Pelvic pain

Chronic pelvic pain is defined as pain that occurs below the belly button (umbilicus) and has been present for at least 6 months.

It can be quite difficult to make the diagnosis and treat the underlying cause may be due to one or more conditions. A variety of disorders can cause pelvic pain .

Gynaecological causes include:

  • Endometriosis – A condition where the cells within the lining of the womb (the endometrium) are found outside the uterus.
  • Pelvic Inflammatory Disease -an acute infection of the womb, fallopian tubes and ovaries
  • Pelvic Adhesions Abnormal scar tissue from previous infection, endometriosis or surgery that causes internal organs and structures to stick together

Non-gynaecological causes include:

  • Interstitial Cystitis -Condition of bladder pain, with a need to urinate both urgently and frequently
  • Irritable Bowel Syndrome– A bowel related condition with abdominal pain and altered bowel habits in the absence of a specific cause
  • Other causes include pelvic floor pain, abdominal myofascial pain and fibromyalgia

How is the diagnosis made?

Detailed information about your symptoms recorded in a pain diary is the first step in making a diagnosis. Your description of the pattern of pain can often provide much more valuable information than laboratory tests.

  • Laboratory tests may be useful to exclude infection
  • Pelvic ultrasound scan may identify ovarian cysts and fibroids
  • Laparoscopy may be helpful in identifying causes such as endometriosis and chronic pelvic inflammatory disease. This is a surgical procedure where a thin telescope with a camera is passed through a small cut in the belly button to inspect the pelvic structures.

What treatment may help?

Gynaecological conditions are often treated medically but surgery may be necessary in some instances. Hormonal treatment is given for endometriosis and stepwise analgesia is offered to alleviate pain. Surgical treatment of endometriosis may be beneficial in selected cases.

Bladder problems require specialist input from the urologists and involvement of physiotherapists for management of pelvic floor pain can be quite successful.

Psychological counselling or referral to specialist pain management teams may be required to manage chronic pelvic pain if no underlying cause is identified. Complimentary therapy may also be helpful

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