Chronic Pelvic Pain

Symptoms, Diagnosis and Treatment of Chronic Pelvic Pain

Chronic pelvic pain is persistent pain in and around the pelvic cavity that has lasted for at least six months. Chronic pelvic pain is often thought of as a womAn’s disease, however it affects men as well. Because it has so many potential causes, chronic pelvic pain can be difficult to diagnose and treat.

There are many different causes of chronic pelvic pain, including women’s reproductive health issues and prostate problems in men. Many other non-gender specific conditions can cause chronic pelvic pain as well, including neuropathy and irritable bowel syndrome.

Types of Chronic Pelvic Pain

Most of the common types of chronic pelvic pain can be broken down by category. While women’s pelvic pain is often the first type that comes to mind, there are many other sources of chronic pelvic pain as well. Here are some of the more common types.

• Women’s pelvic pain. Women’s gynecologic disorders can often lead to chronic pelvic pain. Some of the more common women’s chronic pelvic pain disorders include endometriosis, uterine fibroids, vulvodynia (pain in the external female genitalia) and pelvic joint instability resulting from childbirth.
• Men’s pelvic pain. Certain kinds of chronic prostatitis, or chronic swelling of the prostate, can lead to chronic pelvic pain in men.
• Bowel and Urinary pelvic pain. In men and women alike, certain conditions associated with bowel and bladder problems can lead to chronic pelvic pain. These include irritable bowel syndrome (IBS), interstitial cystitis, chronic kidney stones and tumors.
• Neuropathic pelvic pain. Damage to any of the nerves that run through the pelvic cavity can lead to chronic pelvic pain. Some examples of nerve damage that can cause chronic pelvic pain include pudendal neuropathy, ilio-inguinal neuropathy, ilio-hypogastric neuropathy and genitofemoral neuropathy.
• Pelvic pain caused by pelvis damage. Pelvic joint instability that is not associated with childbirth can also cause chronic pelvic pain. Pelvic fractures, weakness in the pelvic girdle muscles and swelling of the pubic bone (osteitis pubis) can all lead to chronic pelvic pain.

Symptoms of Chronic Pelvic Pain

Many chronic pelvic pain symptoms are often hard to pin down, because they tend to be similar to those of many other chronic health disorders. While the symptoms may differ from one diagnosis to the next, the most common presentations of chronic pelvic pain include:

• Pain during intercourse (for men or women)
• Pain that is worse with urination or a bowel movement
• Pain in and around the genitals (for men or women)
• Pain that radiates to the abdomen, lower back or between the legs
• Painful periods in women
• Painful ejaculation in men

Diagnosing Chronic Pelvic Pain

Diagnosing chronic pain can take many months or more. Because there are so many conditions that cause chronic pelvic pain, and because the symptoms are often similar to other chronic conditions, the cause of chronic pelvic pain may take time to pinpoint. These are some of the things you can expect at the doctor’s office:

• A pelvic exam for women (like you would have at the gynecologist)
• A prostate exam for men
• Lab analysis for cultures of blood, urine, semen and/or cervical tissue
• A physical exam of the muscles and pelvic structure
• Scans, such as an X-ray or MRI
• Exploratory surgery of the abdomen, bladder or bowel
• Nerve conduction testing

Treating Chronic Pelvic Pain

Treatment for chronic pelvic pain can vary greatly depending on the diagnosis. For instance, women's pelvic pain is treated differently than men's pelvic pain. Treating chronic pelvic pain may involve any of the following:

• Hormone therapy
• Antibiotics
• NSAIDs
• Opioids
• Antidepressants
• Anticonvulsants
• Physical therapy
• Nerve blocks
• Surgery

Coping with Chronic Pelvic Pain

Like many other forms of chronic pain, chronic pelvic pain can disrupt your life. However, there are a few things you can do to cope with your pain. Here are some suggestions:

• Keep a pain journal. Documenting your pain can not only help your doctor during the diagnosis stage, but it can help you in your day-to-day life. Write down what makes your pain worse, and what makes it better. Figure out what times of day are the most pain-free. Write down your feelings to get them off your chest.
• Practice relaxation. Tense muscles can intensify feelings of pain, especially if your chronic pelvic pain is the result of pelvic trauma. Close your eyes and meditate, listen to some peaceful music or take a warm bath.
• Try some distraction. Chronic pelvic pain is certainly not in your head, but changing the way you think about your pain can help you get more control. When you are in pain, try directing your attention somewhere else.
• Get some support. Check out the chronic pain forum, and talk to other people who are going through the same thing. It helps!

_Sources:

_{The Merck Manuals Online Medical Library. Pelvic Pain. Accessed 7/24/09. http://www.merck.com/mmpe/sec18/ch242/ch242d.html}

_{National Guideline Clearinghouse. Chronic Pelvic Pain. Accessed 7/24/09. http://www.guideline.gov/summary/summary.aspx?doc_id=12530}

_{National Pain Foundation. Pelvic Pain: Causes. Accessed 7/24/09. http://www.nationalpainfoundation.org/articles/717/causes}

_{National Pain Foundation. Pelvic Pain: Diagnosis. Accessed 7/24/09. http://www.nationalpainfoundation.org/articles/272/diagnosis}