What is Chronic Pelvic Pain in Women: See 2 important causes

Chronic pelvic pain in women is a common yet often misunderstood condition. It refers to ongoing lower abdominal pain that lasts for six months or more. The pain is constant for some women, and for some, it is recurrent. Sometimes it is linked to periods, bladder habits, bowel movements, or sexual activity. Regardless of how it presents, chronic pelvic pain can significantly affect daily life and emotional well-being. 

What makes chronic pelvic pain in women particularly challenging is that it rarely has a single cause. Instead, it is often the result of a combination of gynaecological, urological, gastrointestinal, and musculoskeletal conditions. It can be nerve-related factors in some cases. Conditions such as endometriosis and painful bladder syndrome are commonly linked to chronic pelvic pain. Digestive issues like irritable bowel syndrome and problems with pelvic floor muscle function can also play an important role. As a result, many women experience frustrating delays in diagnosis or are told that nothing is wrong, even while living with persistent and very real pain.

Understanding chronic pelvic pain is the first step toward effective management. With proper assessment and a multidisciplinary approach, many women can achieve meaningful pain relief and a better quality of life.

What is Chronic Pelvic Pain in Women

Chronic pelvic pain is ongoing pain that lasts for six months or more. It is usually felt in the lower abdomen, below the belly button. Around 8 –16% of women with chronic pelvic pain have a clear, treatable cause. In many cases, however, the pain has no single explanation or is linked to more than one factor.

The pain does not always follow the menstrual cycle. In some women, the issue lies in how the nervous system processes pain signals. When this response is heightened, the body becomes more sensitive, making the pain feel stronger or more persistent.

What causes chronic pelvic pain in women?

Chronic pelvic pain in women can have many causes. It may come from the reproductive organs, bladder, bowels, muscles, nerves, or even conditions that affect the whole body. Often, more than one factor is involved.

Gynaecological causes

About 20% women with chronic pelvic pain have an underlying gynaecological cause. Common conditions include:

Endometriosis
Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus or deep within the uterine muscle. This can cause the uterus to enlarge and lead to painful periods. When it affects the ovaries, it may form a chocolate cyst. Some women have no symptoms, while others experience severe period pain, heavy bleeding, pelvic discomfort, or infertility.

Uterine fibroids
Fibroids are non-cancerous growths in the uterus. Nearly half of women develop fibroids at some point in their lives. Although many do not experience symptoms, 25% of them face heavy periods, fertility issues, or pelvic pain.

Pelvic inflammatory disease (PID)
PID is an infection of the reproductive organs in females. It often develops as a complication of a sexually transmitted disease or an abdominal infection. If untreated, PID can lead to long-term pelvic pain and infertility.

Non-gynaecological causes

Not all chronic pelvic pain comes from the reproductive organs. Many non-gynaecological causes are linked to the digestive system, urinary tract, muscles, or nerves. These can irritate pelvic nerves and lead to ongoing pain.

Irritable bowel syndrome (IBS) is common in women with pelvic pain. It causes changes in bowel habits, such as frequent loose stools, bloating, and chronic abdominal discomfort.

Bladder pain syndrome / interstitial cystitis (BPS/IC) causes ongoing bladder pain without an infection. Women may feel urinary urgency, frequent urination, and pelvic discomfort.

Nerve-related pain, such as pudendal neuralgia, can cause burning, stabbing, or aching pain in the pelvis.

Muscle and abdominal wall pain can also contribute, especially when the pelvic floor muscles are tight or overactive.

Past traumatic experiences, including physical or sexual abuse, are linked to chronic pain in some women. Factors such as childhood stress, anxiety, negative pelvic exam experiences, ongoing stress, or depression can also increase pain sensitivity and worsen symptoms.

What are some common signs and symptoms of chronic pelvic pain in women?

Chronic pelvic pain often occurs alongside other symptoms. These can vary from woman to woman and may affect different body systems.

Reproductive system symptoms

• Painful periods
• Abnormal vaginal bleeding or discharge

Urinary symptoms

• Pain or burning during urination
• Needing to urinate more often than usual

Digestive symptoms

• Bloating or abdominal discomfort
• Rectal bleeding
• Diarrhoea or constipation

Sexual symptoms

• Pain during or after intercourse

Other symptoms

• Chills or fever
• Pain in the hip, groin, or lower back

See a doctor 

See a doctor if you have chronic pelvic pain that is severe and does not improve. Do not ignore mild pelvic pain if it comes with other symptoms. Early diagnosis is important. Seek urgent medical care if the pain is sudden, sharp, or worsening. Get immediate help if you notice blood in your urine or stools, develop a fever, or if the pain makes it difficult to stand up straight.

How to diagnose chronic pelvic pain?

• Diagnosing chronic pelvic pain can be challenging. This is because the pain often has multiple causes.
• Initially, the doctor will be taking a detailed medical history. They will ask about your symptoms and overall health. A physical exam is done next. This includes checking the lower abdomen and performing a pelvic examination.
• Laboratory tests may be advised. These can include a pregnancy test, urine tests, blood tests, and vaginal swabs to check for infections or sexually transmitted diseases.
• Imaging tests are often helpful. A pelvic ultrasound can detect problems such as uterine fibroids or ovarian endometriosis. X-rays or CT scans of the abdomen and pelvis may also be used.
• In some cases, further tests are needed. Laparoscopy can help diagnose conditions like endometriosis or chronic pelvic inflammatory disease, especially when the cause is unclear or treatment has not worked. A lower gastrointestinal endoscopy may be done to examine the colon and rectum if bowel causes are suspected.

What are the possible treatments?

• Treatment depends on the cause. If a specific cause is found, treating it can relieve the pain. If no clear cause is identified, treatment focuses on managing and reducing pain.
• Pain relief may include medications such as NSAIDs, paracetamol, antidepressants, anticonvulsants, or muscle relaxants.
• Pelvic floor exercises can ease tight muscles in the abdomen, lower back, hips, and thighs. They are helpful, especially for pelvic floor pain or abdominal myofascial pain.
• Other treatments may include acupuncture, biofeedback, relaxation techniques, or a nerve stimulator. Sometimes, a local anaesthetic injection into the pain trigger point is used to reduce discomfort.

What are some home remedies for Chronic Pelvic Pain

You can try simple measures at home to ease mild pelvic pain. Over-the-counter pain relievers may help. A warm compress on the lower abdomen can reduce discomfort.

Relaxation techniques can lower stress and tension, which may worsen pain. Quitting smoking is important, as tobacco can inflame nerves and increase pain. Regular exercise can improve blood flow and help relieve discomfort.

Even with these remedies, it is important to see a doctor for proper diagnosis and treatment if the pain persists or worsens.

Conclusion 

Chronic pelvic pain in women is common and can affect many aspects of life. It often has multiple causes, making diagnosis and treatment challenging. Early evaluation by a doctor is important to identifying treatable conditions and managing symptoms effectively. With the right medical care, lifestyle measures, and supportive therapies, most women can find relief and improve their quality of life.

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