Chronic pelvic pain is any ongoing pain that is felt in the lower part of the abdomen (below the belly button) that lasts for at least six months . The pain may or may not be related to the menstrual cycle and can have several different causes. Here are a few of the most common ones:
- Endometriosis -This is an extremely common condition that usually affects women of reproductive age (25-40) when tissue from the lining of the womb (uterus) grows outside the uterus. These deposits of tissue still respond the menstrual cycle and can lead to pelvic pain, heavy periods or back pain.
- Fibroids – These are non-cancerous growths in and around the uterus that can cause pressure or a feeling of heaviness in the lower abdomen. Fibroids generally cause no symptoms but if they grow large enough they can lead to pain, discomfort and heavy or prolonged menstrual cycles.
- Pelvic inflammatory disease – Pelvic inflammatory disease is an acute infection usually caused by a sexually transmitted organism such as chlamydia or gonorrhea. About one-third of women who have this inflammatory infection go on to develop chronic pelvic pain . The reasons for this are unknown but it may be due to damage of the uterus, ovaries or fallopian tubes .
- Other causes — Other non-gynecologic causes of chronic pelvic pain may be related to the digestive system (irritable bowel syndrome), the urinary system, or to pain in the muscles and nerves that is felt in the stomach.
As the name suggests the most common symptom of chronic pelvic pain is pelvic pain that is felt just below the region of the belly button. Other symptoms include:
- Dull, sharp or cramping pain that comes and goes
- Pain during intercourse
- Pain while having a bowel movement or urinating
- Pain when you sit for long periods of time
The diagnosis of chronic pelvic pain can only come from your doctor. Usually this will involve your gynecologist taking a history from you, carrying out a physical examination and possibly doing some lab tests which includes things like a vaginal swab, urine test or blood test. In a few cases, more advanced investigations may be required like an ultrasound scan, CT scan or laparoscopy (a camera test that is used to visualize the inside of the uterus).
When to see your gynecologist
It can be difficult to know when you should go and see your doctor but in general, make an appointment with your gynecologist if your pelvic pain starts to impact your life or affects your day to day activities. If your symptoms seem to be getting worse with time, it’s also a good idea to make an appointment.
Your gynecologist can help to diagnose the cause of your pain and suggest possible treatment options.
The treatment of chronic pelvic pain depends on the underlying cause. If the pelvic pain is caused by another medical problem such as fibroids or endometriosis then treatment of that specific condition will usually resolve the pain. In the case where no specific cause is found or the chronic pain is the diagnosis itself then it may be treated using a number of different measures such as pain relief medications, oral contraceptive pills or other targeted therapies to reduce the pain and control the symptoms.
1) Up-to-date. Patient education: Chronic pelvic pain in women (Beyond the Basics). Robert L Barbieri, MD. last updated Aug 18, 2016.