Chronic pelvic pain: Expert insight on diagnosis and management

Chronic pelvic pain can significantly disrupt a woman's life, causing persistent discomfort, decreased quality of life and limitations on physical activity. In addition, chronic pelvic pain can also impact emotional wellbeing, in some cases causing anxiety and depression due to the condition’s ongoing and debilitating nature. Fortunately, there are a number of options available to help you manage your symptoms. To tell us more, we invited esteemed consultant obstetrician and gynaecologist Miss Sameena Kausar to share her expert insight on the diagnosis and management of chronic pelvic pain.

What are the causes of chronic pelvic pain in women?

Pelvic pain is defined as discomfort felt in your lower abdomen or pelvis. Chronic pain refers to pain that occurs always or only sometimes, but consistently throughout a period of over 6 months. Chronic pelvic pain is a description of the symptoms you are experiencing.

Pelvic pain is common, affecting around 1 in 6 women. It can be distressing and affect quality of life and a woman’s ability to carry out everyday activities.

What causes pelvic pain?

The causes of chronic pelvic pain are multifactorial and are typically composed of various physical, psychological and/or social factors as opposed to one single underlying condition. For many women, the cause of chronic pelvic pain cannot be established. Possible causes of pelvic pain include:

Endometriosis and adenomyosis

Endometriosis is a condition where the cells of the lining of the womb (endometrium) are found elsewhere in the body, usually in the pelvis. Adenomyosis is a condition where endometrium are found in the muscle of the womb). Both conditions can cause pain around the time of your period, as well as during sex.
 

Pelvic inflammatory disease

Pelvic inflammatory disease, an infection in the fallopian tubes and/or pelvis, is another possible cause of pelvic pain.


Other possible causes of pelvic pain include:

• interstitial cystitis - bladder inflammation
• adhesions - areas of scarred tissue that may be a result of a previous infection, endometriosis or surgery
• trapped or damaged nerves in the pelvic area
• pelvic organ prolapse
• musculoskeletal pain - pain in the joints, muscles, ligaments and bones of the pelvis
• irritable bowel syndrome (IBS)
• depression, including postnatal depression
• traumatic experiences, such as sexual and/or physical abuse

How is chronic pelvic pain diagnosed?

When you see a specialist, you will be asked to describe the pain you have been experiencing and will be given an opportunity to discuss your concerns. The way in which you describe your symptoms is a key part of making a diagnosis. Your specialist may ask you to keep a pain diary to keep note of when your pain occurs, how severe it is, how long it lasts and what seems to affect it, for example your periods.

You may be asked to describe certain aspects of your everyday life, such as sleep habits, appetite and overall wellbeing. An understanding of how your pain affects your daily life will be taken into account when establishing the most appropriate course of treatment for you.

Your doctor will listen to you and take your concerns seriously. By working in partnership with you, he or she will aim to identify the possible cause of your pain and offer the most appropriate treatment.

Which tests can help make a diagnosis?

• Screening tests for pelvic infections (including sexually transmitted infections)
• Ultrasound scan of uterus and ovaries
• MRI (magnetic resonance imaging) scan of your pelvis

Some patients are also offered a laparoscopy, particularly if your doctor suspects endometriosis, adhesions or pelvic infection may be present. Laparoscopy is a type of operation which is carried out under general anaesthetic, and usually involves making two or three small cuts in the abdomen. This allows a narrow telescope (called a laparoscope) to be inserted through the abdominal wall so your pelvis can be examined. As with any surgical procedure, there are risks and benefits and these will be explained to you.

What are the treatment options for chronic pelvic pain?

Many women are empowered by their consultations with a specialist, where they are listened to and their pain is taken seriously. Receiving a full explanation from a doctor and with a good understanding of test results, allows patients to work together with their specialist to agree a plan of action and cope with their pain better. Many women are reassured by finding that there is no sinister cause behind their pain. In some cases, pelvic pain may also get better with time.

Some women find acupuncture or complementary therapies, or changing diet, helpful. If your pelvic pain is determined to be related to your periods, hormone treatment, such as the contraceptive pill, injections or the Mirena IUS (hormone coil) may be offered as an alternative to laparoscopy. This will stop your periods for 3–6 months and may also be worth trying even if there is no pattern to your pain.

Keyhole or laparoscopy surgery for mild adhesions does not appear to help pelvic pain, however, it may be considered in cases of severe adhesions caused by endometriosis or previous surgery.

Whatever the specifics of your individual case, you should be offered pain relief. If this does not resolve your pain, you may be referred to a pain management team or a specialist pain clinic.




If you are suffering from chronic pelvic pain and wish to schedule a consultation with Miss Kausar, visit her Top Doctors profile today.