If You Have Pelvic Pain

Edited excerpts from our book
A Gynecologist's Second Opinion

WHAT IS CHRONIC PELVIC PAIN?
Pelvic pain that lasts 6 or more months, and is not associated with the menstrual period, is called chronic pelvic pain (menstrual pain is discussed in chapter 3). Chronic pelvic pain is a fairly common problem. It is estimated that about 20% of the visits to gynecologists are for pelvic pain, and one out of every seven hysterectomies are performed for this reason. Chronic pelvic pain can lead to significant distress and even disability. In recent years, a great deal of effort and research has been focused on helping women with chronic pelvic pain and people suffering from all types of chronic pain. Because of this, we are able to help people diminish the effects of pain. 

WHAT CAN CAUSE CHRONIC PELVIC PAIN?
Interestingly, when you were developing as a fetus, the same type of cells that went on to form the uterus, tubes and ovaries also developed into the bladder. Furthermore the bladder, the intestines and the pelvic organs share similar nerves, and your brain may not be able to differentiate pain in one area from that of another area. Lastly, the bladder, the intestines and the pelvic organs are close together in the abdominal area, and it may be difficult for you to tell exactly where a pain originates. Therefore gynecologic problems, as well as bladder problems, intestinal problems and neuro-muscular problems can all be felt as "pelvic" pain. In this chapter we discuss all these causes in detail. 

WHAT CAN BE DONE TO EVALUATE THE CAUSE OF CHRONIC PELVIC PAIN?
Finding the cause of pelvic pain sometimes can be thought of as a puzzle that requires careful and methodical examination until the correct solution comes to light. There are many different causes of pelvic pain, and many of them are non-gynecological. 

The best way to start to solve the puzzle and get to the source of your pain is to provide your doctor with a detailed description of the pain. Keeping a daily pain diary that you fill out in the morning, afternoon and evening can help you track the pain: Where is it? When does it occur? What makes it better or worse? Does eating affect it? Is it accompanied by nausea, vomiting, or diarrhea? Do you have any bladder symptoms? The location of the pain, its severity, and any relationship to physical activity or eating will help determine what organs could possibly be involved. The presence of other symptoms may also help focus on particular areas of the body that may need further testing. 

A thorough physical examination is the next order of business and should include evaluation of the bladder, intestines, abdominal wall muscles and the pelvic organs. Often, a "multidisciplinary approach" will be the most helpful way to approach the pain. This method uses a team of medical professionals, combining their experience and problem-solving skills in order to solve the puzzle, find the source of the pain, and treat it. The team often consists of a gynecologist, a specialized pain-management physician, and a psychologist. While "pain clinics" have been developed for this purpose, these professionals can also be assembled by your primary care physician or gynecologist. The gynecologist is responsible for evaluating possible gynecologic causes of pain, and the pain-management physician should be skilled in the diagnosis and treatment of other causes of pain. In addition, consultants such as a urologist (urinary system), gastroenterologist (stomach and intestine) or orthopedist (muscles, joints and bones) may be needed. The therapist is trained to evaluate stress, family, or marital problems, or feelings of helplessness or depression, which all can affect pain. The therapist can also help design an effective plan for stress reduction and pain relief. This may sound like a lot of work, but a pain-free life is a goal worth working towards. 

SHOULD YOU HAVE A LAPAROSCOPY PERFORMED?
Laparoscopy is a surgical procedure that involves placement of a thin telescope through an incision in the navel in order to see inside the abdomen and pelvis. It is often utilized to help establish the cause of pelvic pain and, in many cases, can be used to treat the cause of the pain as well. The procedure is performed in a hospital or outpatient surgery center under general anesthesia. With the laparoscope, the doctor is able to see the uterus, tubes, ovaries, intestines, appendix, gall bladder, and liver. With a careful inspection, gynecologic problems such as endometriosis, pelvic infection, adhesions, ovarian cysts, and tubal pregnancy can be diagnosed. Inflammation or infection of the appendix, intestines or gall bladder may also be detected, so that appropriate treatment may be started. In addition, by using specialized instruments during the laparoscopy, many of these problems may be treated at the same time. Adhesions and endometriosis may be cut away, and ovarian cysts or a tubal pregnancy removed. 

