Chronic Pelvic Pain

Condition Basics

What is chronic pelvic pain?

Chronic pelvic pain is pain below the belly button that usually lasts more than 6 months. It may or may not have a clear cause. It can range from being mild to being so bad that it gets in the way of your daily activities and sleep.

What causes it?

Sometimes it's clear what is causing chronic pelvic pain. Other times it's not. The pain may come from your reproductive or urinary system, bowels, or muscles and nerves in the pelvis. And there can be more than one cause. Sometimes the brain and nerves become extra sensitive to pain. This makes pain worse.

What are the symptoms?

Chronic pelvic pain may include severe cramping during periods, pain during sex, or pain when you urinate or have a bowel movement. You may have pain in certain postures or positions. Pain may range from mild to severe or dull to sharp.

How is it diagnosed?

Your doctor will ask you about your past illnesses, surgeries, and overall health. You will also be asked about your pain, including whether it disrupts your daily activities, sleep, or mood. Your doctor will do a physical exam. You may need tests, such as imaging tests or blood or urine tests.

How is chronic pelvic pain treated?

You will work with your doctor to make a treatment plan. There are many treatments you can try to manage your pain. These include physical treatments, behavioral health treatments, and medicines. Surgery is sometimes used. It may take several types or combinations of treatments before you find what helps you the most.

Cause

Sometimes chronic pelvic pain has a clear cause. But sometimes the cause isn't clear. And there can be more than one cause. Sometimes the brain or nerves become extra sensitive to the feeling of pain. This makes the pain worse.

Some causes of chronic pelvic pain can include:

• Problems of the female reproductive system, such as:
  • Endometriosis.
  • Adenomyosis.
  • Uterine fibroids.
• Scar tissue (adhesions) in the pelvic area after an infection or surgery.
• Problems with the urinary tract or bowel, such as:
  • Irritable bowel syndrome.
  • Chronic bladder irritation.
• Problems with the muscles, nerves, joints, or ligaments in the pelvis, lower back, or hips.

What Increases Your Risk

Risk factors are things that increase your chances of getting a certain condition or disease. A past pelvic surgery increases your risk for chronic pelvic pain. It's not clear what else increases your risk. Some things, like depression or a past pelvic infection, are common in people with chronic pelvic pain. But it's not clear whether those health issues increase the chances of having chronic pelvic pain.

Symptoms

Chronic pelvic pain may include:

• Severe cramping during periods.
• Heavy or irregular vaginal bleeding.
• Pain during sex.
• Pain when you urinate or have a bowel movement.
• Pain in certain postures or positions.

The pain can range from mild to severe or from dull to sharp.

Chronic pain can make it hard to sleep, work, or enjoy life.

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What Happens

Chronic pelvic pain may be mild to severe. It may go away and then come back from time to time over several weeks, months, or years. Or the pain may be constant. For some people chronic pelvic pain will go away completely, and for others it won't.

If your doctor can find a single cause of your pain, the doctor may be able to cure it. But a single, treatable cause isn't common.

Your doctor can help you find treatments to manage your pain well enough so that you can do the things that are important to you.

When to Call a Doctor

Contact a doctor now if you have sudden, severe pelvic pain, with or without vaginal bleeding.

Contact a doctor if:

• Your periods have changed from relatively pain-free to painful.
• Pain interferes with your daily activities.
• You start to have pain during intercourse.
• You have painful urination, blood in your urine, or an inability to control the flow of urine.
• You have blood in your stool or a significant, unexplained change in your bowel movements.
• You notice any new pelvic symptoms.
• You haven't yet seen a doctor about your chronic pelvic pain.

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Exams and Tests

Your doctor will ask you about your past illnesses, surgeries, and overall health. The doctor will also ask questions about your pain, such as:

• When did your pain start?
• Did something happen that caused or triggered the pain?
• What treatments have you tried?
• What makes your pain better or worse?

Your doctor may also want to know if your pain disrupts your daily activities, sleep, or mood. The doctor will probably also ask you about depression or stress since these can make pain worse.

