Pelvic Pain

Pelvic Pain

Chronic pelvic pain is pain that occurs in the area below the navel and between the hips and lasts six months or longer.

Chronic pelvic pain can have several causes. It may be a symptom of another disease, or it may be a condition in itself.

If chronic pelvic pain appears to be caused by another medical problem, treating that problem may be enough to relieve the pain.

However, it is often not possible to identify a single cause of this pain. If this is the case, the goal of treatment is to reduce pain and other symptoms and improve quality of life.

Symptoms
When you are asked to locate pain, you may pass your hand over the entire pelvic area instead of pointing to a specific point. You may describe your chronic pelvic pain in one or more of the following ways:

• Intense, constant pain
• Pain that comes and goes (intermittent)
• Constant pain
• Sharp pains or cramps
• Pressure or heaviness deep in the pelvis

In addition, you can experience the following:

• Pain during sexual intercourse
• Pain with bowel movement or urination
• Pain when sitting for long periods of time
• The discomfort may intensify after standing for long periods and be relieved when you lie down. The pain may be mild and uncomfortable, or it may be so intense that you miss work, can’t sleep, or can’t exercise.

When to see your doctor
With any chronic pain problem, it may be hard to know when to go to the doctor. In general, ask your doctor if your pelvic pain disrupts your daily life or if your symptoms seem to get worse.

Causes
Chronic pelvic pain is a complex condition that can have multiple causes. Sometimes, a single disorder can be identified as the cause.

At other times, however, the pain may be the result of several medical conditions. For example, a woman may have endometriosis and interstitial cystitis, both of which can cause chronic pelvic pain.

Some of the causes of chronic pelvic pain may be:

• Endometriosis. Endometriosis is a condition in which tissue from the lining of the uterus grows outside the uterus. These tissue deposits respond to the menstrual cycle, as does the uterine lining, i.e., thickening, rupture, and bleeding every month as hormone levels rise and fall. Because this takes place outside the uterus, blood and tissue cannot leave the body through the vagina. Instead, they remain in the abdomen, where they can cause painful cysts and fibrous bands of scar tissue (adhesions).
• Musculoskeletal problems. Disorders that affect the bones, joints, and connective tissues (musculoskeletal system), such as fibromyalgia, pelvic floor muscle tension, inflammation of the pubic joint (pubic symphysis), or hernias, and can lead to recurrent pelvic pain.
• Chronic pelvic inflammatory disease. This can occur if a long-term infection, usually sexually transmitted, causes scarring that affects the pelvic organs.
• Ovarian remnants. After surgical removal of the uterus, ovaries, and fallopian tubes, small traces of the ovary may accidentally remain, which may then lead to painful cysts.
• Fibroids. These non-cancerous uterine growths can generate pressure or a feeling of heaviness in the lower abdomen. In rare cases, they cause severe pain, unless their blood supply begins to run low and they begin to die (degenerate).
  Irritable bowel syndrome. Symptoms associated with irritable bowel syndromes, such as inflammation, constipation, or diarrhea, can be the source of pelvic pain and pressure.
• Painful bladder syndrome (interstitial cystitis). This condition is associated with recurrent bladder pain and a frequent need to urinate. You may have pelvic pain as the bladder fills, which may temporarily subside when you urinate.
• Pelvic congestion syndrome. Some doctors believe that dilated varicose veins (varicose veins) around the uterus and ovaries can cause pelvic pain. However, other doctors doubt that pelvic congestion syndrome is the cause of pelvic pain because most women with dilated veins in the pelvis do not have associated pain.
• Psychological factors. Depression, chronic stress, or a history of sexual or physical abuse may increase the risk of chronic pelvic pain.