FAQS on Pelvic Pain and Treatment Options
Pelvic pain mainly affects women, but can occur in men. Chronic pelvic pain is a lasts longer than 6 months, and is a debilitating condition that significantly alters quality of life. The pain occurs below the belly button (umbilicus), and varies in quality, severity, and intensity. It can be a mild ache that comes and goes or a steady, severe pain that interferes with work, sleep, and daily activities.
How common is chronic pelvic pain?
Chronic pelvic pain in women has a prevalence of 2-20%. Because the condition is often associated with conditions such as interstitial cystitis or endometriosis, the diagnosis is often difficult to establish, which leads to a delay in treatment. There are many psychological and social factors associated with chronic pelvic pain.
What are common causes of long-standing pelvic pain?
In women, chronic pelvic pain can occur due to endometriosis, adenomyosis, adhesions (scar tissue) after surgery or infection, uterine fibroids, interstitial cystitis, chronic bladder irritation, irritable bowel syndrome, or menstrual irregularities.
After a disease has been treated, or once an injury heals, the affected nerves continue to send pain signals to the brain, which is known as neuropathic pain. When doctors cannot find a specific cause for pelvic pain, it is often assumed to be of a neuropathic nature.
What are the symptoms of pelvic pain?
The type of pelvic pain experienced varies from patient to patient. It may or may not be related to menstrual periods. Some patients have pelvic pain isolated to one side of the lower abdomen, whereas other have pain over the entire pelvic region. Chronic pelvic pain can include:
- Pain that ranges from dull to sharp.
- Pain that ranges from mild to severe.
- Pain that occurs during sex.
- Severe cramping during menses.
- Pain with bowel movements and/or urination.
Are there any other symptoms associated with chronic pelvic pain?
Many women who experience chronic pelvic pain report symptoms of a depressed mood. Signs of depression include appetite changes, sleep problems, feelings of sadness and emptiness, and slowed reactions and body movements.
How is pelvic pain treated?
The treatment of pelvic pain typically depends on the specific cause. For chronic, recurrent pelvic pain, options include:
- Medications – These include hormonal agents, painkillers, antibiotics, and tricyclic antidepressants.
- Acupuncture – When performed by a skilled practitioner, acupuncture is proven effective for chronic pain. This involves insertion of fine needles into multiple body areas.
- Transcutaneous nerve stimulation (TENS) – With this pain measure, electrodes are placed on the skin, and a small device delivers electrical current to the affected region to decrease pain.
- Celiac plexus block – With this procedure, the doctor inserts a small needle into the back and deposits an anesthetic agent into the celiac plexus, which is a mass of nerves that supplies the abdomen and pelvic region. This injection is often used for both diagnosis and treatment, and is done under x-ray guidance for precise placement. The efficacy rate for the celiac plexus block is 85-90%, according to research studies.
- Sacral nerve stimulation (SNS) – For chronic bladder and bowel problems, a device is surgically implanted near the lower back to deliver electrical current to the nerves that supply the pelvic area. In one study involving patients with chronic pelvic pain, SNS decreased the rate and duration of pain in participants. In a recent clinical study, more than 71% reported significant improved pain scores.