Chronic Pelvic Pain

Pain that occurs below the belly button and between the hips and lasts for more than half a year is called chronic pelvic pain. Usually, this condition appears due to multiple factors, or it can be a symptom of other health problems.

Usually, to treat chronic pelvic pain caused by another disease, it is enough to treat the underlying disease.

Unfortunately, there are no tests to find the exact cause of chronic pelvic pain. In such cases, the treatment goal is to reduce the symptoms and improve your quality of life.

Symptoms

Usually, chronic pain occurs in different pelvic parts, rather than in one spot only. Those who suffer from this condition usually describe it in the following ways. For example:

Persistent and serious
The pain comes and goes
Sharp pains or cramping
Heaviness and pressure deep within the pelvic area

Pain caused by this condition may also occur during sex, a bowel movement, urinating, and when you stand for long periods.

While pain caused by this condition can be mild, it may be so severe as to interfere with your work, sleep, and other activities. Check below for other chronic pelvic pain symptoms:

Bloating
Stomach upset
Diarrhea
Constipation
Frequent urination or a sudden urge to urinate

It is advised to see a doctor if pain caused by this health condition negatively affects your daily routine.

Causes

This is a complex problem that means sometimes tests can identify the underlying condition, and in other cases, pain may occur due to more than one medical condition. For instance, a person who has endometriosis and interstitial cystitis may experience chronic pelvic pain. Check below some causes of this health condition:

Endometriosis – This is a condition in which the lining of the uterus grows outside. Therefore, it may lead to pain and infertility.
Muscle and bone issues – Pelvic pain may also happen due to problems that negatively affect joints, bones, and connective tissues. For example, fibromyalgia, pelvic floor muscle tension, pubic joint swelling, hernia, and others.
Nerve damage – This condition can appear due to injured or trapped nerves in the pelvis or lower part of the stomach. Surgery (such as C-section) may also damage the nerves in the lower stomach area. In some cases, chronic pelvic pain is caused by pudendal neuralgia. This is a condition in which nerve damage happens due to repetitive activities (including cycling, riding horses, or sitting for a long time).
Chronic pelvic inflammatory disease – This condition occurs due to long-term infection that usually spreads among people during sexual activity. Thus, it may lead to scarring of the pelvic organs.
Ovarian remnant – Sometimes, after the removal of one or both ovaries, a small amount of an ovary may remain inside. Thereafter, this left tissue may form painful cysts.
Fibroids – This is a condition in which certain growths appear that attach to the uterus but are not malignant (cancerous). However, they rarely cause severe pain.

Other Causes

Irritable bowel syndrome (IBS) – Symptoms caused by this condition (including constipation, bloating, or diarrhea) often cause pelvic pressure and pain.
Painful bladder syndrome – This condition is also known as interstitial cystitis. It causes bladder pain and frequent urination.
Pelvic congestion syndrome – Pelvic pain may occur due to enlarged varicose-type veins that are located around the ovaries and uterus.

In addition, mental health problems that occur for long periods (such as depression, long-term stress, or a history of sexual or physical abuse) may increase the risk of developing chronic pelvic pain.

Risk Factors

There are multiple health conditions that are linked to chronic pelvic pain. If you experience one or more of them (such as endometriosis and fibroids), the risk of developing long-term pelvic pain significantly increases.

Diagnosis

To determine the exact cause of chronic pelvic pain, physicians usually begin with a physical examination and questions about the symptoms and your medical history. Check below some examinations and tests used to diagnose chronic pelvic pain or determine the underlying condition:

A pelvic examination – During this procedure, doctors will check the pelvic area for abnormalities linked with chronic pelvic pain.
Laboratory tests – These tests are used to check for sexually transmitted infections (STIs) such as gonorrhea or chlamydia. Lab tests may also identify urinary tract infections.
Imaging tests – The following tests are usually performed to get detailed images of the body organs and structures. Doctors usually use ultrasound, CT (computerized tomography) scans, MRI (magnetic resonance imaging) scans, and others.
Laparoscopy – This test involves a small tube with a camera that is placed in a cut made in the stomach area. It helps doctors determine and treat multiple conditions, including endometriosis, chronic pelvic inflammatory disease, and others.

