Pelvic pain has a significant impact on quality of life. Chronic pelvic pain has prevalence similar to migraine and chronic back pain. Pelvic pain is suspected to affect more women than men although the prevalence among men is unknown. One in six women is suspected to suffer from pelvic pain. Chronic pelvic pain can be defined as intermittent or constant pain in the lower abdomen or pelvis of at least 6 months’ duration, not occurring exclusively with menstruation or intercourse and not associated with pregnancy.
There may be particular difficulties and issues linked with talking about pelvic pain. Perhaps using the term “pelvic pain” is less embarrassing, more acceptable and easier for people we don’t know well to cope with.
Pelvic pain may be arising from bladder, bowel, uterus, genitalia, nerve or could be simple musculoskeletal. There is frequently more than one component to chronic pelvic pain. Assessment should aim to identify contributory factors rather than assign causality to a single pathology.
The cause of chronic pelvic pain is often hard to find. Like many, one may never receive a specific diagnosis that explains the pain. If the source of your chronic pelvic pain is found, treatment focuses on that cause. If no cause can be found, treatment for chronic pelvic pain focuses on managing the pain that is where the role of pain physician come in.
Common causes of chronic pelvic pain include but not limited to endometriosis, chronic pelvic inflammatory disease, pelvic congestion syndrome, ovarian remnant, fibroids, irritable bowel syndrome, interstitial cystitis and psychological factors.
Pelvic pain which varies considerably over the menstrual cycle may be due to a variety of hormonally driven conditions. It is thought that adhesions may be a cause of pain, particularly on organ distension or stretching, as dividing them appears to relieve pain.
Musculoskeletal pain may be a primary source of pelvic pain or an additional component resulting from postural changes. Nerve entrapment in scar tissue, fascia, tumour (cancer) or a narrow foramen may result in pain and dysfunction in the distribution of that nerve.
Management of chronic pelvic pain will focus on treating a specific underlying cause if known.
However, if no cause for pelvic pain can be found, treatment will focus on managing your pain. As with any chronic pain management, treatment of pelvic pain will be multimodal which include medications, interventions, surgery, adjunctive therapy and psychosocial support.
Apart from the regular pain killers like paracetamol and ibuprofen, hormonal therapy and neuropathic pain killers like amitriptyline, gabapentin and pregabalin play an important part in pelvic pain management. Many patients might need interventional procedures like hypogastric plexus block, pudendal nerve block, trigger point injections and ganglion impar block.
Applications of heat and cold to abdomen, stretching exercises, acupuncture, massage and transcutaneous electrical nerve stimulation (TENS) therapy may help. Exercises to strengthen pelvic floor muscles might be useful.
Addressing psychological and social issues which commonly occur in association with chronic pelvic pain may be important in resolving symptoms.