Chronic Pelvic Pain

What is Chronic Pelvic Pain?

Chronic pelvic pain is constant pain felt in the lower abdominal region and the pain may persist for longer duration, for more than six months.

What is the Cause of Chronic Pelvic Pain?

Chronic pelvic pain can be caused by different conditions that may or may not be related to reproductive organs such as pain due to urinary tract conditions. Cause for the pain may be unknown in some cases.

What are the Symptoms?

The common symptoms include pain during periods, ovulation, intercourse, and pain when passing urine or bowel movements or lower back pain.

How is Chronic Pelvic Pain Diagnosed?

Chronic pelvic pain is diagnosed based on your medical history and pelvic examination. Certain tests such as

• ultrasound,
• laparoscopy,
• cystoscopy,
• colonoscopy and
• sigmoidoscopy

are performed to find out the cause of your pain.

What are the Treatment Options for Pelvic Pain?

There are several treatment options to relieve chronic pelvic pain. They include

• medications,
• physical therapy,
• nutrition and
• surgery.

Lifestyle changes such as maintaining a good posture and regular exercise help reduce pain.

Pain medications such as nonsteroidal anti-inflammatory drugs may relieve pelvic pain. Vitamin B1 and magnesium supplements may help reduce pain.

Surgery to destroy nerves and block pain signals may be considered when all other treatment methods are unsuccessful.

Pelvic Floor Conditions

Pelvic floor is the group of muscles lining the pelvis. Any diseases or disorders that affect these pelvic floor muscles can lead to pelvic floor deformities. Local organs can also be affected including the bladder, urethra, vagina, anus, and rectum.

Some of the pelvic floor conditions are explained below

Urinary incontinence:  Refers to loss of bladder control resulting in involuntary leakage of urine. It commonly occurs in women due to pregnancy and childbirth, menopause and the structure of the female urinary tract. There are two types of urinary incontinence; stress incontinence and urge incontinence.

Stress incontinence – Refers to leakage of small amounts of urine during physical activities such as coughing, laughing, sneezing, or exercising that suddenly increases the pressure within the abdomen.

Urge incontinence – This condition refers to urine leakage with the sudden urge to urinate or unable to hold the urine.

Your physician diagnoses your condition through physical, pelvic and neurologic examination and suggests appropriate treatments.

Treatments for Pelvic Floor Conditions

The treatment options include

• pelvic floor exercises,
• bladder control techniques,
• diet and
• lifestyle changes,
• urethral inserts,
• sacral nerve stimulators, and
• minimally invasive surgeries, and
• biofeedback treatments.

Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease (PID) is characterized by infection of the female reproductive organs, such as the uterus, fallopian tubes, and ovaries. It is mostly acquired through unsafe sexual practices and is one of the most serious consequences of sexually transmitted diseases (STD).

PID can cause permanent damage to the female reproductive system, and is one of the leading causes of infertility.

Causes of Pelvic Inflammatory Disease (PID)

PID can occur when your cervix is exposed to an STD, such as chlamydia or gonorrhea. The cervix loses its ability to protect the internal organs from bacteria and the infection eventually spreads to your uterus, ovaries, and fallopian tubes.

Ninety percent of PID occurs as a result of untreated chlamydia and gonorrhoea. Sexual practices that involve multiple partners and unprotected sex increase your chances of acquiring STDs, which can in turn lead to PID. Some of the other causes include:

• Intrauterine device (IUD) use
• Birthing
• Miscarriage
• Abortion
• Endometrial biopsy (procedure to remove a piece of tissue from your uterine lining for examination)
• Regular douching
• Previous history of PID or STD

Symptoms of Pelvic Inflammatory Disease

Pelvic inflammatory disease PID can show minor symptoms or no symptoms at all (common with chlamydial infection). They can often vary, but may include:

• Dull pain in your stomach and lower abdomen and pelvis
• Green or yellow vaginal discharge, having a distinct and often unpleasant odor
• Pain during urination
• Irregular menses
• Fever or chills
• Nausea, vomiting or diarrhea
• Pain in the lower back
• Painful intercourse

If you notice these symptoms, it is important to stop having intercourse and visit Dr Alexander immediately, as prompt treatment is vital for PID.

Complications with Pelvic Inflammatory Disease

If left untreated, PID can cause scarring and collection of abscesses (infected fluid) in the fallopian tubes. PID can also lead to infertility or ectopic pregnancy (implantation of embryo outside the uterus). Scarring or damage can occur to other reproductive organs, which can cause chronic pelvic pain that can last for many months.

Diagnosis of Pelvic Inflammatory Disease

Based on your signs and symptoms, Dr Alexander may perform a pelvic examination, obtain a sample of your vaginal discharge, and perform cervical cultures and urine tests. Samples may be obtained from your cervix and vagina using a cotton swab, and sent to the laboratory to identify the bacteria causing the infection.

Dr Alexander may also recommend the following tests to confirm and determine the extent of your infection.

• Blood tests,
• Pelvic ultrasound to check your reproductive organs and exclude any abscesses ( pus collection ).
• Endometrial biopsy
• Laparoscopy, where a thin, lighted tube with a camera is inserted through a small cut in your abdomen to examine your pelvic organs

Treatment for Pelvic Inflammatory Disease

Confirmation of PID will be immediately followed by treatment. You will be started on oral antibiotic medications for mild cases of PID. For more severe cases, you may be treated with a combination of oral and intravenous medications, or hospitalized for more aggressive management. It is important that your partner also gets treated, even if he does not have any symptoms, in order to prevent future recurrence of the infection.

If antibiotics fail to clear the infection, and if the infection forms abscesses in your uterus or ovaries, you may be recommended to undergo laparoscopy for removal of abscess and pelvic wash, occasionally oophorectomy ( removal of the ovary ) is necessary or salpingectomy ( removal of tube ) if filled with pus.

When your infection, abscess, or inflammation has cleared, but you are still experiencing chronic pelvic pain, you may be recommended to undergo a nerve ablation surgery, where the nerves that provide sensation to your pelvic organs are surgically removed or destroyed.

Prevention of Pelvic Inflammatory Disease

Prevention is the best way to deal with PID.

• Avoid unsafe sexual practices, multiple partners, and use barrier methods such as condoms and spermicides.
• Avoid IUD if you have multiple partners.
• Watch for symptoms and be prompt to get treatment.
• Have regular follow up with Dr Alexander, as infections identified during the early stages can be prevented from spreading to your reproductive organs.
• Avoid douching, as douching disturbs the fragile balance of bacteria in your vagina, masks your vaginal discharge, and pushes the bacteria up into the genital tract.