Sometimes, the exact cause of chronic pelvic pain cannot be identified. In such cases, the treatment focuses on lessening the symptoms.

Treatment

Doctors usually recommend different treatments for people with chronic pelvic pain. It depends on your age and preferences, other existing health problems, and other factors. Check below some treatments usually recommended by doctors for people with this disease:

Medicines

Painkillers – While doctors may recommend over-the-counter (OTC) pain relievers (such as Ibuprofen, Acetaminophen, Naproxen sodium, and others), they can prescribe some strong pain relievers.
Hormone treatments – Sometimes, doctors may prescribe birth control pills or other hormonal medications to lessen pelvic pain.
Antibiotics – When this condition occurs due to a bacterial infection, you may need antibiotics.
Antidepressants – There are some antidepressants that may also help with pelvic pain. For example, tricyclic antidepressants (such as Amitriptyline, Nortriptyline, and others), serotonin norepinephrine reuptake inhibitors (such as Venlafaxine and Duloxetine), and others.
Muscle relaxers – Physicians may prescribe some medicines to relax the muscles if they cause pelvic pain. They often prescribe Cyclobenzaprine, but may recommend other medicines as well.

Therapies

The following therapies are usually recommended by doctors along with medicines. For example:

Physical therapy involves techniques that help relax the muscles and treat pain. These techniques include myofascial release (used to relieve stiff areas linked with pelvic pain), transcutaneous electrical nerve stimulation, biofeedback, and dry needling.
Spinal cord stimulation – This therapy is also known as neuromodulation, and it involves the implantation of a device that blocks nerve pathways. As a result, it helps lessen the pain caused by this condition.
Trigger point injections – It involves numbing medicine administered to the sensitive spots on the body.
Talk therapy – This is a treatment often used in people with mental disorders (such as depression, anxiety, personality disorder, or others). It may be helpful if you experience chronic pelvic pain due to sexual, physical, or emotional abuse. It involves multiple techniques that help to cope with negative and faulty thoughts.

Surgery

Sometimes, to treat chronic pelvic pain, you may need surgery. Check below some options usually recommended by doctors:

Laparoscopy – It helps lessen pelvic pain in people with endometriosis. It can also be used to treat abnormal tissue that may appear outside of the uterus. This procedure is usually performed through one or more small incisions in the abdomen.
Hysterectomy – This surgery is used to completely remove the uterus. Sometimes, you may need to remove either one or both ovaries (oophorectomy). Unfortunately, previous surgeries may have serious health consequences. Discuss with your healthcare professional about the risks and benefits before choosing them as treatment.

Frequently Asked Questions

What are the causes of chronic pelvic pain?

These include:

Gynecological conditions (for example, adenomyosis, pelvic inflammatory disease, endometriosis, and others)
Urological diseases (including interstitial cystitis)
Musculoskeletal conditions (such as pelvic floor muscle dysfunction, nerve entrapment, and others)
Gastrointestinal diseases (including irritable bowel syndrome, Crohn’s disease, GERD, and others)
Psychological factors (for example, stress, anxiety, depression, abuse, and others)

Sometimes, the exact cause of the disease cannot be identified. In such cases, it is usually called idiopathic chronic pelvic pain.

How to make pelvic pain go away?

There are multiple treatment options for pelvic pain. These include:

Pain relievers (such as Acetaminophen, Ibuprofen, Naproxen sodium, and others)
Muscle relaxants, including Cyclobenzaprine (this group of medicines is prescribed by doctors when pelvic pain is caused by muscle stiffness or other problems)
Physical therapy
Lifestyle changes (including regular physical exercise and a healthy diet)

If any of the previous treatments do not work, immediately contact your healthcare provider.

Is chronic pelvic pain a disability?

Yes, this condition can be a disability, especially if it interacts with your daily routine (such as work). If you have additional questions, ask your healthcare professional.