Pelvic Pain Diagnosis and Treatment at Lee Gynecology
I understand the effect of pelvic pain on quality of life, and I have the experience to effectively determine the causes and develop a plan of treatment with each patient.
– Michael J. Lee
Pelvic pain can be caused by a variety of conditions related to the reproductive organs, urinary tract or bowel. Even the musculoskeletal and nervous systems can be the source. Some women have more than one condition that may be causing their pain.
There also appears to be a link between chronic pelvic pain and sexual or physical abuse. Depression also appears to be a complicating factor, though it is rarely the sole cause.
Physical causes should always be considered:
- Pelvic Inflammatory Disease
Pelvic inflammatory disease (PID) is an infection of the reproductive organs that may cause both acute and chronic pelvic pain. Symptoms include abnormal vaginal discharge, fever and pain in the lower pelvic area, although many cases of PID do not trigger symptoms at all. PID is often caused by sexually transmitted infections. Long-term problems such as infertility can occur if PID is not treated promptly. Some women do continue to experience pelvic pain even after treatment.
Although mild pain is common during the menstrual period, some women have severe pain that lasts one or two days a month. This type of pain is called dysmenorrhea. One cause of dysmenorrhea is high levels of chemicals called prostaglandins. These chemicals are produced by the lining of the uterus during menstruation and cause the uterus to contract. High levels of prostaglandins may lead to strong uterine contractions, causing severe pain.
If menstrual pain worsens over time, if the pain lasts beyond the first one or two days of menstrual flow, or if pain occurs throughout the month or during sex, endometriosis may be the cause.Endometriosis occurs when tissue lining the uterus is found in other places of the body, such as the ovaries, fallopian tubes, bowel or bladder. During menstruation, the tissue breaks down and bleeds, which can cause adhesions to form.
Fibroids are benign growths that may cause heavier or more frequent menstrual periods and can trigger pain or pressure in the abdomen or lower back. These might appear on the inside, within the wall or on the outside of the uterus. Fibroids can cause acute pain.
- Urinary tract problems
Many urinary conditions have been linked to chronic pelvic pain, including kidney stones, repeated urinary tract infections and bladder cancer. One of the most common is interstitial cystitis, an inflammation of the bladder wall and lining. Symptoms include pelvic pain, frequent urination and urgency.
- Digestive system problems
Irritable bowel syndrome (IBS), a condition in which abdominal or pelvic pain is accompanied by diarrhea or constipation, is one of the most common disorders associated with chronic pelvic pain. Other digestive problems that may cause pelvic pain include inflammatory bowel disease, diverticulitis (inflammation of a pouch bulging from the wall of the colon) or cancer.
- Muscular and skeletal problems
Lower back pain, disk injuries and pelvic muscle spasms may all trigger chronic pelvic pain. Pain that begins during or right after pregnancy might point to a condition called peripartum pelvic pain syndrome. This is caused when ligaments in the pelvis and spine are strained from the uterus’ extra weight during pregnancy. Myofascial pain syndrome occurs when tender spots in the muscle cause pain in nearby areas of the body, which could lead to chronic pelvic pain. Obesity and poor posture might also be causes.
Because pelvic pain can have many causes, it’s often hard to diagnose. Dr. Lee will ask about your medical history, and you may be asked to keep a journal of your pain and other symptoms. You’ll likely have a physical exam that includes checking your pelvis along with a pelvic ultrasound. Depending on your symptoms and the results of the exam, you might have other tests and possible referral to other specialists:
- Lab tests, such as tests of your blood or urinary tract
- MRI or CT scan: Sound waves produce an image of your pelvic organs that can be viewed on a screen.
- Laparoscopy: A special scope is used to view your pelvic organs.
- Cystoscopy: A slender tube with a lens and light source is used to view the inside of your bladder and urethra.
- Colonoscopy: The entire colon is examined for growths or cancer using a small, lighted device.
- Sigmoidoscopy: A slender device is placed into/inserted in the rectum and lower colon to look for growths or cancer.
Treatment varies based on each person’s unique condition. If medications are ineffective, a surgery might be recommended for further diagnosis and treatment, including laparoscopic surgery (removing endometrial tissue and/or scar tissue, use of CO2 laser, removal of fibroids, ovarian cysts or hysterectomy, if required).
When no cause of pain is found, your treatment will focus on pain relief. Some pain relief measures include:
- Lifestyle changes
- Pain-relieving drugs
- Physical therapy
- Nutrition therapy
In addition to medical treatment, counseling may be helpful. If Dr. Lee suggests this, it doesn’t mean your pain is “all in your head.” Counseling may be helpful as part of an overall treatment plan, especially if you have a history of physical or sexual abuse or depression. Learning techniques that help you relax or manage stress may also help ease pain.