Chronic Pelvic Pain: Causes, Symptoms, Diagnosis and Treatment

Chronic pelvic pain is defined as pain that lasts for six months or more in the area between the hips and under the belly button. Chronic pelvic discomfort can have a variety of causes. It can be a symptom of another illness or a separate condition.

If your chronic pelvic pain seems to be the result of another medical condition, treating that condition may help you feel better. Examinations, however, often fall short of determining the cause of chronic pelvic pain. In that case, your care will focus on minimizing your pain and other symptoms that could raise your living standard.

Causes Of Chronic Pelvic Pain

Persistent pelvic pain is a complicated medical condition. Sometimes tests will show that a specific illness is the cause. In other cases, there may be more than one medical problem causing the discomfort. For example, you might have endometriosis or interstitial cystitis, both of which might exacerbate your ongoing pelvic pain.

Listed below are a few causes of ongoing pelvic pain:

• Endometriosis: This disease is characterized by the growth of uterine lining-like tissue outside of the body. It could lead to discomfort or infertility.
• Muscular and bone problems: Persistent pelvic pain can be brought on by connective tissue problems, osteoarthritis, and periodontal disease. Hernias, fibromyalgia, pubic joint edema, and strains in the pelvic floor muscles are among these problems.
• Chronic pelvic inflammatory illness: If a prolonged infection which is often spread during sexual activity leads to pelvic organ scarring, this could happen.
• Remnant ovarian tissue: After surgery to remove one or both ovaries, it is possible that a small portion of the ovary would unintentionally stay inside. Later on, these remnants of tissue could become painful cysts.
• Fibrous materials: These growths on, inside, or related to the uterus are not malignant. Nevertheless, they could cause a heaviness or lower back or stomach strain. They rarely cause severe pain.
• Intestinal distress syndrome: Pelvic pain and discomfort can be brought on by symptoms of irritable bowel syndrome, such as bloating, constipation, or diarrhea.
• Bladder Pain Syndrome: Another term for this is interstitial cystitis. It has been linked to recurrent episodes of urinary discomfort. It's linked to frequent urinating as well. One potential side effect of bladder filling is pelvic pain. There's a chance the ache will go away once you pass gas.
• Pelvic Constriction Syndrome: Expanded, varicose-like veins encircling the ovaries and uterus may be the cause of pelvic pain.
• Mental health risk factors: Depression, extended stress, or a history of physical or sexual abuse may raise your risk of having chronic pelvic discomfort. Pain is made worse by emotional distress. Furthermore, persistent pain may make discomfort worse. These two components often spiral into one another.

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Symptoms Of Chronic Pelvic Pain

Instead of in just one place, you may experience persistent pelvic pain in multiple areas of your pelvic region. One or more of the following descriptions of the pain could apply:

• Intermittent pain.
• Dull pain.
• Cramps or sharp aches.
• Something heavy or pressurized in the lower pelvis.
• Frequent or pressing urge to urinate.
• Ballooning.
• Upset stomach.
• Diarrhea or constipation.

Additionally, the pain could occur:

• While having sex.
• While urinating or having a bowel movement.
• After extended periods of sitting or standing.
• Mild pelvic pain may persist over time.

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Diagnosis Of Chronic Pelvic Pain

Your healthcare professional will ask you about your symptoms and any health difficulties that you and your blood relatives (parents, siblings, etc.) have had over time to establish the underlying reason for your chronic pelvic discomfort. To help you understand how the pain affects your daily activities, they can also ask you to keep a journal of your pain and other symptoms.

Furthermore, you may need examinations or tests such as:

• Examination of the Pelvis: This can detect abnormal growths, signs of disease, or stress in the muscles of the pelvic floor. Your doctor touches around to check for any tender sites. Please speak up if you feel uncomfortable at any point during the assessment, especially if it seems like pain you've recently felt. In addition, if the exam is making you anxious, you can ask your doctor to stop it at any time.
• Lab experiments: These may come back positive for chlamydia or gonorrhea. You may also need a blood test to determine your blood cell count or rule out an infection of the urinary system.
• Ultrasonography: This diagnostic technique creates images of the body's tissues, organs, and other parts using sound waves. It can be applied to identify growths or cysts in the fallopian tubes, uterus, or ovaries. 
• Additional imaging examinations: Imaging tests such as CT or MRI can be used to find growths or other anomalous structures within the body.
• Laparoscopy: To observe your pelvic organs and check for odd tissues or infections, a small incision in the stomach is made, and a thin tube with a small camera is inserted. Chronic pelvic inflammatory disease and endometriosis are two ailments for which it can be utilized as a diagnosis and treatment.

