Chronic pelvic pain is the pain that occurs in the pelvic area and persists for at least 6 months. It can vary in the intensity, location and time of occurrence.

The pain may be severe or mild, sharp or just a dull ache, continuous or occurs at intervals. It may be localised to a certain area or a generalised discomfort involving the whole pelvic area (area between belly button and hips) or shift from place to place. It may reach its extremes at a certain time such as on sitting down, during sexual intercourse or in some particular phase of menstrual cycle.

What Are The Causes Of Chronic Pelvic Pain?

There are several conditions, which can cause chronic pelvic pain. Along with pain there will be other symptoms as well, such as menstrual irregularities, bleeding in between the periods, vaginal discharge, fever, constipation, diarrhoea, frequent or burning urination, pain in stomach etc, which may suggest a cause for the pelvic pain.

Among various conditions are tumors of the womb, infection of the pelvic organs (pelvic inflammatory disease), endometriosis (presence of tissue similar to normal endometrium - inner lining of womb - at places other than in the womb), and inflammation of the bladder wall, overly tense pelvic muscles, stomach ulcers, back sprains, urinary tract infections, kidney stones, infection of appendix and many more.

How To Evaluate Chronic Pelvic Pain?

Your GP will inquire about the nature, onset, location and severity of pain and also about the factors aggravating and relieving the pain. This may help the doctor in deciding what the diagnosis is, for example, pain that goes down to legs is suggestive of uterine fibroids, or pain beginning just before the periods and reaching its peak in the first few days of your period is typical of endometriosis.

The GP may also ask questions about any injuries to the back, bowel and urinary habits, or about any operations you had in the pelvic area.
S/he may also ask about any sexual or physical abuse, depression, domestic or job problems, as emotional trauma can also lead to chronic pelvic pain in otherwise healthy woman.

After that a detailed physical examination with special emphasis on the pelvis an exam is usually carried out. Your GP may then decide to do certain tests, such as blood tests, urologic tests, or an ultrasound. S/he may refer you for a laparoscopy (A surgical procedure in which a slender, telescope like instrument is inserted into the abdomen through a small incision made either through the navel or just below it to view the pelvic organs).
Sometimes even with all these investigations, he may not have found the cause of your pelvic pain.

What Is The Treatment Of Chronic Pelvic Pain?

The treatment of your pain will depend on what is causing it. Here are some examples of how it might be treated:

• In case of endometriosis, oral contraceptive pills are used to prevent ovulation for six months. Painkillers like aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drug (NSAID) can also used to relieve the pain.
• If pelvic inflammatory disease is the culprit, a 2-week course of antibiotics usually clears the infection as well as relieves the pain.
• If uterine tumors are the cause, surgical removal may help.
• If pain arises from an emotional cause, psychiatric counseling may help.
• If the pain results from tension in pelvic muscles, relaxation exercises may help.
• Sometimes it may be possible to find a trigger point. A trigger point is a tender area in the lower wall of the abdomen, which causes pain when pressure is put on it. Medicine may be injected into this point to block the pain.

If the cause of pain is unknown, the GP usually prescribes some painkillers. In addition antidepressant or anti-anxiety medication may also help in some patients. Non-drug treatments such as acupuncture may also bring substantial relief.
Some people will find rest gives good relief during attacks of pelvic pain but regular exercise may help by strengthening the muscles and preventing stiffness. Your GP may suggest an exercise programme.