The chronic pelvic pain in women is pain that happens in the area below the bellybutton and between your hips and it lasts 6 months or longer. The chronic pelvic pain in women can have many different causes. It can be a condition on its own right or it can be a symptom of another disease.
if the chronic pelvic pain in women appears to be caused by another medical problem, then the treatment of that problem may be enough to eliminate the pain. But, there are many cases in which are not possible to identify a single cause for chronic pelvic pain. In this case, the goal of the treatment is to reduce the pain and other symptoms and to improve the quality of your life. [1]
Chronic pelvic pain in women symptoms
When your doctor asks you to locate the pain, you might sweep your hand over your entire pelvic area rather than point to a single spot. You may describe your chronic pelvic pain in one or more of the following ways: [1]
- Pressure or heaviness deep within your pelvis
- Sharp pains or cramping
- Dull aching
- Pain that comes and goes (intermittent)
- Severe and steady pain
Also, you can experience additional symptoms, such as
- A pain when you sit for long periods of time
- Pain while having a bowel movement or urinating
- Pain during intercourse
The pain which you feel in your pelvic area may intensify after standing for long periods and it may be relieved when you lie down. This pain may be mild and annoying, or it may be so severe that you miss work or you cannot exercise and you cannot sleep. It can be difficult to know when you should go to the doctor, like with any other chronic pain problem. Usually, you should make an appointment with your doctor if your pelvic pain disrupts your daily life or if you have symptoms which you think that they get worse. Your doctor will make pelvic exam, lab tests, ultrasound to be sure for your diagnosis.
Chronic pelvic pain in women causes
The chronic pelvic pain is a complex condition which has multiple causes. In some cases, a single disorder may be identified as a cause. In other cases, the chronic pelvic pain may be result of several medical conditions. For example, women can endometriosis and interstitial cystitis and both of them contribute to chronic pelvic pain. Some causes of chronic pelvic pain in women include:
- Ovarian remnant: After the surgical removal of the uterus, ovaries and fallopian tubes, a small piece of ovary may accidentally be left inside and later develop painful cysts. [2,3]
- Irritable bowel syndrome: The symptoms which are associated with irritable bowel syndrome (diarrhea, constipation or bloating) can be a source of pelvic pain and pressure. [4]
- Musculoskeletal problems: Those conditions which affect your joints, bones and connective tissues (such as hernia, fibromyalgia, inflammation of the public joint and pelvic floor muscle tension) can lead to recurring pelvic pain in women. [5]
- Endometriosis: This is a condition in which the tissue from lining of your womb grows outside the uterus. It is known that these deposits of tissue are same as the menstrual cycle, just as the uterine lining does (thickening, breaking down and bleeding each month as your hormone levels rise and fall). This is happening outside the uterus, so the blood and tissue cannot exit your body through the vagina. Instead, these deposits of tissue remain in your abdomen, where they may lead to painful cysts and fibrous bands of scar tissue (adhesions). [6]
- Psychological factors: The chronic stress, depression or a history of sexual or physical abuse can increase the risk of chronic pelvic pain in women. The emotional distress can make the pain worse and living with chronic pelvic pain contributes to emotional distress. These two factors often become a vicious cycle. [7]
- Fibroids: These are noncancerous uterine growths which cause pressure or a feeling of heaviness in your lower abdomen. In rare cases, they cause sharp pain unless they become deprived of a blood supply and begin to die (degenerate). [8]
- Chronic pelvic inflammatory disease: This can happen if a long – term infection, often sexually transmitted, which cause scarring that involves your pelvic organs.
References:
[1] Passavanti MB, Pota V, Sansone P, et al. Chronic pelvic pain: Assessment, evaluation, and objectivation. Pain Research and Treatment. 2017;2017: 9472925.
[2] Yosef A, Ahmed AG, Al-Hussaini T, et al. Chronic pelvic pain: Pathogenesis and validated assessment. Middle East Fertility Society Journal. 2016;21(4):205-21.
[3] Ghaly AFF, Chien PFW. Chronic pelvic pain: clinical dilemma or clinician’s nightmare. Sexually Transmitted Infections. 2000;76:419-25.
[4] Choung RS, Herrick LM, Locke R, et al. Irritable bowel syndrome and chronic pelvic pain: A population-based study. Journal of Clinical Gastroenterology. 2010;44(10):696–701.
[5] Tu F, As-Sanie S, Steege JF. Prevalence of pelvic musculoskeletal disorders in a female chronic pelvic pain clinic. The Journal of Reproductive Medicine. 2006;51(3):185-9.
[6] Bloski T, Pierson R. Endometriosis and chronic pelvic pain: Unraveling the mystery behind this complex condition. Nursing for Women’s Health. 2008;12(5):382–95.
[7] Alappattu MJ, Bishop MD. Psychological factors in chronic pelvic pain in women: Relevance and application of the fear-avoidance model of pain. Physical Therapy. 2011;91(10):1542–50.
[8] Olive DL. Fibroids, adenomyosis, and chronic pelvic pain. n book: Chronic Pelvic Pain. 2011;77-85.
