted tube inserted into the abdomen to look for infection or disease
    • Cystoscopy —a thin, lighted tube inserted into the bladder to look for abnormalities
    • Sigmoidoscopy —a thin, lighted tube inserted into the rectum to look for abnormalities
    • Intravenous pyelography—type of x-ray that uses dye to look at the kidneys; used to look for damage or disease

    Treatment

    Talk with your doctor about the best plan for you. Options include the following:

    Medications

    Chronic pelvic pain is treated based on what caused it:
    • Nonsteroidal anti-inflammatory drugs (NSAIDs)—to treat pain and reduce inflammation
    • Opioid pain relievers (morphine-like medications)—used for severe pain
    • Antibiotics—given if there is an infection present
    • Antidepressant medications—sometimes used to treat chronic pain
    • Antiseizure medications—helpful in certain situations (especially when pain is caused by nerve damage)
    • Birth control pills—used to treat pain caused by certain gynecological conditions (in some cases of chronic pelvic pain)

    Complementary Therapies

    The following have been used to treat pelvic pain:
    The following have been used to treat pelvic pain:

    Interventional Approaches

    In some cases interventional approaches, including nerve blocks, may be used.

    Psychological Counseling

    Managing stress through counseling is helpful to many women with chronic pelvic pain.

    Surgery

    There are numerous causes of pelvic pain. Many are treated with surgery. The type of surgery depends upon the specific problem.

    Prevention

    Among ways to help reduce your chance of developing chronic pelvic pain, use methods to prevent contracting sexually transmitted diseases (such as using condoms), since symptoms of these diseases can be painful.

    RESOURCES

    The American College of Obstetricians and Gynecologists http://www.acog.org/

    The International Pelvic Pain Society http://www.pelvicpain.org/

    National Pain Foundation http://www.nationalpainfoundation.org/

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca/

    The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org/

    References

    Chronic pelvic pain. American Family Physician website. Available at: http://familydoctor.org/online/famdocen/home/women/reproductive/gynecologic/033.html . Accessed November 7, 2008.

    Chronic pelvic pain. DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Accessed November 9, 2008.

    Chronic pelvic pain. Mayo Clinic website. Available at: http://www.mayoclinic.com/print/chronic-pelvic-pain/DS00571/DSECTION=all&METHOD=print . Accessed November 7, 2008.

    Chronic pelvic pain, getting help. National Pain Foundation website. Available at: http://www.nationalpainfoundation.org/MyTreatment/articles/Pelvic%5FGettingHelp.asp . Accessed November 7, 2008.

    Chronic pelvic pain. The International Pelvic Pain Society website. Available at: http://www.pelvicpain.org/pdf/Patients/CPP%5FPt%5FEd%5FBooklet.pdf . Accessed November 7, 2008.

    Levy BS. The complex nature of chronic pelvic pain. J Fam Pract . 2007 Mar;56(3 Suppl Diagnosis):S16-7. Review.

    Pelvic Pain. The American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/publications/patient%5Feducation/bp099.cfm . Accessed November 7, 2008.

    Reiter RC. Evidence-based management of chronic pelvic pain. Clin Obstet Gynecol . 1998;41(2):422-435.

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