Pelvic pain is a common complaint among women. Its nature and intensity may fluctuate, and its cause is often obscure. In some cases, no disease is shown to be evident. Pelvic pain may originate in genital or extragenital organs, or it may be psychogenic. Many women experience pain in the lower abdominal area during ovulation, around the middle of the
menstrual cycle. It usually lasts a few minutes to a few hours and is rarely severe. This does not necessarily indicate that there is any underlying problem. Pelvic pain may also be part of premenstrual syndrome (PMS). In this case, your breasts and abdomen may swell and you may become irritable, depressed, and fatigued for a few days before your period begins.
Pain in the area of the ovaries and fallopian tubes is often due to infection. Lower abdominal pain, fever, and chills that begin a few days after a menstrual period may be caused by gonorrhea or chlamydia. Pelvic pain that is present most of the time but worsens during menstruation and intercourse may be due to chronic pelvic inflammatory disease. Chronic PID is caused by one or more episodes of pelvic infection, usually from gonorrhea or chlamydia and can lead to infertility. Many organs live in the pelvis, including the uterus, ovaries, fallopian tubes. The bladder and intestine, and appendix also live next to the reproductive organs, and sensations from these organs can feel like pain from the uterus or ovaries. To further confuse things, pain from the kidney and pain from muscles and from the abdominal wall can also seem to come from the pelvis.
Other causes of pelvic pain include ovarian cysts and endometriosis. Pain due to endometriosis usually increases during menstruation and, sometimes, during intercourse. Problems with pregnancy, such as cramping before a miscarriage or a pregnancy in the fallopian tubes rather than in the uterus, can also cause pelvic pain.
Chronic pelvic pain is different from other pain that you may have experienced. There usually is no simple single answer to pain relief since the tissue damage has already occurred and further damage has typically stopped. Emotional changes over a long period of time, coupled with behavioral changes, may result in development of Chronic Pelvic Pain Syndrome. It is very important to realize that this pain is not psychological. All chronic pain is neither purely physical nor purely psychological. Rather, due to the chronic nature, it is physical and psychological. The pain is not “in your head” and you are not “crazy.” The pain is real. The pain, however, is usually not dangerous in a physical sense.
Colicky pain may be caused by spasm in a hollow or tubular soft organ, such as the intestine, ureter, gallbladder, or appendix. Sudden onset of pain usually results from ischemia, a temporary deficiency of blood supply due to an obstruction in the circulation of blood. A more insidious onset over several hours may occur due to inflammation or obstruction such as in salpingitis, appendicitis, or intestinal obstruction. Localized pain may be due to an inflammation or a problem with part of the uterus. Pain involving the entire abdomen suggests a generalized reaction such as flooding of the peritoneum with blood, pus, or intestinal contents. Pain from irritation in the lining of the abdominal cavity usually increases with abdominal, general body, or bowel or bladder movement, or with examination. A tender uterine mass suggests an ectopic pregnancy, ovarian cyst, or inflammatory mass. Vomiting occurs early with acute appendicitis or inflammation of the bile duct and may or may not accompany salpingitis or pyelonephritis; it occurs later with bowel obstruction.
The need for diagnostic tests in women with chronic pelvic pain varies greatly, and depends largely on findings at the time of the history and physical examination. Thus, the more thorough you can be relating your history, the better the chance of appropriately performing diagnostic tests. Certain commonly performed diagnostic studies, such as ultrasound and plain x-rays, are frequently not very helpful, but are still done in most women with chronic pelvic pain as part of the initial evaluation. If there is suspected disease of the urinary tract, a CT-IVP (intravenous pyelogram) may be ordered, and if intestinal disease is suspected, a barium enema may be needed. More expensive radiologic tests, such as a CAT scan or MRI, may be done to look for suspected pelvic mass, nerve compressions, hernias, or spinal problems that might contribute to the pelvic pain.
Cystoscopy, a minor surgical procedure done by inserting a lighted optical tube (cystoscope) into the urethra and bladder, is often performed if the history and physical exam suggest problems with the urethra or bladder. Often this must be done under anesthesia to allow over-distention of the bladder. Urodynamic testing, a way of testing the pressure and flow functions of the bladder and urethra, can sometimes be needed. A potassium chloride test is another test of the bladder that is sometimes necessary. This test involves instilling water and potassium chloride solution into the bladder to see if either causes urgency or pain.
One of the most important diagnostic test for chronic pain is laparoscopy, a surgical procedure done by inserting a lighted optical tube (laparoscope) into the abdominal cavity. Laparoscopy is the most reliable way to endometriosis and adhesions. This is done either under local anesthesia with a small needle-like laparoscope to allow an accurate localization of pain to specific internal organs or structures (called conscious pain mapping when it is performed this way) or under general anesthesia to permit surgical treatment as well as diagnosis.
Treatment depends on your individual problem. Your doctor will help you determine which form of treatment is right for you. Some treatment options include: Stopping ovulation (release of eggs from the ovary) with birth control pills or Depo-Provera injections. Use of nonsteroidal anti-inflammatory pain relievers such as ibuprofen (one brand name: Motrin) or naproxen (brand name: Aleve). Relaxation exercises, biofeedback (treatment to control emotional states using electronic devices) and physical therapy. Abdominal trigger point injections. A trigger point is a tender area in the lower wall of the abdomen. Pressure that is put on this area causes pain. Injecting medicine into the trigger point can block this pain. Antibiotics. Psychological counseling. Surgery is usually only an option if abnormalities in the pelvis are seen.