Chronic pelvic pain in women

Diagnosis

Due to the wide range of illnesses that can cause pelvic pain, determining the reason of your chronic pelvic pain frequently includes an elimination procedure.

Your doctor may ask you to keep a journal of your pain and other symptoms as well as analyzing your personal health history, and family history.

Your doctor may recommend the following tests or examinations:

• Pelvic exam. This may show indications of an infection, unusual growths, or tense muscles in the pelvic floor. Your doctor looks for sore spots. If you have any pain during this exam, especially if it is comparable to symptoms you’ve been having, let your doctor know.
• Lab tests. Your doctor may request lab tests to screen for infections like chlamydia or gonorrhea during the pelvic exam. Additionally, your doctor could request a urinalysis to look for a urinary tract infection and blood work to evaluate your blood cell counts.
• Ultrasound. High-frequency sound waves are used in this test to produce clear images of the internal organ structures. This procedure is particularly helpful for finding masses or cysts in the fallopian tubes, uterus, or ovaries.
• Other imaging tests. To help identify abnormal structures or growths, your doctor may advise abdominal X-rays, Computed Tomography (CT) scans, or Magnetic Resonance Imaging (MRI).
• Laparoscopy. Your surgeon will make a small incision in your abdomen and insert a thin tube that is connected to a small camera (laparoscope) to examine your pelvic organs with a laparoscope and look for any abnormal tissue or infection signs. This helps to detect endometriosis and chronic pelvic inflammatory disease.

Chronic pelvic pain can have many underlying causes, and in some instances, a definitive diagnosis may never be made, but a treatment plan that enables you to live a full life with the least amount of discomfort may be developed.

Treatment

Treatment aims to improve quality of life and lessen symptoms. The focus of treatment will be on controlling your pain and other symptoms if a reason cannot be found. The best strategy for many women entails combining therapies.

Medications

Your doctor may prescribe a variety of drugs to treat your illness depending on the cause, including:

• Pain relievers. Your pelvic pain may be partially relieved by over-the-counter pain relievers such aspirin, ibuprofen, or acetaminophen. A prescription painkiller may be required on occasion. However, a single painkiller rarely addresses the issue of persistent pain.
• Hormone treatments. Some women discover that the days they experience pelvic discomfort may be related to a specific time during their menstrual cycle and the hormonal shifts that govern ovulation and menstruation. When this is the case, hormonal drugs such as birth control tablets may ease pelvic pain.
• Antibiotics. If an infection is the source of your pain, your doctor may prescribe antibiotics.
• Antidepressants. Antidepressants of a certain type may be beneficial for chronic pain. Amitriptyline, nortriptyline, and other tricyclic antidepressants appear to have both pain-relieving and antidepressant effects. Even in those women who do not suffer from depression, they might aid in reducing persistent pelvic pain.

Other therapies

As a part of your treatment for chronic pelvic pain, your doctor might advise particular therapies or techniques. These may consist of:

• Physical therapy. Your chronic pelvic discomfort may be reduced with stretching exercises, massage therapy, and other relaxing methods. These therapies and the creation of pain management techniques can be helped by a physical therapist. Physical therapists will occasionally use a medical device known as transcutaneous electrical nerve stimulation (TENS) to target particular pain spots. Electrical impulses are delivered to neighboring nerve pathways via TENS. Physical therapists may also employ the biofeedback psychological technique, which teaches you to locate your stiff muscles and relax them.
• Neurostimulation (spinal cord stimulation). A device that blocks nerve pathways is implanted as part of this therapy in order to prevent the pain signal from reaching the brain. Depending on the origin of your pelvic pain, it can be beneficial.
• Trigger point injections. If your doctor determines specific areas of your body that cause you pain, you can benefit from having a numbing medication injected directly into those painful areas (trigger points). The drug, which is typically a long-acting local anesthetic, has the ability to block pain and reduce discomfort.
• Psychotherapy. You might benefit from speaking with a psychologist or psychiatrist if your pain is connected to depression, sexual abuse, a personality problem, a troubled marriage, or a family crisis. Psychotherapy comes in a variety of forms, including biofeedback and cognitive behavioral therapy. Psychotherapy can assist you in creating coping mechanisms for the pain, no matter what the underlying reason of your discomfort may be.

Surgery

Your doctor might suggest surgery to treat an underlying issue that results in persistent pelvic pain, such as:

• Laparoscopic surgery. Laparoscopic surgery can be used to remove adhesions or endometrial tissue in the case of endometriosis. During laparoscopic surgery, your doctor makes one or more small incisions around your navel through which a thin viewing instrument (laparoscope) and tools to remove endometrial tissue are inserted.
• Hysterectomy. Your doctors may advise removing your uterus (hysterectomy), fallopian tubes (salpingectomy), or ovaries (oophorectomy) in rare, severe circumstances. The consequences for your health of having this operation are significant. Before advising this course of action, your doctor will thoroughly go over the advantages and disadvantages.