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updated February 15, 2011

Chronic pelvic pain

Filed under: Women's Health
In women, chronic pelvic pain refers to pain in your pelvic region — the area below your bellybutton and between your hips — lasting six months or longer. If asked to locate your pain, you might sweep your hand over that entire area rather than point to a single spot. Chronic pelvic pain can be a symptom of another disease, or it can be designated as a condition in its own right.

The cause of chronic pelvic pain is often hard to find. Like many women, you may never receive a specific diagnosis that explains your pain. But that doesn't mean your pain isn't real and treatable.

If the source of your chronic pelvic pain is found, treatment focuses on that cause. If no cause can be found, treatment for chronic pelvic pain focuses on managing the pain.

©1998-2013 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Chronic pelvic pain exhibits many different characteristics. Among the signs and symptoms are:

  • Severe and steady pain
  • Pain that comes and goes (intermittent)
  • Dull aching
  • Sharp pains or cramping
  • Pressure or heaviness deep within your pelvis

In addition, you may experience:

  • Pain during intercourse
  • Pain while having a bowel movement
  • Pain when you sit down

Your discomfort may intensify after standing for long periods and may be relieved when you lie down. The pain may be mild and annoying, or it may be so severe that you miss work, can't sleep and can't exercise.

When to see a doctor
With any chronic pain problem, it can be difficult to know when you should go to the doctor. In general, make an appointment with your doctor if your pelvic pain disrupts your daily life or if your symptoms seem to be getting worse.

©1998-2013 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Several gynecologic problems may be the source of chronic pelvic pain. However, other diseases can cause pelvic pain, such as irritable bowel syndrome and interstitial cystitis. In addition, psychological factors may contribute to your pain.

Some causes of chronic pelvic pain include:

  • Endometriosis. This is a condition in which tissue from your uterine lining 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).
  • Tension in your pelvic floor muscles. Spasms or tension of the pelvic floor muscles can lead to recurring pelvic pain.
  • Chronic pelvic inflammatory disease. This can occur if a long-term infection, often sexually transmitted, causes scarring involving your pelvic organs.
  • Pelvic congestion syndrome. Some doctors believe enlarged, varicose-type veins around your uterus and ovaries may result in pelvic pain. However, doctors don't agree on pelvic congestion syndrome as a cause of pelvic pain because most women with enlarged veins in the pelvis have no associated pain.
  • Ovarian remnant. During a complete hysterectomy — surgical removal of the uterus, ovaries and fallopian tubes — a small piece of ovary may 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 nutrients and begin to die (degenerate).
  • Irritable bowel syndrome. Symptoms associated with irritable bowel syndrome — bloating, constipation or diarrhea — can be a source of uncomfortable pelvic pain and pressure.
  • Interstitial cystitis. Chronic inflammation of your bladder and a frequent need to urinate characterize interstitial cystitis. You may experience pelvic pain as your bladder fills, which may improve temporarily after you empty your bladder.
  • 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 frequently get locked into a vicious cycle.

©1998-2013 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

You're likely to start by seeing your family doctor or a doctor who specializes in conditions affecting the female reproductive tract (gynecologist). Depending on the suspected cause of your pain, you may eventually be referred to a specialist in digestive system problems (gastroenterologist) or a specialist in urinary and gynecological problems (urogynecologist).

Here's some information to help you prepare for your appointment and what to expect from your doctor.

What you can do

  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Make a list of your key medical information, including any other conditions for which you're being treated and the names of any medications, vitamins or supplements you're taking.
  • Take a family member or friend along, if possible. Sometimes it can be difficult to soak up everything you're told during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write down questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.

