Chronic Pelvic Pain

Pelvic pain is a common problem affecting women of all ages. It refers to pain occurring anywhere between the hips, and below the bellybutton. It is considered chronic if the pain lasts for at least six months and is severe enough to disrupt patient's life. Living with such a distressing symptom could present a heavy economic and social burden to the sufferer. Although, there are several well-characterized causes for chronic pelvic pain, in up to 50% of the cases no cause can be found.

The pain may be intermittent (comes and goes), constant or cyclical i.e. occurring around the time of the period. It also varies in nature and could be sharp, cramping, stabbing, twisting, burning, heaviness or a dull ache. It may be associated with or provoked by certain activities such as sexual intercourse, eating, opening bowel, urinating, walking or taking certain body positions.

The causes of chronic pelvic pain are varied and could be gynaecological or non-gynaecological in origin. A gynaecological cause should be considered if the pain occurs in or just above the pelvic region or in the lower back. Other features of gynaecological causes include a cyclical pattern or occurrence with intercourse. Common gynaecological conditions that cause chronic pelvic pain include endometriosis, pelvic adhesions (scar tissue), ovarian cyst, and fibroids. Non-gynaecological causes of chronic pelvic pain include bowel conditions (e.g. irritable bowel syndrome, constipation and inflammatory bowel disease), urinary (e.g. interstitial cystitis, recurrent urinary tract infections and urethral syndrome) and musculoskeletal (e.g. myofascial pain, neuralgia, fibromyalgia, poor posture, muscle strains, vertebral disease or joint disorder). The pain could also be psychosomatic in origin.

The process of identifying the underlying cause of chronic pelvic pain could be complex and requires a great deal of experience with this condition. A successful management of chronic pelvic pain relies heavily on accurate diagnosis of the underlying cause, which can be achieved by careful analysis of the pattern and nature of the pain. It is usually very helpful if the woman could keep a diary of her pain. Preliminary tests would include a pelvic ultrasound scan. If an underlying gynaecological problem were suspected a laparoscopy, which involves a camera inspection of the pelvis, would be the gold standard diagnostic procedure. This procedure allows the visualization of all the pelvic organs with identification of any disease. An important advantage to the laparoscopy is that it allows treatment of most of the gynaecological causes of pelvic pain at the same time.

Saad Amer

Saad Amer MSc., FRCOG, MD
Consultant Gynaecologist

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