Pelvic pain affects approximately 1 in 5 women over the course of their lifetime, with some women going on to develop chronic pelvic pain – defined as pain present on most days for at least 6 months. This can have a significant impact on a woman’s quality of life, potentially affecting school, work and relationships. Gynaecologic pelvic pain can arise from many sources, but not all pelvic pain is gynaecologic in nature – see the table below for examples of causes of chronic pelvic pain.
Causes of pelvic pain:
Pelvic inflammatory disease
Chronic urinary tract infections
Painful bladder syndrome
Irritable bowel syndrome
Inflammatory bowel disease
Pelvic floor muscle dysfunction
Trauma, old injury (including nerve injury)
Leg length discrepancy
|Depression and/or anxiety
When you see your GP and/or gynaecologist, it will be important for them to take a detailed history of your pain, including where it is present, what triggers it, what makes better, any associated symptoms (e.g. nausea, diarrhoea, bloating, painful sex), and whether or not the pain is cyclical – i.e. whether or not it relates to your menstrual cycle. Your doctor should also ask about your bladder and bowel habits, and any other pain symptoms that you might experience, e.g. migraines or back pain. It is a good idea to keep a symptom diary for a few months prior to seeing your GP or specialist, so that any patterns in relation to your menstrual cycle can be more easily identified. A good example of a symptom diary can be found at:
With a thorough history and pelvic examination, your doctor will be able to narrow down potential causes for your particular pain, and refer you on for more tests or to the appropriate specialist, if needed. Often, more than one cause may be present, and treatment needs to address all of the causes of pain.
Causes of gynaecologic pelvic pain can sometimes be seen on pelvic ultrasound scan; for example, ovarian cysts or congenital anomalies. However, some gynaecologic pelvic pain can only be diagnosed with a surgical procedure. For example, endometriosis can only be seen on pelvic ultrasound scan in the minority of cases, so laparoscopic surgery (“keyhole surgery”) is performed to look for endometriosis and to treat it at the same time. Your history and examination may be suggestive of endometriosis, so it may be that you can be treated with medications to manage the symptoms of endometriosis (e.g. heavy periods, period pain) without proceeding to surgery, at least initially.
Unfortunately, some women with chronic pelvic pain will develop a modified pain response over time, and their pain will need to be treated with a combination of lifestyle changes, surgery, physiotherapy, and medications. This is a complex problem, involving the brain’s response to pain as well as the local pelvic response to pain, and a minority of women will require long-term management of ongoing pain symptoms long after the initial cause has been treated, usually in conjunction with specialists in pain management.
It is very important to know that if you have chronic pelvic pain, you are not alone, and that help is available. It is not “normal” to be missing out on school or work because of pain – so please, ask for help if chronic pelvic pain is affecting your life!