A Pelvic Pain Specialist’s guide to chronic pelvic pain in women

Chronic pelvic pain is felt in the lowest part of the abdomen, the area below the bellybutton and between the hips.

Here to provide an expert insight into chronic pelvic pain in women, including causes and treatment, is Dr Sandesha Kothari, esteemed Consultant in Pain Medicine.

When is female pelvic pain concerning?

Patients should look out for a sudden onset of pain within the pelvis that is accompanied with associated symptoms, such as nausea, diarrhoea, heavy bleeding, and even incontinence. This is especially important if the pain: keeps worsening over a period of time; starts affecting bowel and bladder function; disrupts sleep, mood or quality of life.

If these signs are present, patients should go and see a specialist to be examined.

What are the causes of chronic female pelvic pain?

The causes can be varied, because pelvic pain can rise from many different organs within the pelvis.

Pain can originate from the uterus, the urinary tract, the bowel, and all the parts that are related to these organs. For example, the pelvis involves several muscles and ligaments (connective tissue) within the structures of the pelvic floor, which can also cause pelvic pain. In addition, pelvic pain can also stem from an infection in one of the organs of the pelvis.

Common causes of pelvic pain include:

• No obvious ailment that is present
• Adhesions (bands of scar-like tissue) or a pelvic inflammatory disease that has become chronic
• Musculoskeletal or neuromuscular disorders
• Digestive disorders (for example, irritable bowel syndrome)
• Urinary diseases (for example, painful bladder syndrome, interstitial cystitis or urinary tract infections)
• Psychological factors (for example, stress or trauma)

Having said this, the commonest cause of pelvic pain in women is endometriosis, which is the presence of endometrial-like tissue outside of the uterine cavity.

How is chronic pelvic pain relieved?

When it comes to chronic pelvic pain, the decision-making process of treatment should be carried out with the input of a multidisciplinary team, involving specialists, Physiotherapists and Psychologists. There are many techniques and treatments available.

Simple over-the-counter painkillers, such as Paracetamol and Ibuprofen, are the first line of treatment. Besides these, there are also other medications available, which can work on the affected nerves that are involved in pain. It is important to avoid medications that give side effects of constipation, because constipation itself (straining) can increase pelvic pain.

If the cause of pelvic pain is endometriosis, hormonal therapy may be recommended. This should be taken cyclically, because pelvic pain often worsens during menstruation.

Another therapy that may be recommended is an over-the-counter transcutaneous electrical nerve stimulator that can be self-administered. Likewise, heat and hot water bottles are also helpful.

Gentle exercises for the pelvic floor muscles can sometimes help to relieve pain. However, if the pain is not relieved, patients should go and see a specialist, who will recommend and provide personalised treatment for their pelvic pain.

Can chronic pelvic pain be cured?

Chronic pelvic pain, by definition, means that it is chronic; it lasts for more than six months and there is no specific cure that can completely take away the pain.

Despite this, a multidisciplinary approach to chronic pelvic pain treatment can help to reduce symptoms and improve quality of life, making the condition more manageable.

If you are suffering from long-term pelvic pain that does not seem to improve, do not hesitate to visit Dr Sandesha Kothari’s Top Doctors profile today to receive expert treatment and management.