Chronic Pelvic Pain

Chronic Pelvic Pain

Symptoms, treatment and more related to chronic pelvic pain.

Chronic pelvic pain is pain localized in the lower abdomen and pelvis present for at least six months. It may come and go, and vary in character and intensity. Women with chronic pelvic pain may have painful periods with severe cramps. They may also have pain with sexual activity, urination or bowel movements.

The most common cause of chronic pelvic pain is endometriosis. Endometriosis is a condition in which cells that normally line the inside of the uterus also grow on other organs such as the ovaries, peritoneum, bowel, or bladder. Endometriosis can cause ovarian cysts (endometriomas), pelvic adhesions (scarring), and infertility.

Pelvic pain may also be due to adhesions or scar tissue from prior infections or surgeries, including hysterectomies. Sometimes no specific cause of pelvic pain is found.

Evaluating the symptoms of chronic pelvic pain includes a thorough history and physical examination, and imaging studies such as ultrasound. Because scarring cannot be seen on ultrasound, a laparoscopy may prove useful in certain cases. A slender telescope with a camera at the end is inserted through the belly button to evaluate the pelvic and abdominal organs. If endometriosis or scar tissue is found, it can be cauterized or excised as long as it is not on vital structures (i.e. bowel).

Unrelieved, unrelenting pelvic pain can affect a woman’s demeanor, self-image, and outlook on life. It can interfere with work, recreation and personal relationships. For this reason, a multidisciplinary approach is usually most successful at managing pain, particularly when it has been inadequately treated or no specific cause is found. Working with specialists experienced in addressing pelvic disorders, including physical and massage therapists, psychologists, and practitioners in pain management, can be helpful. Boulder Gynecology can make referrals to excellent professionals in the area.

Some women elect to undergo hysterectomy for chronic pelvic pain. In our view, this is the treatment of last resort. First, women must be ready to give up future fertility. Secondly, even hysterectomy may not always alleviate the pain. If hysterectomy is elected, we use the least invasive approaches, laparoscopic supracervical hysterectomy or total laparoscopic hysterectomy.