Pelvic Pain

The chronic pelvic pain is the localized pain in the pelvic region (located between the navel and between the hips area) that lasts at least six months.

Signs and Symptoms

• Intense and maintained pain
• Intermittent pain
• Acute pain and colic
• Sensation of internal heaviness in the pelvis
• Pain during sexual intercourse (dyspareunia)
• Pain with defecation (disquecia) or urination (dysuria)
• Pain with bowel movements.

When should I see a Doctor?

In general, we consider that the gynecologist should be consulted when pain alters daily life or if symptoms worsen.

Causes

Some of the causes of chronic pelvic pain are:

• Endometriosis
• Tension in the muscles of the pelvic floor: the pelvic floor musculature can suffer contractures and spasms that cause chronic pelvic pain.
• Pelvic inflammatory disease: after suffering a pelvic inflammatory disease (usually caused by a sexually transmitted infection) can be adhesions or scars that affect the pelvic organs.
• Ovarian cysts: ovaries can develop recurrent cysts that cause pain
• Myomas
• Irritable bowel syndrome
• Interstitial cystitis
• Pelvic co-management syndrome
  • Psychological factors

Diagnosis

• Ultrasound
• Pelvic exam
• Laboratory analysis
• CT Scan
• Laparoscopy

Treatment and Management

In case of finding out the cause, the treatment will be destined to treat it.

In any case, always (whether the cause is found or not) the treatment will focus on relieving pain. As previously mentioned, the frustration generated by the pain itself, the lack of sleep and the life alterations caused by the pain can worsen it to a great extent, so it is highly recommended to manage the psychological symptoms caused by the illness.

• Analgesic drugs: According to the WHO therapeutic scale, they will be indicated from non-steroidal anti-inflammatory drugs to significant opioids as well as adjuvant medications.
• Birth control pills or other hormonal medications can help relieve pelvic pain.
• Some types of antidepressants can help with chronic pain. Tricyclic antidepressants, such as nortriptyline (Pamelor) and others, appear to have pain relief effects in addition to antidepressant effects.
• Stress management techniques: Multiple techniques have been described for managing anxiety such as breathing control, meditation practice, increasing physical activity, improving sleep.