Although new adhesions can sometimes form as part of the healing process after any surgery, many women found to have significant adhesions at the time of the laparoscopy will feel better after the adhesions are surgically removed. Also, laparoscopic surgery for moderate or severe endometriosis has been shown to provide pain relief about 70% of the time. 

However, the presence of thin adhesions or a small quantity of endometriosis does not often cause pelvic pain, and, therefore, surgery for these problems should be approached cautiously. Also, in as many as 30% of women having laparoscopy for chronic pelvic pain, a normal uterus, tubes, and ovaries are found. A normal pelvis may suggest that other tests need to be performed to see if the problem is elsewhere. But if the findings during the laparoscopy are normal, it is extremely unlikely that any serious problem exists with the pelvic organs, and this information can be very reassuring. 

While not a major abdominal surgery, laparoscopic surgery does have risks and should be considered only when other non-gynecologic causes of the pain have been excluded. Be sure that any surgery is warranted and will provide the relief you are seeking. However, the information acquired at the time of laparoscopy can be valuable. Nothing else, not ultrasound, nor CT scan, nor MRI, nor blood tests can diagnose problems such as endometriosis or adhesions. Therefore, the procedure can be helpful when used appropriately. 


The following questions and answers can be found in our book

ABOUT PELVIC PAIN 

WHAT IS PAIN? 

WHAT IS ACUTE PAIN? 

WHAT CAN CAUSE ACUTE PELVIC PAIN? 

CAN FIBROIDS CAUSE PELVIC PAIN? 

WHAT CAN CAUSE PAIN WITH INTERCOURSE? 

WHAT IS CHRONIC PAIN? 

WHAT IS CHRONIC PELVIC PAIN? 

WHAT CAN CAUSE CHRONIC PELVIC PAIN? 

WHAT CAN BE DONE TO EVALUATE THE CAUSE OF CHRONIC PELVIC PAIN?

CAN PELVIC INFECTION CAUSE CHRONIC PAIN? 

CAN PELVIC SCAR TISSUE (ADHESIONS) CAUSE CHRONIC PELVIC PAIN? 

CAN ENDOMETRIOSIS CAUSE PELVIC PAIN? 

HOW CAN THE PAIN FROM ENDOMETRIOSIS BE TREATED? 

SHOULD YOU HAVE A LAPAROSCOPY PERFORMED? 

IS THERE A RELATIONSHIP BETWEEN SEXUAL OR PHYSICAL ABUSE AND PELVIC PAIN? 

WHAT TYPES OF BLADDER PROBLEMS CAN CAUSE PAIN? 

WHAT IS INTERSTITIAL CYSTITIS, AND CAN IT CAUSE PELVIC PAIN? 

WHAT IS THE TREATMENT FOR INTERSTITIAL CYSTITIS? 

WHAT TYPES OF INTESTINAL PROBLEMS CAN CAUSE PELVIC PAIN? 

WHAT IS IRRITABLE BOWEL SYNDROME? 

WHAT IS THE TREATMENT FOR IRRITABLE BOWEL SYNDROME? 

WHAT IS INFLAMMATORY BOWEL DISEASE? 

WHAT IS DIVERTICULITIS? 

CAN INTESTINAL CANCER CAUSE PELVIC PAIN? 

CAN MUSCLE PROBLEMS CAUSE PELVIC PAIN? 

WHAT CAN CAUSE MUSCULOSKELETAL PAIN? 

TREATMENT FOR PELVIC PAIN 

WHAT CAN BE DONE TO TREAT MUSCULOSKELETAL PAIN? 

WHAT IS THE BEST WAY TO USE PAIN MEDICATIONS FOR CHRONIC PELVIC PAIN? 

SHOULD NARCOTIC MEDICATIONS BE USED FOR CHRONIC PAIN? 

WHAT OTHER MEDICATIONS ARE HELPFUL IN THE TREATMENT OF CHRONIC PELVIC PAIN? 

CAN YOUR ATTITUDE ABOUT PAIN INFLUENCE WHAT YOU FEEL? 

CAN RELAXATION METHODS BE USED TO HELP TREAT PAIN? 

DOES ACUPUNCTURE WORK FOR PELVIC PAIN? 

CAN BIOFEEDBACK TREAT CHRONIC PAIN? 

SHOULD YOU HAVE A HYSTERECTOMY FOR PELVIC PAIN?

Please visit 'A Gynecologist's Second Opinion", the site of William H. Parker, MD