What is Pelvic Pain?
Pelvic Pain Explained by Las Vegas, Summerlin, and Henderson Nevada’s Top Pain Doctors
Pelvic pain is a localized pain that occurs within the lower region of the abdomen (i.e., at or below the umbilicus or buttocks) and the pelvis. Pelvic pain is multifaceted in nature and can originate from a variety of sources. For instance, pelvic pain may be related to problems with the reproductive system, or the pain may arise as the result of a musculoskeletal condition. As such, its symptom presentation can be quite diverse, making diagnosing the underlying cause somewhat of a challenge.
Pain within the pelvis can have many forms and can range in severity from mild to severe. Pelvic pain may be described as dull or sharp, intermittent or constant. The pain may be experienced as recurring or chronic in nature, or it may be limited to a single, acute episode. Further, the pain may be limited to only the abdominal or pelvic region, or it may radiate toward the lower back or thighs.
Pelvic pain is relatively common within the general population. Lifetime prevalence rates of pelvic pain are as high as 33% for women. Given the high prevalence among women in particular, pelvic pain was historically viewed as an indicator of an underlying gynecological condition; however, making this assumption runs the risk of frequent misdiagnosis, as there are a wide variety of etiologies that give rise to pelvic pain.
Prevalence rates for chronic pelvic pain, which is classified as pelvic pain that persists for six months or more, are estimated to be as high as 3.8% for women. Moreover, pelvic pain is believed to account for up to 40% of outpatient gynecological visits each year.
Causes of Pelvic Pain
Pelvic pain is relatively common, particularly among women, and can have a variety of causes. Further, pain within the pelvic region may be the result of more than one underlying condition, and in general is likely to be caused by a condition within one of the following systems:
- Digestive: colon cancer, constipation, Crohn’s disease, diverticulitis, intestinal obstruction, irritable bowel syndrome, or ulcerative colitis
- Reproductive: adenomyosis, endometriosis, dysmenorrhea (menstrual cramping), ectopic pregnancy, miscarriage, pain with ovulation, ovarian cancer, ovarian cysts, pelvic inflammatory disease, uterine fibroids, vulvodynia, or past sexual abuse
- Urinary: kidney stones, interstitial cystitis, prostatitis, or urinary tract infection
Pelvic pain is also shown to be associated with appendicitis, fibromyalgia, and inguinal hernia. In some cases, chronic pelvic pain may indicate a dysfunction in the muscles ligaments within the pelvic floor. Indeed, chronic pelvic pain can also be neuropathic in nature.
Given that pelvic pain can arise from these different sources, identifying the underlying cause typically becomes a process of elimination in conjunction with your doctor. The following information may help your physician make an accurate diagnosis of the source of your pain:
- The onset of pain. Your physician will want to know how the pain began. Did it begin suddenly? Did it begin following an injury or trauma?
- Where the pain is located. The location of the pain can provide assistance with targeting a cause for the pain. For example, appendicitis usually results in pain experienced in the middle of the belly and toward the right (the location of the appendix).
- The pattern of the pain. Your physician will want to know if the pain has followed any sort of predictable pattern. For instance, is the severity of the pain experienced in waves or does it come on only after you’ve eaten something? It is also expected that the pattern of pain will change over time, and your physician will need that information as well.
- The duration of the pain. How long the pain lasts is an important consideration. Does the pain come and go over the course of several months, such as that of irritable bowel syndrome? Does the pain occur everyday while you are on the highway on your way to work, but then disappear completely while you are at home?
- Factors that affect the pain. Your physician will want to know what you’ve attempted to remedy the pain and the effectiveness of each strategy. He or she will also want to know if there is anything that makes your pain worse, such as lying down or eating specific foods.
Typically, patients with chronic pelvic pain will undergo a pelvic examination and lab testing to aid in determining a proper diagnosis. Depending on the course and severity of the pain, ultrasounds or CT scans of the abdomen and pelvis may also be warranted.
Treatment for Pelvic Pain
There are a number of treatments available to address the symptoms of pelvic pain; however, they are largely determined by the source of the pain. While pain that is not severe or debilitating may respond well to at-home treatments without the use of medication, chronic or severe pelvic pain may necessitate a more substantial form of intervention.
For chronic pelvic pain, a non-surgical nerve block procedure is recommended to provide patients with significant, and often complete, relief from visceral pain located in the abdomen or pelvis. Located behind the stomach, the celiac plexus is a bundle of nerves whose job is to transfer pain information from the abdomen to the spinal cord and brain. Thus, the celiac plexus block is a non-surgical procedure to anaesthetize the celiac plexus nerve bundle and thereby prevent the transmission of pain information. Additionally, there is some indication that patients can experience a significant reduction in pain with spinal cord stimulation. This procedure involves implanting a device near the spinal column that delivers electrical impulses to control the transmission of pain signals from the nerves within the spine.
In terms of pharmacotherapy, there are a number of medications available. Specifically, non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen and naproxen; oral analgesics, including acetaminophen; as well as anti-depressants are recommended and have received some support in terms of their effectiveness in relieving pelvic pain. For women with chronic pelvic pain, gabapentin, a drug frequently used to treat neuropathic pain, has received empirical support as providing significant pain relief. Individuals, whose pain is severe and does not respond well to over-the-counter remedies, may wish to speak to their doctor about prescribing an opioid medication to help manage the pain.
In terms of alternative techniques, biofeedback training has received support for helping patients manage symptoms of pelvic pain. This treatment involves teaching patients relaxation and coping skills, thereby allowing them to gain some control of reducing their own symptoms of pain.
Pelvic pain is chronic pain experienced within the pelvic and abdominal region. This type of pain has a very wide range of symptoms and therefore can be associated with a number of different etiologies, making diagnosis somewhat difficult. The underlying conditions associated with pelvic pain range from non-serious conditions, such as menstrual cramps, to serious and requiring immediate care, such as appendicitis. A number of treatment options are available and are determined based on the specific characteristics of the pain episode and/or diagnosis. It is recommended that you speak with your physician to develop an appropriate course of treatment.
- Carinci AJ, Pathak R, Young M, Christo PJ. Complementary and alternative treatments for chronic pelvic pain. Curr Pain Headache Rep. 2013;17(2):316
- Fritz J, Chhabra A, Wang KC, Carrino JA. Magnetic resonance neurography-guided nerve blocks for the diagnosis and treatment of chronic pelvic pain syndrome. Neuroimaging Clin N Am. 2014; 24(1):211-34.
- Ismail M, Mackenzie K, Hashim H. Contemporary treatment options for chronic prostatitis/chronic pelvic pain syndrome. Drugs Today. 2013;49(7):457-62.
- Ortiz DD. Chronic pelvic pain in women. Am Fam Physician. 2008;77(11):1535-1542.
- Pontari M, Giusto L. New developments in the diagnosis and treatment of chronic prostatitis/chronic pelvic pain syndrome. Curr Opin Urol. 2013;23(6):565-9.
- Rhodin A. Successful management of chronic pelvic pain. J Pain Palliat Care Pharmacother. 2013;27(3):289-91.