Chronic pelvic pain

Introduction

Chronic pelvic pain in females is a pain that is felt below the belly button and lasts for at least 6 months. The pain may be in your pelvis, tummy, lower back, or buttocks.

Although it affects around one in six women, the exact cause of chronic pelvic pain in females is not fully understood. It can be caused by a combination of factors, but for many women, a cause is often not found.

There are a number of treatments for chronic pelvic pain treatments that help to improve the pain, increase daily functioning, and treat any potential underlying cause.

Symptoms

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The main symptom of chronic pelvic pain is pain in the area below the belly button. However, the nature, location, and severity of the pain can differ from person to person.

The pain may be constant or it may come and go.

It may happen during or outside of your period, and may feel more intense and last longer than ordinary period pain.

You may also have other symptoms, such as bladder and bowel problems, depending on the cause of the pain.

As chronic pelvic pain in females can be distressing and interfere with your daily activities, it is not uncommon for some women to experience changes in their mental health, such as anxiety or depression.

Causes

Chronic pelvic pain in females is not very well understood. It is usually caused by a combination of physical, psychological, and social factors, although it can also be caused by a single underlying condition.

The pain may come from the female organs (the uterus or ovaries), the digestive system (the gut), the urinary tract (the kidney, bladder, and tubes that carry urine between these organs and out of the body), or the muscles, bones, or nerves in and around the pelvis.

In many women, no specific cause of chronic pelvic pain can be found. However, the most common causes include:

Disorders of the womb or ovaries

  • endometriosis – when small pieces of womb lining (endometrium) are found outside the womb
  • adenomyosis – when small pieces of womb lining are found in the womb’s muscle layer
  • fibroids – non-cancerous tissue growths in or around the womb
  • chronic pelvic inflammatory disease – a bacterial infection of the womb, fallopian tubes, or ovaries
  • womb prolapse – where the womb slips down from its normal position
  • ovarian cysts – fluid or blood-filled sacs that develop on the ovaries

Bowel disorders

  • irritable bowel syndrome (IBS) – a long-term bowel condition that often causes stomach cramps, bloating, diarrhoea, and/or constipation
  • inflammatory bowel disease – a term used to describe two ongoing gut conditions: ulcerative colitis and Crohn's disease

Bladder disorders

Nerve, muscle or bone abnormalities

  • trapped or damaged nerves in the pelvic area
  • musculoskeletal pain (pain in the joints, muscles, ligaments, and bones of the pelvis)
  • lower back pain

Other causes

  • pelvic adhesions – pockets of scarred tissue due to previous infection, endometriosis, or surgery
  • social and psychological factors, such as depression and previous or ongoing traumatic experiences, such as sexual abuse

a hernia – where fatty tissue or part of the bowel pushes through a weakness in the surrounding muscle or tissue wall

Diagnosis

To make a diagnosis of chronic pelvic pain, your doctor will usually begin by asking you questions about the pain you’re experiencing, any other symptoms, previous illnesses and surgeries, your family’s history of illness, and about your health and lifestyle.

You may be asked to keep a diary of when your pain occurs, how long it lasts, what makes it better or worse, and how severe it is.

Your doctor is also likely to examine you, which may include:

  • feeling your abdomen
  • feeling and looking at the inside of your vagina (using an instrument called a speculum) for any problems with your womb or ovaries

You may be given the option to see a female doctor if this helps you feel more comfortable.

To help your doctor find the cause of the pain, you may be offered the following:

  • a blood test – for example, a full blood count to look for any abnormalities that provide clues about the cause of the pain
  • a urine test – to check if a urinary tract infection might be causing your symptoms
  • a pregnancy test – if you haven’t gone through the menopause, your doctor will need to rule out pregnancy as a cause of the pain
  • tests for sexually transmitted infections – a swab may be taken from high up in the vagina and from the neck of the womb (cervix) to test for infections like chlamydia or gonorrhoea

Your doctor may also suggest the following:

  • imaging scans – scans, such as an internal ultrasound (in which a small ultrasound probe is inserted into the vagina) and an MRI, may help to identify any growths or changes in your womb or bladder that could be causing the pain
  • a laparoscopy – a keyhole surgery procedure in which your doctor uses a small camera telescope to look inside your abdomen and pelvis. This is usually done to diagnose, rather than treat, the cause of the pain

Treatment

Because ongoing pain can significantly impact your quality of life, chronic pelvic pain treatment focuses on improving pain and daily functioning, as well as reducing the likelihood of the symptoms returning.

The exact chronic pelvic pain treatment you may be given will depend on your individual problem and may involve:

  • medication
  • complementary therapies
  • surgery

If you have psychological, bladder, or bowel symptoms as well as pain, you may be referred to a specialist. You may also be referred to a pain management team or a specialist pelvic pain clinic if the pain persists despite treatment.

Chronic pelvic pain medication

Pain medication

To relieve the pain, your doctor may offer simple non-prescription painkillers, such as ibuprofen or paracetamol.

If these do little to improve the pain, you may be given other types of medicines that are known to help with chronic pain. These include:

  • Antidepressants
  • antiepileptic drugs

Antispasmodics/muscle relaxants

If your doctor thinks the pain might be related to IBS, you may be given medicines that relax the muscles in your gut wall.

Hormone treatment

If your doctor suspects that the pain may be related to your sex hormones, you may be given hormone treatment in the form of:

  • combined contraceptives, such as the contraceptive pill, patch, vaginal ring, implant, or injection
  • an IUS (levonorgestrel-releasing intrauterine system)
  • GnRH (gonadotropin releasing hormone) analogues – man-made hormones that stop the production of oestrogen in your body

Complementary therapies and lifestyle changes

In some cases, complementary therapies, such as acupuncture and TENS (transcutaneous electrical nerve stimulation), a type of pain relief involving the use of a mild electrical current, can help to ease the pain.

Identifying and cutting out any foods that trigger your symptoms may help.

Surgery for chronic pelvic pain

Less commonly, your doctor may recommend surgery if the pain remains despite trying the above treatments, or if a physical (and removable) cause has been identified.

The type of surgery you may receive is likely to depend on the cause of the pain, the severity of your symptoms, and if you plan to have a baby in the future.

While surgery can help some cases of chronic pelvic pain, it is not guaranteed to completely remove the pain, especially if your doctor can’t find the cause.

Psychological therapy for chronic pelvic pain

Dealing with ongoing pain can be difficult, especially when the cause is unknown. To help, your doctor may refer you to have psychological support, such as counselling, alongside other treatment.

Outlook

Chronic pelvic pain is a common condition that affects one in six women. While it can take time to find the best way to manage your symptoms, many effective treatment options exist.

Being fully involved in your care can also make it easier to live with the condition. Many women find that being listened to, taken seriously, reassured, and included at every stage makes a difference.

However, the impact of ongoing chronic pelvic pain can be hard to live with. It can cause social, emotional, and physical problems such as depression, poor sleep, and disruption to daily activities.

If you are experiencing these difficulties, it is important to talk to your doctor as soon as possible. Not only can your doctor help with your treatment, but they may be able to direct you to useful organisations for further support.

To find answers to any other health questions you might have, visit our Health A-Z.

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