PELVIC PAIN

Pelvic pain is pain that occurs in the lower abdomen and pelvis.

The pelvic region is the area between the umbilicus (belly button) and the groin in the front and between the buttocks at the back. This may involve the reproductive system (uterus, tubes and ovaries), the bladder and digestive system (intestines, stomach).

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.

Pelvic pain can be acute or chronic. Acute pelvic pain occurs suddenly and stays only for a short period of time.  Chronic pelvic pain lasts for more than six months and does not show any improvement with treatment.

Symptoms of Pelvic Pain

Pelvic pain may be dull or sharp; persistent or intermittent; mild to severe, and can extend to your lower back or thighs.

The common symptoms with pelvic pain are:

  • Pain in the hip and groin area

  • Pain and cramps during menstruation

  • Pain during urination, bowel movements, and intercourse

  • Fever or chills

  • Constipation or diarrhoea

Causes of Acute Pelvic Pain

Usually, pelvic pain is considered a symptom of infection or problem in the pelvic area. It is observed most commonly in women but can also occur in men.

The common causes of acute pelvic pain are:

  • Pelvic inflammatory disease (infection of the reproductive organs),

  • Urinary tract infection

  • Appendicitis (inflammation of appendix)

  • Ectopic pregnancy (pregnancy that occurs outside the uterus)

  • Twisted or ruptured ovarian cyst

  • Ruptured fallopian tube

  • Miscarriage or threatened miscarriage

  • Congestion or abscess (collection of pus) in the pelvic region

Causes of Chronic Pelvic Pain

Chronic Pelvic Pain is constant pain which is felt in the lower abdominal region and is longer in duration - usually longer than six months.

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 (interstitial cystitis). The cause for the pain may be unknown in some cases.

Common causes of chronic pelvic pain

  • Endometriosis, the abnormal growth of uterus lining where the lining of the uterus (endometrium) grows in areas of the pelvis outside the uterus

  • Interstitial cystitis (inflammation of urinary bladder)

  • Irritable bowel syndrome

  • Pelvic floor disorders (spasm or tension in the pelvic floor muscles)

  • Uterine fibroids (non-cancerous uterine growths)

  • Chronic pelvic inflammatory disease

  • Psychological factors such as stress, depression or a history of physical abuse

What are the symptoms of chronic pelvic pain?

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. Additional tests including blood tests, urine culture may be organised. Certain tests such as

  • Ultrasound

  • X-Ray

  • CT (Computerised Axial Tomography)

  • MRI (magnetic resonance imaging)

  • laparoscopy,

  • cystoscopy,

  • colonoscopy and

  • sigmoidoscopy

are performed to find out the cause of your pain.

Treatment of Pelvic Pain

Treatment for pelvic pain depends on the cause of pain, intensity and frequency of the pain.

Conservative management of pelvic pain includes

  • rest

  • participating in regular physical therapy including pelvic floor physiotherapy

  • exercise.

  • Nutrition

Medication can be used to relieve

  • pain (pain killers) - non steroidal anti-inflammatory drugs may relieve pelvic pain. Vitamin B1 and magnesium supplements may help reduce pain.

  • muscle spasm/ contraction (muscle relaxants)

  • Dr Cook may also instruct you to take hormonal medications for pain relief during ovulation and menstruation.

  • to treat infection (antibiotics).

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

Surgery is considered for patients with chronic pelvic pain due to

  • endometriosis,

  • pelvic floor disorders

  • other chronic pelvic problems.

Laparoscopic surgery

Laparoscopic surgery (removal of endometriosis or pelvic adhesions) and hysterectomy (removal of uterus) are the common surgical options for treating pelvic pain.

Adhesions

Adhesions are bands of scar tissue which cause organs inside the abdomen to stick to each other. Adhesions occur following infection (such as appendicitis or pelvic inflammatory disease), inflammation (endometriosis) or previous surgery.

Symptoms of adhesions

Adhesions can be associated with chronic pelvic pain. Adhesions can interrupt the bowel and lead to obstruction. Adhesions can affect the tubes and ovaries and affect fertility.

What is the role of keyhole surgery

Adhesions are known to occur very commonly after open surgery - in 60-100% of cases. The incidence of adhesions following keyhole surgery is only 6-10%. Thus keyhole surgery is an ideal way to minimise the risk of adhesions.

Keyhole surgery is also the most ideal approach to divide adhesions to minimise the risk of the adhesions recurring. Dr Cook can talk to you further about this.