Chronic pelvic pain is defined as any pelvic pain, continuous or episodic, that persists for more than 6 months. A recent study reported that more than 5000 American woman between the ages of 18 and 50 found that 1 in 7 woman reported chronic pelvic pain. There are verities of syndromes that can lead to pelvic pain. The management starts with medical management including the use of medications such as membrane stabilizers, nerve blocks, ablations, hypo-gastric blocks, spinal cord stimulation, and intraspinal medications.
Chronic pelvic pain is a complex condition that can have multiple causes. Sometimes, a single disorder may be identified as the cause.
In other cases, however, pain may be the result of several medical conditions. For example, a woman might have endometriosis and interstitial cystitis, both of which contribute to chronic pelvic pain.
Some causes of chronic pelvic pain include:
- Endometriosis. This is a condition in which tissue from the lining of your womb (uterus) grows outside your uterus. These deposits of tissue respond to your menstrual cycle, just as your uterine lining does — thickening, breaking down and bleeding each month as your hormone levels rise and fall. Because it’s happening outside your uterus, the blood and tissue can’t exit your body through your vagina. Instead, they remain in your abdomen, where they may lead to painful cysts and fibrous bands of scar tissue (adhesions).
- Musculoskeletal problems. Conditions affecting your bones, joints and connective tissues (musculoskeletal system) — such as fibromyalgia, pelvic floor muscle tension, inflammation of the pubic joint (pubic symphysis) or hernia — can lead to recurring pelvic pain.
- Chronic pelvic inflammatory disease. This can occur if a long-term infection, often sexually transmitted, causes scarring that involves your pelvic organs.
- Ovarian remnant. After surgical removal of the uterus, ovaries and fallopian tubes, a small piece of ovary may accidentally be left inside and later develop painful cysts.
- Fibroids. These noncancerous uterine growths may cause pressure or a feeling of heaviness in your lower abdomen. They rarely cause sharp pain unless they become deprived of a blood supply and begin to die (degenerate).
- Irritable bowel syndrome. Symptoms associated with irritable bowel syndrome — bloating, constipation or diarrhea — can be a source of pelvic pain and pressure.
- Painful bladder syndrome (interstitial cystitis). This condition is associated with recurring pain in your bladder and a frequent need to urinate. You may experience pelvic pain as your bladder fills, which may improve temporarily after you empty your bladder.
- Pelvic congestion syndrome. Some doctors believe enlarged, varicose-type veins around your uterus and ovaries may result in pelvic pain. However, other doctors are much less certain that pelvic congestion syndrome is a cause of pelvic pain because most women with enlarged veins in the pelvis have no associated pain.
- Psychological factors. Depression, chronic stress or a history of sexual or physical abuse may increase your risk of chronic pelvic pain. Emotional distress makes pain worse, and living with chronic pain contributes to emotional distress. These two factors often become a vicious cycle.
Many different conditions can cause chronic pelvic pain. You may have one or more of them. All can have similar symptoms, and that often makes it hard to figure out the source of the pain. The main symptom is pain that lasts for more than six months, but there are usually other symptoms, as well. Understanding your symptoms can help you and your doctor begin to pinpoint the cause or causes of your chronic pelvic pain.