The Basics of Pelvic Pain

 

pelvic pain2Pelvic pain often refers to discomfort in the body area of a woman’s reproductive organs, such as the uterus, fallopian tubes, cervix, or ovaries. However, it can also occur in men. Pain in the pelvic region may be a symptom of disease or infection of the colon, bladder, or pelvis bone.

Chronic pelvic pain affects 1 in 7 women, with a prevalence rate of 39%. This type of chronic discomfort is most common among women aged 26 to 30 years. In men, chronic pelvic pain is most often the result of prostatitis.

Common Causes of Pelvic Pain

  • Appendicitis – Infection and inflammation of the appendix.
  • Kidney stone – Calcium deposit that forms a ball inside the kidney.
  • Bladder disorders – Neurogenic bladder that is a complication of diabetes.
  • Interstitial cystitis – Chronic painful bladder condition.
  • Bowel disorders – Includes irritable bowel syndrome, Crohn’s disease, and ulcerative colitis.
  • Adhesions – Scar tissue inside the pelvis and abdomen.
  • Broken pelvis – Small fractures of the pelvic bone.
  • Endometriosis – When tissue lining the uterus starts growing outside the uterus.
  • Adenomyosis – When the uterine lining starts growing in the uterine muscle.
  • Uterine fibroids – Noncancerous growths of the uterus.
  • Ectopic pregnancy – Pregnancy that occurs outside the uterus.pelvic pain
  • Ovarian cysts – Fluid filled cysts on the ovaries.
  • Prostatitis – Inflammation of the prostate gland.
  • Pelvic congestion syndrome – Caused when pelvis veins do not drain properly and become enlarged and/or twisted.

Diagnosis of Pelvic Pain

The cause of pelvic pain must be determined for the discomfort to be treated. The doctor will take a medical history and conduct a physical examination. Several laboratory and diagnostic tests are often done, including:

  • Urinalysis and urine cultures
  • Pregnancy test
  • Vaginal and penile cultures for infections
  • X-rays – Visualize the bone and internal structures.
  • Laparoscopy – Allows the doctor to visualize the pelvis and abdomen structures.
  • Stool test – Check for microscopic blood.
  • Ultrasound – Uses sound waves to see internal structures.
  • MRI – Done to assess for herniated discs and other injuries.

Treatment of Pelvic Pain

Depending on the cause of pelvic pain, treatment options include:

  • Medications – Oral contraceptives and hormonal agents, antibiotics, painkillers, and tricyclic antidepressants.

 

  • Transcutaneous nerve stimulation (TENS) – External unit that is worn to deliver electric current to decrease pain.

 

  • Celiac Plexus BlocksAcupuncture – Insertion of fine needles in multiple areas of the body to alleviate pain. When performed by a skilled practitioner, this is an effective measure for chronic pain.

 

  • Celiac plexus block – This is performed to relieve pain in patients with certain cancers of the pelvic area or chronic pelvic pain related to endometriosis and other causes. The doctor inserts a small needle into the back to deposit an anesthetic agent into the celiac plexus, which is a group of nerves. This injection is often used for diagnostic purposes, as well as treatment, and it is done under x-ray guidance for precision.

 

  • Sacral nerve root stimulation – This treatment is used for bladder and bowel problems. The device emits electrical current to decrease pain signals from the nerves of the pelvic area.

 

  • Intrathecal pump implant – This device delivers controlled pain medicine into the cerebrospinal fluid, so there is no unpleasant gastrointestinal side effects.

 

Resources

Mathias SD, Kuppermann M, Liberman RF, et al. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol. Mar 1996;87(3):321-7.

Jamieson DJ, Steege JF. The prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome in primary care practices. Obstet Gynecol. Jan 1996;87(1):55-8.