For chronic pelvic pain, some basic questions to ask your doctor include:

  • What are the possible causes of my symptoms or condition?
  • What tests do you recommend now?
  • If these tests don't pinpoint the cause of my symptoms, what additional tests will you schedule?
  • What approach will you recommend if we can't locate an underlying cause?
  • What types of treatments are most likely to improve my symptoms?
  • For how long will I need to be treated?
  • How long might it take for me to feel better?
  • Are there any restrictions that I need to follow?
  • Should I see a specialist?
  • Is there a generic alternative to the medicine you're prescribing me?
  • Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may leave extra time to go over any points you'd like to have clarified. Your doctor may ask:

  • When did you first begin experiencing pelvic pain?
  • Has your pain changed or spread over time?
  • How often do you experience pelvic pain?
  • How severe is your pain, and how long does it last?
  • Where is your pain located? Does it always occur in one place?
  • Would you describe your pain as sharp or dull?
  • Does your pain come in waves or is it constant?
  • Can you anticipate when the pain is coming?
  • Do you feel pain during urination or a bowel movement?
  • Does your menstrual cycle affect your pain?
  • Does anything make your pain better or worse?
  • Does your pain limit your ability to function? For example, have you ever had to miss school or work because of your pain?
  • Is your pain causing difficulty in your marriage or other important personal relationships?
  • Have you recently felt down, depressed or hopeless?
  • Have you ever had pelvic surgery?
  • Have you ever been pregnant?
  • Have you ever been treated for a urinary tract or vaginal infection?
  • Have you ever been touched against your will?
  • What treatments have you tried so far for this condition? How have they worked?
  • Are you currently being treated or have you recently been treated for any other medical conditions?

©1998-2013 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Figuring out what's at the root of your chronic pelvic pain often involves a process of elimination, because numerous disorders could be responsible. In addition to a detailed interview about your pain, your personal health history and your family history, your doctor may ask you to keep a journal of your symptoms.

Possible tests or exams your doctor might suggest include:

  • Pelvic examination. This can reveal signs of infection, abnormal growths or tense pelvic floor muscles. Your doctor will check for areas of tenderness and changes in sensation. Let your doctor know if you feel any pain during this exam, especially if the pain is similar to the discomfort you've been experiencing.
  • Cultures. Lab analysis of cell samples from your cervix or vagina may detect infections, such as chlamydia and gonorrhea.
  • Ultrasound. This test uses high-frequency sound waves to produce precise images of structures within your body.
  • Other imaging tests. Your doctor may recommend abdominal X-rays, computerized tomography (CT) scans or magnetic resonance imaging (MRI) to help detect abnormal structures or growths.
  • Laparoscopy. During laparoscopy, your doctor makes a small incision in your abdomen and inserts a thin tube attached to a small camera (laparoscope). The laparoscope allows your doctor to view your pelvic organs and check for abnormal tissues or signs of infection in your pelvis. This procedure is especially useful in detecting endometriosis and chronic pelvic inflammatory disease.

Finding the underlying cause of chronic pelvic pain can be a long process, and in many cases, a clear explanation may never be found. With patience and open communication, however, you and your doctor can develop a treatment plan that helps you live a full life with minimal discomfort.

©1998-2013 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

If your doctor can pinpoint a specific underlying cause, your treatment will focus on eliminating that particular cause. However, if you're unable to find the cause of your pelvic pain can be found, treatment will focus on managing your pain.

Medications
Depending on the underlying cause, your doctor may recommend a number of medications to treat your condition, including:

  • Pain relievers. Over-the-counter pain remedies, such as aspirin, ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others), may provide partial relief from your pelvic pain. Sometimes a prescription pain reliever may be necessary. Pain medication alone, however, rarely solves the problem of chronic pain.
  • Hormone treatments. The days when you have pelvic pain may coincide with a particular phase of your menstrual cycle and the hormonal changes that control ovulation and menstruation. Birth control pills or other hormonal medications may help relieve cyclic pelvic pain.
  • Antibiotics. If an infection is the source of your pain, your doctor may prescribe antibiotics.
  • Antidepressants. Antidepressants can be helpful for a variety of chronic pain syndromes. Tricyclic antidepressants, such as amitriptyline, nortriptyline (Pamelor) and others, 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.

