Solving the pelvic pain puzzle

Treatment depends on the individual problem and pelvic pain can be an indication of a variety of things, consult your doctor.

Not only can pelvic pain be a problem for thousands of women but also its diagnosis can be elusive. Here s an overview of the many possible causes and treatments.

Nearly all women experience pelvic pain at some point in their lives. In some women, however, it can signal a problem that needs attention. Often the cause of the pain can be difficult to determine, complicated by the fact that there may be more than one reason. It's therefore important to note your individual symptoms (see box) to help your doctor come to a likely diagnosis.

Causes of pelvic pain

Because many organs are situated in or near the pelvic region, the source of the pain could be your bladder, appendix or kidneys even though it feels as if the pain is coming from the uterus or ovaries. The most common causes of pelvic pain are urinary system disorders, such as a bladder or kidney problem, bowel problems or conditions involving the reproductive system.

Pelvic pain can be acute or chronic:

Acute pain
This often lasts a short time and has a single cause, acting as a warning sign of an underlying problem such as an infection, ovarian cysts or an ectopic pregnancy.

Infections of the urethra, bladder or kidneys may cause pain, usually when you are urinating, or they may make you feel the need to empty your bladder more often than normal. Vaginal infections–known as vaginitis–can cause pelvic pain, mainly during and after sex. Most vaginal infections are easily treated.

When ovarian cysts persist, you may feel them as a dull ache, and they can also cause discomfort during sex. Sharp pain can occur if a cyst leaks fluid or bleeds a little. This may happen around the middle of the menstrual cycle. If a cyst is large or has twisted (don t worry, this happens only rarely), your doctor may suggest surgery.

Ectopic pregnancy occurs when the fertilized egg grows outside the uterus, often in a fallopian tube. Women with damaged tubes are more likely to have ectopic pregnancies. The pain often starts on one side of the stomach after a missed period and vaginal bleeding or spotting may occur.

Chronic pain
This refers to any pain in your pelvic region that lasts 6 months or longer. Chronic pain can be caused by more than one problem. The pain can either start as one that comes and goes but then develops into a steady pain, or it can occur in cycles.

Conditions that cause chronic pelvic pain include severe pain during menstruation (dysmenorrhea), ovulation pain in the middle of your menstrual cycle (also known as mittelschmerz), endometriosis, fibroids, PID and adenomyosis, which occurs when the lining of the uterus moves into the muscle wall of the uterus. Studies have shown that women who have a history of sexual abuse also may have chronic pelvic pain.

What tests and treatments are available?

After performing a pelvic exam and asking about your medical history, your doctor may order a number of lab tests including laparoscopy, colonoscopy or magnetic resonance imaging (MRI).

Treatment depends on the individual problem. For example, infections are treated with medication, while nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, may alleviate the pain of dysmenorrhea. Some conditions, such as endometriosis and fibroids, can be treated with hormones although symptoms could return once treatment is stopped. Surgery is sometimes the answer–your doctor will discuss the options with you.

Heat therapy, muscle relaxants, nerve blocks, mental exercises and physical therapy–such as exercise, stretching and massage–may all help. When the source of the pain can t be identified, treatment will focus on managing the symptoms.

Finally…

Since pelvic pain has a number of causes, determining the source can be a long and complex process. The good news is that even when no specific cause can be found, there are treatments that may help. Your best course of action is to work closely with your doctor and health care team to find the treatment that suits you.