Chronic pelvic pain is pain located in the pelvic region (the area between the navel and between the hips) that lasts at least 6 months.
It may be a symptom of another disease, or it may be a condition in itself.
The treatment will be aimed at treating the cause. Occasionally, the cause may be difficult to find, however, this does not mean that the pain is not real and treatable. In these cases, treatment should focus on pain management.
Causes
There are multiple conditions that can cause pelvic pain. However, sometimes, pelvic pain develops for no apparent reason, and the definitive cause is diagnosed. Multiple psychological factors that can contribute to the development of pain have been described; to this, we must add that the emotional impact of suffering pain for a long period of time without knowing the cause with certainty, contributes to worsening the perception of it.
Some of the causes of chronic pelvic pain are:
- Endometriosis
- The tension in the muscles of the pelvic floor: the pelvic floor musculature can suffer contractures and spasms that cause chronic pelvic pain.
- Pelvic inflammatory disease: after suffering a pelvic inflammatory disease (usually caused by a sexually transmitted infection) can be adhesions or scars that affect the pelvic organs.
- Ovarian cysts: ovaries can develop recurrent cysts that cause pain
- Myomas: are benign tumors that grow from the uterine musculature. Its growth can cause a feeling of pressure or heaviness as well as pain in the lower abdomen. Rarely produce acute pain when they are without adequate blood supply and begin to necrosis inside (myoma degeneration)
- Irritable bowel syndrome: symptoms associated with irritable bowel (swelling, constipation, diarrhea …) can cause discomfort and pelvic pressure.
- Interstitial cystitis: this is a condition associated with a chronic inflammation of the urinary bladder and is often associated with the need to urinate very often. When the bladder fills, pelvic pain may occur, which usually improves after emptying.
- Pelvic co-management syndrome: the presence of varicose veins around the uterus and/or ovaries can result in pelvic pain. However, in many cases, the presence of pelvic varicose veins is absolutely asymptomatic.
- Psychological factors: depression, chronic stress or having suffered sexual abuse can generate or worsen chronic pelvic pain. Emotional distress worsens pelvic pain, and in turn, pelvic pain generates emotional distress thus generating a vicious circle.
Treatment
In case of finding out the cause, the treatment will be destined to treat it.
In any case, always (whether the cause is found or not) the treatment will focus on relieving pain. As previously mentioned, the frustration generated by the pain itself, the lack of sleep and the life alterations caused by the pain can worsen it to a great extent, so it is highly recommended the management of psychological symptoms caused by pain.
- Analgesic drugs: according to the WHO therapeutic scale, they will be indicated from non-steroidal anti-inflammatory drugs to major opioids as well as adjuvant drugs.
- Stress management techniques: Multiple techniques have been described for managing anxiety such as breathing control, meditation practice, increasing physical activity, improving sleep.