Diagnosing chronic pelvic discomfort can be difficult and time-consuming. It's possible that the suffering will always have an unknown origin. Be truthful in your contact with your healthcare team throughout this phase. Decide on a plan of action together that will allow you to live a pleasant life with the least amount of suffering.

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Treatment Of Chronic Pelvic Pain

Treatment for persistent pelvic pain aims to improve your quality of life and lessen your symptoms.

Your doctor's treatment will target the precise reason if one can be identified. If a cause cannot be identified, managing your pain and other symptoms will be the main goal of treatment. More than one treatment can be required.

Drugs

You may be treated for your persistent pelvic pain with one or more of the following medications, depending on the cause:

• Pain relievers: Over-the-counter medications may provide some pain relief. These consist of acetaminophen, ibuprofen, and aspirin. You might occasionally require a powerful painkiller on a prescription. However, using painkillers by themselves to treat chronic pain.
• Hormone treatments: Some women find that the days they have pelvic pain may coincide with a menstrual phase. Birth control pills or other hormonal drugs may be able to relieve pelvic pain in such a case.
• Antibiotics: Antibiotics may be required if a bacterial illness is the source of your symptoms.
• Antidepressants: Persistent pain may benefit from certain drugs used to treat depression. Among them are tricyclic antidepressants like nortriptyline (Pamelor) and amitriptyline. Serotonin-norepinephrine reuptake inhibitors such as duloxetine and venlafaxine are also included in them. They could be able to lessen chronic pelvic discomfort even in the absence of depression.
• Muscle relaxants: Some drugs, such as cyclobenzaprine (Amrix), can help relax the muscles that are involved in pelvic pain.

Alternative medical interventions

In addition to medication, other therapies may be beneficial for chronic pelvic discomfort. These could include:

• Physical therapy: Some persons who have persistent pelvic pain can get relief from this. More can be included in physical therapy than merely getting a massage and learning therapeutic stretches and relaxation techniques. Procedures for reducing pain might also be included.
  • A physical therapist might find, for example, that there are areas of tight tissue related to pelvic pain. After that, to assist them relax, the therapist may apply pressure and stretches to particular places. This is known as myofascial release.
  • Occasionally, physical therapists will employ medical equipment called transcutaneous electrical nerve stimulation to target particular pain spots. Low-voltage electric currents are sent to nearby nerves. Furthermore, as a psychological tool, physical therapists may employ biofeedback. This helps you find the spots where your stiff muscles are so you can learn how to relax them.
• Dry needling is one method of pain alleviation that some people could use. The therapist pierces trigger points sensitive, stiff areas associated with pain with extremely fine needles.
• Stimulation of the spinal nerve: The word "neuromodulation" is also applicable here. Implanting a device that obstructs nerve pathways and keeps the brain from getting pain signals is one aspect of the treatment approach. Depending on what is causing your pelvic pain, it can be useful.
• Injections are given at the sites of the trigger: The body's sensitive, tense areas are known as trigger points. An illustration of numbing medicine could be able to stop the discomfort in these areas.

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Talk therapy.

 Some people with chronic pelvic discomfort also experience mental health issues such as depression, anxiety, or personality disorders. Some have experienced emotional or sexual assault that has left them with lifelong anguish. Talk therapy with a psychologist or psychiatrist can be beneficial for both the body and the psyche. It can ease stress and teach you pain management techniques.

One type of talk therapy that may be helpful is cognitive behavioral therapy. It means learning to identify negative and erroneous beliefs. Sex therapy is an additional potential help. A therapist can help couples learn how to have sex gently and eliminate pelvic pain.

Surgery

When treating a condition that causes ongoing pelvic pain, your healthcare provider may recommend surgery. Among the surgeries are:

• Endoscopy: If you have endometriosis, this type of surgery can treat or remove the uncomfortable tissue outside the uterus. A minor incision near the belly button is made during the surgery to introduce a thin viewing tool. To remove the painful tissue, one or more further microscopic incisions are performed.
• Hysterectomy: In rare cases, a hysterectomy a medical operation in which your uterus is removed might be required. You may also need to have one or both of your ovaries removed. This is known as an oophorectomy. These procedures have a significant negative impact on health. Ask your doctor to provide you with a thorough explanation of the advantages and hazards.

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