Pelvic Pain Causes, Symptoms & Treatment | Dr Varsha Kurhade

Alot has been discussed till now about women’s health with respect to gynaecological, psychological and hygiene aspects. In modern India today we know that the position of women is much improved and respectful in society. But still we can’t neglect the huge number from underprivileged and so called ignorant society (note – applies to upper, middle or lower class!). Apart from above mentioned issues, pelvic pain is another dimension of female health issues, which remains underdiagnosed! pelvic can be seen: pelvic pain during pregnancy l pelvic pain for men l pelvic pain for women.

Reasons being not much spoken about pelvic pain could be related to social stigma attached with it related to private parts, pain associated with sexual activities, not considering it as significant as women have started experiencing it since teenage related to menstrual cycle and most important is accepting it as usual accompaniment of one’s life being female!!

I always feel, as a woman we can definitely understand the pain of another woman better… physical as well as psychological if its accompanied with! Whenever we are dealing with female patients in routine practice, just a patient ear & good rapport building can help us screen patients with pelvic pain and guide them for further management if not related to one’s specialty

What is Pelvic Pain?

• Pelvic pain is pain occurs at the lowest part of your abdomen and pelvis.
• In women, pelvic pain might refer to symptoms arising from the reproductive, urinary or digestive systems, or from musculoskeletal sources.
• Most of the times Pelvic pain can occur suddenly, sharply and acute.
• Chronic pelvic pain refers to any constant or intermittent pelvic pain that has been present for six months or more

How is Pelvic pain diagnosed?

• When diagnosing the cause of pelvic pain, the we have to review the symptoms and medical history of the patient.
• A physical examination along with other tests might also help in diagnosing the cause of pelvic pain.
• Some diagnostic might include:
• Blood and urine tests
• Pregnancy tests in females of reproductive age
• Diagnostic laparoscopy
• Hysteroscopy
• Stool guaiac test (checking of a stool sample for presence of microscopic blood)
• Lower endoscopy such as colonoscopy or sigmoidoscopy
• Ultrasound
• CT scan (if suspecting abdominal pathology)
• MRI scan (if suspected to originate from spine)
• PET / SPECT scan in select class

Chronic pelvic pain:

• Chronic pelvic pain includes a cluster of conditions, most of which are inoperable because they don’t involve the pelvic region or physical examination is normal
• Endometriosis and Interstitial cystitis(IC) are among the most common conditions that place women at risk for chronic pelvic pain
• Other conditions include vulvodynia, pelvic inflammatory disease, irritable bowel syndrome, scarring after abdominal surgery, fibromylgia and chronic fatigue syndrome
• Many studies have even suggested that women who have suffered physical or sexual abuse are also at risk for chronic pelvic pain

Many women who have these conditions are treated successfully and do not go on to experience chronic pelvic pain.

According to the International Pelvic Pain Society, pelvic pain is considered chronic when:

• It has been present for at least six months.
• Conventional treatments yield little relief.
• The degree of pain perceived seems out of proportion to the degree of tissue damage detected by conventional means.
• Physical appearance of depression is present, such as sleep problems, poor appetite, constipation, and slowed body movements.
• Physical activity is extremely limited.
• Emotional roles in the family are altered, and the patient is displaced from her accustomed role, such as wife, mother, or employee. WebMD talked to experts in chronic pelvic pain and pain management about the latest developments in understanding and treating chronic pelvic pain.

Pelvic Pain Treatment

The goal of treatment is to reduce symptoms and improve quality of life. For many women, the optimal approach involves a combination of treatments.

Medications

• Pain relievers – Aspirin, ibuprofen or acetaminophen, may provide partial relief from pelvic pain. Pain medication alone, however, rarely solves the problem of chronic pain
• Hormone treatments – if pelvic pain coincides with a particular phase of menstrual cycle and the hormonal changes that control ovulation and menstruation, birth control pills or other hormonal medications may help relieve pelvic pain
• Antibiotics – If an infection is the source of pain
• Antidepressants – Tricyclic antidepressants, such as amitriptyline, nortriptyline, etc seem to have pain-relieving as well as antidepressant effects. They may help improve chronic pelvic pain even in women who don’t have depression

Other therapies

• Physical therapy
• Stretching exercises
• Massage and other relaxation techniques
• Coping strategies
• Transcutaneous electrical nerve stimulation (TENS)
• Cognitive behavioural therapy
• Biofeedback, which helps you identify areas of tight muscles so that you can learn to relax those areas
• Trigger point injections

Advanced treatment options

The treatment of pelvic pain, if it is intense to affect daily living quality of life, can be done Interventional multidisciplinary pain management treatments with following options:

• Abdominal Plane blocks
• Selective peripheral nerve blocks
• Ganglion impar block
• Continuous epidural infusions
• Lumbar sympathectomy
• Neurostimulation (spinal cord stimulation) – This treatment involves implanting a device that blocks nerve pathways so that the pain signal can’t reach the brain.