What is chronic pelvic pain?
Chronic pelvic pain is pain that is recurrent or persistent for 6 months or longer. There may or may not be an identifiable causative lesion.
From what pelvic structures can chronic pelvis pain arise?
- Vulva (e.g., vulvodynia)
- Vagina (e.g., atrophy, chronic infection)
- Cervix (e.g., tumor, cervical stenosis)
- Uterus (e.g., dysmenorrhea)
- Fallopian tube (e.g., chronic infection)
- Ovary (e.g., cyst, tumor, adhesions, torsion)
- Uterine ligaments (e.g., endometriosis)
- Bowel (e.g., IBS, constipation, diverticulitis, obstruction)
- Bladder (e.g., interstitial cystitis)
- Perineum (e.g., pudendal neuralgia)
With chronic pelvic pain, pain and disability can sometimes appear out of proportion to physical abnormalities, and are unrelieved by usual medical or surgical therapies. Patients complain of pain confined to the lower abdomen, pelvis and pelvic floor that may be constant or intermittent. The pain may be described as dull, sharp, or burning in nature. In women, the intensity and quality of pain may be influenced by the stage of the menstrual cycle. Depending on the initial cause of the pain, There may be signs of depression, such as loss of appetite, weight change, and sleep disturbance. Pain interferes with daily lifestyle, causing inability to perform normal household or job-related tasks, exercise, or sexual intercourse. A history of physical or sexual abuse may be elicited.
Diagnosis is based on history and physical examination. Occasionally, further investigations may be needed such as imaging modalities like ultrasound.
Treatment for chronic pelvic pain, like all forms of chronic pain is multifaceted and involves input from multiple specialties including pain psychology and physiotherapy. Irrespective of the original cause, all patients may benefit from a trial of medications including, but not limited to antidepressants such as amitryptilline, gabapentanoids such as pregabalin and even ketamine.
Other treatments used depend on which anatomical structures are considered to be the origin of the pain. For example:
- Endometriosis: hormonal treatment, surgical treatment (cautery, laser removal)
- Vulvodynia: topical NSAIDs, topical tricyclic antidepressants (which can have a localanalgesic effect), topical nitrates (reduce inflammation and pain), antiepileptic and antidepressant medications
- Cervical stenosis: dilatation, NSAIDs
- Adhesions: surgical division (but likely to reoccur)