Pelvic Pain

Pelvic pain is very common. Most women expereience mild pain, often related to menstrual cycle or bowel activities, and this pian is transient and does require little or no intervention. However moderate to severe pain are also quite common, needing a visit to the doctor or referral to a gynaecologist. Pelvic pain may be either sudden (acute) or long-term (chronic).

Acute pelvic pain

Sudden (Acute) pelvic pain in women is often related to periods, ovulation or sexual intercourse, all being of gynaecological origin, but could also be related to bowel or urinary causes in women, such as in appendicitis or urinary tract infection.

Causes: Common causes include

Pelvic inflammatory disease (PID), Urinary tract infection (UTI), Miscarriage, ectopic pregnancy and Torsion or rupture of ovarian cysts, Ovulation (mid-cycle, may be severe pain), Dysmenorrhoea, Degenerative changes in a fibroid; appendicitis, irritable bowel syndrome, pelvic adhesions,

Chronic pelvic pain

Chronic pelvic pain in women often results form underlying problem involving the pelvic structures, – gynaecological, bowel, urinary and sometimes, involving the muscle, bone or blood vessels. It is not unusual to not find a definite cause at laparoscopy (3 in 10). It is defined as persistent pain, felt in the pelvic area or within strutures related to the pelvis, that is not related to cancer, and that is continous or recurrent for at least six months.

Causes: Common causes include:

• Endometriosis, including adenomyosis (endometriosis within the musle of the womb):
• Chronic Pelvic inflammatory disease is commingly associated with pelvic pain.
• Pelvic Adhesions (scarring amongst pelvic organs) may be a cause of pain but can also be asymptomatic.
• Bowel-related causes; e.g. irritable bowel syndrome, diverticular disease, constipation.

• Urinary Tract-related causes,g. urinary tract infection, interstitial cystitis (also called bladder pain syndrome), chronic urethritis, urinary tract stones are all associated with pain
• Musculoskeletal pain , g. low back pain, fibromyalgia.
• Pelvic venous congestion has been proposed as a cause of pelvic pain, but this is not widely accepted.
• Fibroids: Not all fibroids cause pelvic pain, but size or the fibroid, pressure from fibroid may.
• Postherpetic neuralgia. Nerve pain after inflammation of the nerve, after genital herpes.
• Psychological and social issues commonly occur in association with chronic pelvic pain.

Diagnosis

Your doctor will seek for detailed information about your pelvic pain, in order to determine the possible underlying causes outlined above. It is helpful if you can keep a record of these pain episodes, in relation to your menstrual cycle, the pattern of the pain and its association with other problems, such as bladder, bowel, posture or vaginal discharge. (A large number of women will experience a worsening of symptoms in association with menstrual period). The doctor’s abdominal and vaginal examinations may often point to the presence of pelvic problem such as large uterine fibroid, presence of ovarian cyst or constipation. It may be necessary to arrange some blood tests, vaginal swabs, urine analysis or request pelvic +/- abdominal ultrasound, or perform investigations such as an abdominal X-Ray, or diagnostic laparoscopy or cystoscopy. A pregnancy test is a good one to perform early in the process, and more advance investigation such as magnetic resonance imaging (MRI) may be required, later in the process.

Treatment

Treatment should focus on the underlying cause(s), however, it should be born in mind that chronic pelvic pain may be a result of more than one underlying gynaecological disorder. Regardless of the underlying cause(s), it is often necessary to give appropriate analgesia, for pain control. Psychosocial causes and effects of chronic pelvic pain should also be considered. Women with cyclical pain may be offered a trial of treatment using the combined oral contraceptive pill or a gonadotrophin-releasing hormone (GnRH) agonist for a period of three months before having a diagnostic laparoscopy. The levonorgestrel-releasing intrauterine system (Mirena® coil) could be considered.