Pelvic Pain

Introduction

Chronic pelvic pain is usually defined as constant, cyclic, or intermittent pain of 6 months duration or greater. There are a variety of causes of pelvic pain, both gynecologic and nongynecologic. Gynecologic causes include: endometriosis (can be present in up to 80% of patients with chronic pelvic pain), fibroids, ovarian cysts, ovarian remnant syndrome, adhesions, adenomyosis, cervical stenosis, pelvic congestion syndrome, pelvic inflammatory disease, chronic endometritis, and various gynecologic malignancies. Other causes include physical and sexual abuse.

Gastrointestinal causes include diverticulitis, inflammatory bowel disease, irritable bowel syndrome, chronic constipation, and colon cancer. Problems with the abdominal wall such as hernias, muscle strains, back injuries, and fibromyalgia are also causes. Disorders of the bladder such as interstitial cystitis, chronic or recurrent bladder infections, and cancer of the bladder, are also possibilities.

Teenagers require special attention when presenting with chronic pelvic pain. As stated above, endometriosis is frequently the underlying cause of chronic pelvic pain. The diagnosis of endometriosis is often delayed in teenagers because their families often interpret the typical symptoms of endometriosis such as pelvic pain, painful periods, and painful intercourse as normal. Occasionally teenagers have these complaints for many years, but only seek care when they suffer from infertility or consequences of advanced disease such as bowel obstruction. Teenagers that suffer from severe menstrual cramps causing them to miss school or depriving them from their everyday activities need a thorough investigation to rule out endometriosis. Early diagnosis and treatment via minimally invasive procedures (laparoscopy) can help these women to live a pain-free life and preserve their fertility.

Treatment

Treatment is based on the cause of the pelvic pain. First a complete work-up including patient history, physical exam, appropriate blood tests and imaging studies (especially pelvic ultrasound) is performed. Treatments could include observation, medical or hormonal therapy, or surgical therapy.