Treating pelvic pain requires extensive training and experience. Dr. Gitiforooz is a board-certified and fellowship-trained gynecological surgeon, with over 20 years of surgical and medical experience. She continues to further her education every year through continuous training to learn the most advanced and modern techniques and procedures for treating pelvic pain.
Does this topic relate to you?
This topic focuses on pelvic pain in females. Pain may be anywhere from below the belly button to the pelvic area.
What is female pelvic pain?
Female pelvic pain is referred to pain below the belly button, in the lowest part of the abdomen and pelvis. The pain can sometimes extend to the lower back, the buttocks, or thighs. This pain may feel dull or sharp, may be constantly hurting or sporadic and may be rated mild, moderate, or severe.
What is chronic pelvic pain?
Chronic pelvic pain is defined as long lasting pain of at least six months duration and is severe enough that it is affecting your quality of life and day-to-day activities. These activities may include but are not limited to sleep, work, or physical activity. Chronic pelvic pain is not related to pregnancy. In the United States, about 15% of women report having pelvic pain that has lasted at least 6 months, and about 4% of these women reported that their pelvic pain has been so severe that they have had to miss work.
Causes of pelvic pain:
If you have had chronic pelvic pain, or a recent onset of severe pelvic pain, there is a 50% chance you may have one of the complex gynecology conditions listed below:
- Endometriosis: a disorder in which tissue that lines the uterus unexpectedly begins to grow outside of the uterus
- Adenomyosis: a disorder similar to endometriosis, in which tissue lining the inside of the uterus grows into the muscular wall of the uterus
- Uterine fibroids: non-cancerous growths in the uterus
- Ovarian tumor or pelvic mass: abnormal growths inside of the ovaries or the pelvis
- Scar tissue in the pelvis: scar tissue in the pelvis, or pelvic adhesions; these scars may appear as the result of infections, endometriosis, or prior surgery
- Pelvic Inflammatory Disease (PID): an infection of the female reproductive organs due to sexually transmitted bacteria which spreads from the vagina to other parts of the reproductive system
Other causes of pelvic pain may include:
- Urological conditions:
- Interstitial cystitis (painful bladder syndrome)
- Recurrent urinary tract infections, urethral diverticulum, bladder cancer
- Gastrointestinal conditions:
- Irritable bowel syndrome
- Inflammatory bowel disease
- Diverticulitis, colon cancer, chronic constipation, and celiac disease
- Musculoskeletal conditions:
- Mental health conditions:
- Drug addiction
- Physical and sexual abuse experience
- Depression, somatization disorder
Pelvic pain symptoms:
The type of pelvic pain that females experience varies from patient to patient. The pain may be characterized as acute (recent onset), chronic (longer than 6 months), sporadic, constant, or related to menstrual periods.
Symptoms of pelvic pain include:
- Excessive and abnormal vaginal bleeding
- Severe cramping during menstrual periods
- Pain during intercourse
- Pain during urination
- Pain during bowel movement
- Pain when in certain postures or positions
- Lower back pain
- Nausea or vomiting
Diagnosing pelvic pain:
Because there are several causes of pelvic pain, it oftentimes may require an extensive work up and several doctors’ visits. This is important to keep in mind when planning for your appointment.
During your initial visit, your doctor will typically perform a complete pelvic exam to check for any abnormalities in the reproductive system. The doctor will also ask you questions about your past and present health conditions and the symptoms you are having.
Some diagnostic tests that may be ordered include a blood or urine sample to check for any infection and a pregnancy test.
Imaging that may be ordered include a pelvic ultrasound, an MRI of the pelvis and/or a CT of the pelvis. A pelvic ultrasound is the best tool to diagnose pelvic masses, ovarian cysts, and fibroids. An MRI may be necessary if the doctor suspects you may have endometriosis or adenomyosis, although endometriosis and adenomyosis cannot be diagnosed through MRI. A CT scan may be necessary if your doctor suspects diverticular disease, or a mass in the pelvis, colon, or bladder.
Surgical diagnosis of pelvic pain:
If the doctor suspects you have endometriosis or adenomyosis after completing a MRI, a laparoscopic surgery may be necessary. A laparoscopy is the most common procedure performed in the operating room to diagnose and possibly remove mild to moderate endometriosis. This procedure will allow the doctor to visualize the internal organs to look for endometriosis and other possible problems that may be causing the pelvic pain.
Instead of using a large abdominal incision, the surgeon will use a laparoscope which is a small camera inserted through a small incision in the belly button or lower abdomen. The surgeon will then examine the internal organs to check for endometriosis. If endometriosis, pelvic adhesions or scar tissue are visible, the surgeon will remove it during your surgery. Following the procedure, the surgeon will close the incision(s) with a few stiches. The procedure typically has minimal downtime and the patient usually has little to no scarring.
Pelvic pain treatment:
If your doctor diagnoses you with a specific problem that is causing your pain, you will be treated for that problem.
Common treatments include:
- Birth control pills or hormone treatment
- Surgery to remove a growth, cyst, fibroid or tumor
- Medication to treat the problem such as antibiotics for an infection
Alternative treatment options for chronic pelvic pain:
If the cause of your pelvic pain remains unknown after a complete work up, there are several other treatment options that you and your doctor may explore, including:
- Trigger point injections: This is a procedure performed in the outpatient clinic. The doctor will carefully locate trigger points in the pelvic wall and inject an anesthetic pain reliever. The area where you are experiencing chronic pain should be numbed within a few minutes. The amount of relief provided from trigger point injections vary from person to person. The relief may last anywhere from a few days to a few months, and you may continue getting injections as the pain returns.
- Pudendal nerve block: The pudendal nerve carries sensation from the uterus, labia and vagina, perineum and skin of the surrounding area. The pudendal nerve block is beneficial in women who have pelvic pain that is caused by another injury such as endometriosis, multiple sclerosis, interstitial cystitis or a surgical injury. This is a procedure performed in the outpatient clinic where the doctor carefully injects an anesthetic pain reliever into the pudendal nerve area. The amount of relief provided from a pudendal nerve block varies from person to person, and may last anywhere from days to months. You may continue to receive injections as the pain returns.
- Pelvic physiotherapy: aims to help strengthen and provide rehabilitation the pelvic floor muscle group
- Biofeedback therapy: helps patients to learn to strengthen or relax their pelvic floor muscles
- Nerve stimulation
- Behavioral and relaxation therapy
Keep in mind:
Every patient is unique and may respond to treatments differently than someone else. You may need to try several different treatment options before you find what is the best treatment to control your pelvic pain. Be patient, and if things are not working well, ask your doctor what other options are available for you. Your doctor will only know if your treatment is not working when you inform he/she, therefore make sure you are taking an active role in your treatment and advocating for yourself!