Authored By: Dr. K. Shilpi Reddy

HOD & Sr. Consultant Obstetrician & Gynaecologist,

High-Risk Pregnancy Care, Minimal Invasive Surgeon (Mini Lap, Laparoscopy, Robotic Team)


WHAT IS PELVIC PAIN?

Chronic pelvic pain is pain that persist for six or more months in the area localised below the bellybutton and between your hips hindering in your day to day activities.

Chronic pelvic pain is a very common gynaec problem which is not often discussed, however chronic pelvic pain appears to be caused by another medical problem, treating that problem may be enough to eliminate your pain.

Mostly Chronic pelvic pain are caused by multiple causes. So, the treatment is targeted to reduce pain and other symptoms, ultimately improving quality of life.

HOW DO YOU KNOW IF YOU HAVE PELVIC PAIN?
Chronic pelvic pain can present to you as one of the following:
  • Pain before and during periods
  • Cramping or pain during sexual intercourse
  • Pain during passing stools
  • Pain during urination
  • Low back pain
  • Feeling of Pressure or heaviness deep within your pelvis
In addition, you may experience:
  • Pain on sitting for long periods of time
  • Constipation
  • Irregular or heavy menstruation
  • excessive weight loss
  • bleeding after intercourse
  • new pain after attaining menopause
WHEN TO SEE A DOCTOR?

Any pain that you feel which is outside your comfort level should be discussed with your doctor .if your pelvic pain interfere with  your daily life or if your symptoms seem to be getting worse consult your doctor immediately

CAUSES OF CHRONIC PELVIC PAIN:

Chronic pelvic pain is a condition that can have multiple causes. Sometimes, it is associated with single disorder. In other cases, however, pain may be multifactorial.

Some causes of chronic pelvic pain include:

  Endometriosis. This is a condition in which the endometrial lining of your uterus deposits outside your uterus. These deposits of tissue are active to your hormonal respond to your monthly menstrual cycle, just as your uterine lining does — thickening, breaking down and bleeding each month as your hormone levels rise and fall. Because it’s happening outside your uterus, the blood and tissue they collect in your abdomen, where they may become painful cysts and fibrous bands of scar tissue and may get attached to other organs causing adhesions

  Musculoskeletal problems. Conditions affecting your bones, joints and connective tissues — such as fibromyalgia, pelvic floor muscle tension, inflammation of the pubic joint (pubic symphysis) or hernia — can lead to recurring pelvic pain.

  Chronic pelvic inflammatory disease. This can occur if a long-term infection, often sexually transmitted, causes scarring that involves your pelvic organs.

  Ovarian remnant. After Hysterectomy, a small piece of ovary may accidentally be left inside and later develop painful cysts.

  Fibroids. These may cause pressure or a feeling of heaviness in your lower abdomen. Fibroids do not cause sharp pain unless they become deprived of a blood supply and begin to die (degenerate).

  Irritable bowel syndrome. Symptoms like — bloating, constipation or diarrhea — can be a source of pelvic pain and pressure.

  Painful bladder syndrome (interstitial cystitis). This condition is associated with recurring pain in your bladder and a frequent need to urinate. You may experience pelvic pain as your bladder fills, which may improve temporarily after you empty your bladder.

  Pelvic congestion syndrome. Enlarged, varicose-type veins around your uterus and ovaries may result in pelvic pain. However, other doctors are much less certain that pelvic congestion syndrome is a cause of pelvic pain because most women with enlarged veins in the pelvis have no associated pain.

  Psychological factors. Depression, chronic stress or Previoussexual or physical abuse may increase your risk of chronic pelvic pain. Emotional distress worsens the pelvic pain, and living with chronic pain contributes to emotional distress. These factors often leads to a vicious cycle. 

DIAGNOSTIC TEST REQUIRED TO  DETREMINE THE CAUSE OF CHRONIC PELVIC PAIN

You might be asked to get a pelvic ultrasound done after a gentle pelvic examination to rule out fibroids, ovarian cysts, endometriosis and adenomyosis. Sometimes a diagnostic laparoscopy can be done to diagnose and to remove adhesions. Infections can be ruled out with STI screening 

MANAGEMENT OF CHRONIC PELVIC PAIN

As the cause of pelvic pain can be variable ,the root cause of pain is determined by your doctor hence underline treatment is done ,if treatable medically analgesic are given or ovarian suppression medication to control the hormones are given to decrease the pain 

If not surgical management with laparoscopic for excision or ablation of endometriosis adhesiolysis, myomectomy that is the fibroid removal or as a last resort hysterectomy can be advised.

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