Therapies
Your doctor may recommend specific therapies or procedures as a part of your treatment for chronic pelvic pain. These treatments may include:

  • Physical therapy. Applications of heat and cold to your abdomen, stretching exercises, massage and other relaxation techniques may improve your chronic pelvic pain. Your doctor might also recommend exercises to strengthen your pelvic floor muscles. A physical therapist can assist you with these therapies and can help you develop coping strategies for the pain.
  • Transcutaneous electrical nerve stimulation (TENS). This approach may help improve localized or regional pain. During TENS therapy, electrodes deliver electrical impulses to nearby nerve pathways — which can help control or relieve some types of pain.
  • Counseling. Your pain could be intertwined with depression, sexual abuse, a personality disorder, a troubled marriage or a family crisis. Getting help for psychological, social, spiritual and emotional challenges may be an essential part of your treatment plan.
  • Trigger point injections. If your doctor finds a specific point where you feel pain, a possible treatment option is the direct injection of a numbing medicine into a painful spot (trigger point). The medicine, usually a long-acting local anesthetic, can block pain and ease discomfort.

Surgery
To correct an underlying problem, your doctor may recommend a surgical procedure:

  • Laparoscopic surgery. In some instances, pelvic adhesions or endometrial tissue can be removed by laparoscopic surgery. During laparoscopic surgery, your surgeon performs an operation through several small incisions in your abdomen, using instruments with an attached camera.
  • Hysterectomy. As a last resort, your doctor might recommend a hysterectomy — surgery to remove your uterus. Hysterectomy may be an option for certain causes of pelvic pain but usually isn't recommended unless you're also experiencing severe menstrual pain that hasn't gone away after more-conservative treatment approaches.

You will often need to try a combination of treatment approaches before you find what works best for you.

©1998-2013 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

One frustrating aspect of chronic pain is that it can have a major impact on your daily life. When pain strikes, you may have trouble sleeping, exercising or performing physical tasks. If you're depressed and pain is sapping your energy, you may withdraw from social situations.

These self-care measures may help ease your discomfort:

  • Try an over-the-counter pain reliever. Aspirin, ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others) may provide a temporary respite from your pain.
  • Seek emotional support. Chronic pain can trigger some intense, negative emotions, which can affect your self-esteem and your relationships with others. Admit your feelings to yourself, to supportive family members and friends and to your doctor. Acknowledging and talking about your feelings are the first steps toward improved emotional health.
  • Learn strategies for managing stress. Becoming too anxious or stressed over certain situations may exacerbate chronic pain. Effective stress management techniques not only help reduce your stress levels but may also have the indirect effect of easing stress-triggered pain. Try to use relaxation and stress-reduction techniques that have worked for you in the past, such as exercise, meditation or simple deep breathing.

©1998-2013 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Several types of alternative therapies may reduce pain associated with certain medical conditions. Ask your doctor whether you should consider trying these approaches, and whether he or she can recommend a trusted practitioner.

Depending on your medical history, life situation and test results, your doctor may be able to tell you how likely these alternative therapies are to relieve your symptoms. He or she can also let you know about any potential risks based on your personal health history.

  • Relaxation techniques. Deep breathing and targeted stretching exercise for your pelvic region could help minimize bouts of pain when they occur.
  • Biofeedback. This alternative therapy is based on the idea, confirmed by scientific studies, that you can use your mind to control your body. Working with a biofeedback therapist, you'll use monitoring equipment that beeps or flashes when your body is sending cues that pain is on the way. As you recognize these cues, you can train your body to respond differently and decrease the sensation of pain.
  • Acupuncture. During acupuncture treatment, a practitioner inserts tiny needles into your skin at precise points. Pain relief may come from the release of endorphins, your body's natural painkillers, but that's only one of many theories about how acupuncture works. Acupuncture isn't safe if you're taking blood thinners or if you have low blood counts.

©1998-2013 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

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