Your doctor will examine you to check for painful areas and to check for problems with the organs in your pelvis. The doctor may suggest tests such as an ultrasound, blood tests, or urine tests. Sometimes the doctor may recommend a surgery called laparoscopy. This lets the doctor look for problems inside your pelvis.

Your doctor may ask you to see other specialists, such as a gastroenterologist.

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Treatment Overview

You and your doctor will work together to make a treatment plan. Treatment can help you manage your pain enough so that you can do the things that are important to you. It may take several types or combinations of treatments before you find what helps you the most. Treatment options may include:

• Hormone treatment. This can help if part of your pain is related to your periods.
• Treatment for bladder or bowel issues.
• Pelvic floor physical therapy.
• Behavioral health treatments. These are things like cognitive behavioral therapy (CBT) and sex therapy.
• Medicines. These can include over-the-counter pain medicines or prescription medicines like antidepressants and anticonvulsants.
• Trigger point injections. These are shots of medicine to help relieve painful areas.
• Surgery.

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Self-Care

You can try these tips at home to ease pelvic pain.

• Take medicines as prescribed by your doctor. Talk to your doctor about taking an over-the-counter pain medicine, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Read and follow all instructions on the label.
• Try heat. Put a heating pad, a hot water bottle, or a warm compress on your lower belly, or take a warm bath. Heat improves blood flow and may relieve pain.
• If you have back pain, try lying down and elevating your legs by placing a pillow under your knees. When lying on your side, bring your knees up to your chest.
• If you are given physical therapy exercises, it's important to do them.
• Think about trying acupuncture, yoga, or massage. These may help some people. Or you can try relaxation techniques, such as breathing exercises or meditation.
• Be as active as you can be. It helps some people feel less pain.

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Medicines

Depending on what's causing your chronic pelvic pain, different medicines might help. Some examples include:

• Hormone treatments. These may be used for menstrual pain or pain from endometriosis.
• Medicines that help with your bowels.
• Medicines for your bladder.
• Over-the-counter pain medicines, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin).
• Antidepressant medicines or anticonvulsant medicines. They can help calm the nerves that send pain signals.

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Surgery

Surgery for pelvic pain is most likely to help when it's done for a specific condition, like fibroids, endometriosis, or diverticulitis.

If a problem with the uterus is causing pain, removing the uterus (hysterectomy) can help. One example is if a very large fibroid is pressing on the bladder.

With any surgery for chronic pelvic pain—such as hysterectomy or cutting of specific pelvic-area nerves—there's a risk of lasting pain or pain that's worse after surgery. And it can have serious side effects.

During surgery, the doctor may remove scar tissue (adhesions) from previous surgery or from pelvic inflammatory disease or endometriosis. But most studies have shown that this doesn't relieve pain.

Laparoscopy to diagnose chronic pelvic pain may be done before other treatment. Areas of endometriosis or scar tissue may be removed or destroyed during the procedure.

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Other Treatment

Counseling-based therapies

Counseling and mental skills training can help when you have chronic pelvic pain. They help you gain the mental and emotional tools to help manage chronic pain and the stress that makes it worse. You can combine medical treatment with other treatments, such as counseling. This can increase your chances of success.

Common treatments include:

• Cognitive behavioral therapy. It focuses on changing the way you think about and mentally manage pain. A psychologist, licensed counselor, or clinical social worker who specializes in pain management skills can help.
• Biofeedback. This is the conscious control of body function that you normally control unconsciously.
• Interpersonal counseling. It focuses on managing your life events, stressors, and relationships.

Alternative treatments

Alternative pain treatments for chronic pelvic pain aren't well studied. But they may help you to manage stress and learn ways to deal with pain. Alternative treatments that some people find helpful include:

• Acupuncture.
• Transcutaneous electrical nerve stimulation (TENS).
• Yoga.
• Relaxation techniques, such as breathing exercises or meditation.
• Massage therapy.

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