Chronic pelvic pain is pain in the lower abdomen, pelvis or genital area that lasts longer than six months. It can come and go or remain constant. The pain can range from below the belly button down to the genital area and may even wrap around to the rectum and lower back.
“Chronic pelvic pain falls under a wide umbrella and is a complex, often frustrating, issue for patients. It can be made worse with stress, life changes or a misdiagnosis. Chronic pelvic pain can have more than one cause, making diagnosis and treatment a challenge. Pain may be a symptom of another disease, or it can be a condition on its own. If chronic pelvic pain seems to be caused by another health condition, treating the root cause of the problem may get rid of the pain,” says Katherine Rotker, MD, urologist at the Yale School of Medicine.
Common causes of pelvic pain could include:
- Endometriosis: Tissue similar to the uterine lining grows outside the womb, often causing chronic pelvic pain.
- Pelvic Floor Dysfunction: Muscles in the pelvis remain tight, leading to tenderness and pain.
- Interstitial Cystitis (Bladder Pain Syndrome): Chronic inflammation and sensitivity of the bladder walls.
- Irritable Bowel Syndrome: Affects the colon and bowel, causing abdominal pain and cramps.
- Vulvodynia: Chronic pain in the vulva.
- Urinary Tract Infection (UTI): Bacterial infections along the urinary tract, including the urethra, bladder, ureters and kidneys.
- Sexually Transmitted Infections (STIs): Infections you get from another person through sexual contact.
- Prostatitis: Inflammation of the prostate gland.
- Chronic testicular pain: Severe pain that won’t go away in the scrotum and nearby structures.
Chronic pelvic pain affects both men and women. It tends to affect women more. Because it often goes underreported, it is hard to know how many people suffer from this condition.
Dr. Rotker says, “To diagnose chronic pelvic pain, we want to rule out the most dangerous diagnosis first. A urologist will start with a physical examination. A pelvic exam is often done to check for signs of illnesses, unusual growths or tense pelvic floor muscles. During the exam, your urologist will look for tender areas and assess any pain you might have. Then lab tests will be done. Blood tests may be done to measure blood cells or check for infections. Urine tests can detect urinary tract infections. Specific tests may be done to rule out sexually transmitted diseases like chlamydia or gonorrhea.
Imaging tests like an ultrasound, CT scan or MRI may be suggested to see unusual structures or growths. If other tests do not give a clear diagnosis, laparoscopy may be performed. During this minimally invasive surgery, a small cut is made in the abdominal area, and a thin tube with a camera is inserted. The surgeon looks at the pelvic organs for abnormalities, such as endometriosis or chronic pelvic inflammatory disease.”
In addition to tests, your urologist may ask you questions about the pain such as:
- When and where does the pain happen?
- How long does the pain last?
- Is the pain related to your menstrual cycle, passing urine and/or sex?
- What does the pain feel like (i.e. sharp or dull)?
- How did the pain begin?
- How suddenly did the pain begin?
Other details about the timing of the pain and the presence of other symptoms related to activities such as eating, sleeping, sexual activity and movement can also help your doctor with a diagnosis.
Chronic pelvic pain can be tough to manage, but there are many treatment options available. It depends on the underlying cause, and sometimes, even when a specific cause is not found, managing symptoms becomes the main focus. Here are some treatment options:
- Medications:
- Pain relievers. Over-the-counter pain medications like aspirin, ibuprofen and acetaminophen can help with mild to moderate pain. In some cases, stronger prescription pain relievers may be needed.
- Hormone treatments. For conditions like endometriosis or heavy menstrual bleeding, hormone therapies may help.
- Physical Therapy:
- Pelvic floor physical therapy. This form of physical therapy focuses on strengthening and relaxing the muscles of the pelvic floor. It can be helpful for conditions like pelvic muscle tension or dysfunction.
- Nerve Blocks:
- Local anesthetic injections. Nerve blocks involve injecting a local anesthetic near specific nerves to give temporary pain relief.
- Psychological Counseling:
- Counseling or therapy. Chronic pain can take a toll on mental health. Talking to a counselor or therapist can help manage stress, anxiety and depression linked with pelvic pain.
- Complementary Therapies:
- Acupuncture. Some people find relief from chronic pelvic pain through acupuncture sessions.
- Transcutaneous Nerve Stimulation (TENS). TENS units deliver low-voltage electrical currents to specific areas, which may help reduce pain.
- Surgery:
- Laparoscopy. If endometriosis or other pelvic conditions are suspected, laparoscopy (a minimally invasive surgical procedure) can help diagnose and treat them.
Making dietary changes can play a role in managing chronic pelvic pain. Eating an anti-inflammatory diet with foods like fruits, vegetables, healthy fats and whole grains can help. Some people find relief when they avoid certain foods that may make their pain worse like coffee, tea, energy drinks, spicy foods, alcohol and artificial sweeteners. Staying hydrated is key. Aim for at least eight cups of water per day. A diet high in fiber can help regulate bowel movements and prevent constipation, which may contribute to pelvic pain.
“Many patients suffer for years without getting a diagnosis or treatment. It is of great value to listen to your body, advocate for yourself and seek care sooner rather than later. Pain is a sign that something is wrong in the body, and it deserves your attention,” says Dr. Rotker. “Remember that finding the cause of chronic pelvic pain may take time, and sometimes a clear reason may never be found. Open communication with your urologist and patience is needed during this process. You have options. You don’t have to live with the pain.”