FAQs on Pelvic Pain

Pelvic pain can last longer than six months. If you have a sudden onset of pelvic pain, you should see a doctor soon as possible. If you suffer from chronic pelvic pain, pain management can help.

What is chronic pelvic pain?

Female pelvic pain is any pain felt below the belly button. Chronic pelvic pain is long-term pain that persists for more than six months. Men also can have chronic pelvic pain, which is often related to the reproductive organs, prostate, and/or bladder.

What causes pelvic pain?

Experts do not always understand the things that cause chronic pelvic pain. Sometimes, the cause will remain a mystery. For women, pelvic pain often is caused by problems with the reproductive organs and structures. Neuropathic pain causes burning and searing pain of the pelvis. Common causes include:

  • Endometriosis
  • Uterine fibroids
  • Irritable bowel syndrome
  • Adhesions scar tissue
  • Chronic bladder irritation

What symptoms are associated with pelvic pain?

Pelvic pain ranges from mild to severe, from dull to sharp, and from cramping to squeezing. Pain during sex often is associated with pelvic pain. Many pain occur when you have a bowel movement or urine. Chronic pain often leads to depression, anxiety, and feelings of stress.

How is pelvic pain diagnosed?

At the first visit, the doctor will conduct a physical examination, as well as a pelvic exam. A Pap smear and infectious cultures are done to assess for underlying diseases. The doctor asks questions about your past medical history and current symptoms. Emotional issues often plays a role in chronic pelvic pain. The doctor will ask questions about sexual and physical abuse, as well as take a history of current medications. The testing may include:

  • Blood and urine tests for signs of infection
  • A pregnancy test
  • Cultures for sexually transmitted infections (STIs)
  • Transvaginal ultrasound
  • Magnetic resonance imaging (MRI)
  • Computed tomography (CT) scans

A laparoscopy is a special procedure that allows the doctor to examine inside of the pelvic cavity. A thin, lighted tube with a camera is inserted into the abdomen so the doctor can view the organs and structures.

What is the treatment for pelvic pain?          

Chronic pelvic pain is a medical problem. The options of treatments are:

  • Medications – Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are used for pain. For depression and pain, tricyclic antidepressants are used. If muscle spasms exist, a mild muscle relaxant is given.
  • Celiac plexus block (CPB) – For management of intractable, severe abdomen and pelvic pain, the doctor can inject the celiac plexus nerves with a long-acting anesthetic or neurolytic agent. In clinical studies, the efficacy rate was 85-90%.
  • Superior hypogastric block – With this procedure, the doctor injects a bundle of nerves that supply the pelvic region (the superior hypogastric plexus). In a recent study, 70% of patients enjoyed a significant decrease in pain medications, and another study showed a 72% success rate when neurolysis was done.
  • Transcutaneous electrical nerve stimulation (TENS) – This device is worn on the outside of the body. Small wires attach to electrodes place near the spine. Mild electrical current is emitted to interfere with pain signal transmission.
  • Intrathecal pump implant – For severe pain, the doctor can surgically implant a device in the lower abdomen or pelvic area. The catheter runs from the device to the spinal cord region. This way, the narcotic analgesic and other medicines bypass the gastrointestinal tract. In a research study, this technique had an 86% efficacy rate.

Resources

Corrado P, Alperson B, & Wright (2006). Perceived success and failure of intrathecal infusion pump implantation in chronic pain patients. Neuromodulation, 11(2), 98-102.

Mishra S, Bhatnagar S, Gupta D, Thulkar S. Anterior ultrasound-guided superior hypogastric plexus neurolysis in pelvic cancer pain. Anaesth Intensive Care. 2008; 36:732-5.

Schmidt AP, Schmidt SR, Ribeiro SM. Is superior hypogastric plexus block effective for treatment of chronic pelvic pain? Rev Bras Anestesiol. 2005;55(6):669-679.