Delving Deep Into Pelvic Pain
Many women experience pain in the lower abdomen or pelvis and this pain may be continuous, sometimes on and off and sometimes during periods. It may arise from the uterus, bladder or bowel and may be neuro muscular in nature.
Any pelvic pain which persists beyond six months is called chronic pelvic pain (CPP). Many gynaecological conditions such as fibroids, endometriosis and adhesions cause pelvic pain. Pelvic pain could also be caused due to psychological issues. In some cases, pain subsides with medication but some cases may require surgery and your doctor would evaluate you to find out the cause and accordingly suggest a treatment.
One common cause of pain in women is during the periods, it may be idiopathic when there is no cause for it and this is called primary dysmenorrhea. The causes of secondary dysmenorrhea (when there is an underlying cause of
painful periods) is explained below.
Common Causes Of Pelvic Pain
Urinary Tract Infection Or UTI
It is the most common cause of lower abdominal pain and found more in women than men. Bacteria is the most common cause of UTI and it may infect the bladder, ureter or kidneys in its severest forms, Most common symptoms are frequency of urination, pain in pelvis, pressure, hesitancy of urine, smell in urine along with burning, cloudy urine and back pain.
“Many gynaecological conditions such as fibroids, endometriosis and adhesions cause pelvic pain”
This condition is experienced when there is an inflammation of the bladder. Usually, there is no infection but the common symptoms may be painful intercourse, frequency of urination and discomfort while urinating.
It is the implantation of the inner lining of the uterus outside the uterine cavity. It may cause daily pelvic pain, painful periods and pain during Intercourse, bladder and bowel symptoms. Endometriosis is one of the commonest causes for infertility as well.
This condition is similar to endometriosis but the only difference is that the implantation of the uterine lining happens in the muscle layer of the uterus. It usually presents as painful and heavy bleeding and also causes infertility sometimes.
Adhesions in the pelvis and surrounding structures may form, if you have endometriosis, pelvic infection or previous surgery. These bands of adhesions may restrict movements of pelvic organs and put pressure symptoms and cause severe pelvic pain.
Pelvic Inflammatory Disease
This is the infection of the uterus, tubes and ovaries. It usually happens through the vagina and through sexually transmitted infections. Most common causes include chlamydia and gonorrhea. Various symptoms of PID may be vaginal discharge, back pain, difficulty in urination, painful sex, infertility, irregular bleeding or spotting.
In most cases, fibroids are asymptomatic but in some cases, it may cause pelvic pain. These are benign growths or tumours of the uterus and mostly manifest with bleeding problems. In some cases, it appears as painful periods, heavy bleeding or causes pressure symptoms.
This condition is characterised by pain in the vulva. Usually, there is no obvious cause for it. There may be burning or stinging in the vulva, pain while sitting or when something presses against the vulva, for instance during sex.
In some cases, pelvic pain may be psychological when there is no identifiable physical cause for the pain. This does not mean that there is no pain, but it is caused because of emotional stress and no physical cause can be found for it. The women who have this pain are generally the victims of sexual abuse in childhood. Thus, the pain is caused due to the psychological trauma.
“Any pelvic pain which persists beyond six months is called chronic pelvic pain (CPP)”
Pelvic Pain Evaluation
The doctor will ask about the pain and its character and when it happens. During the examination, the doctor may try to elicit pain at different locations, to identify the cause of the pain and correlate it clinically with the proper cause for the pain. An ultrasound may be suggested to rule out appendicitis, and other conditions such as endometriosis, pelvic inflammatory disease, tubo-ovarian mass and fibroids. Urine tests may also be advised to rule out UTI.
Depending upon the diagnosis, the doctor may advise some medication for pain relief and contraceptive tablets for some conditions like endometriosis.
Diagnostic Laparoscopy/ Surgical Management
One may need laparoscopy to determine the exact reason for the pain. This is an invasive procedure in which a telescope is inserted Inside the abdomen to see the pelvic pathology and causes such as endometriosis, adhesions, hernia, and appendicitis can be treated in the same sitting as well. Sometimes, finding no cause at laparoscopy may also be useful to decide further management. Most common conditions which can be treated by laparoscopy are endometriosis, adhesions and fibroids.