What Is Pelvic Pain Syndrome?
Pelvic Pain Syndrome in Women
Chronic pelvic pain is pain in the area below your bellybutton and between your hips that lasts six months or longer. Chronic pelvic pain can have multiple causes. It can be a symptom of another disease, or it can be a condition in its own right.
If your chronic pelvic pain appears to be caused by another medical problem, treating that problem may be enough to eliminate your pain. However, in many cases it’s not possible to identify a single cause for chronic pelvic pain. In that case, the goal of treatment is to reduce your pain and other symptoms and improve your quality of life.
When asked to locate your pain, you might sweep your hand over your entire pelvic area rather than point to a single spot. You might describe your chronic pelvic pain in one or more of the following ways:
- Severe and steady pain
- Pain that comes and goes (intermittent)
- Dull aching
- Sharp pains or cramping
- Pressure or heaviness deep within your pelvis
In addition, you may experience:
- Pain during intercourse
- Pain while having a bowel movement or urinating
- Pain when you sit for long periods of time
Your discomfort may intensify after standing for long periods and may be relieved when you lie down. The pain may be mild and annoying, or it may be so severe that you miss work, can’t sleep and can’t exercise.
Pelvic Pain Syndrome in Men
Men may have chronic pelvic pain from a number of disorders, including urinary dysfunction or irritable bowel syndrome (IBS). However, prostatitis is the only male-specific cause of pelvic pain. While a bacterial infection is a common cause, in many cases the cause often remains unknown.
What Are the Symptoms of Male Pelvic Pain?
Men with prostatitis may have any of the following pain symptoms:
- Pain or burning sensation when urinating (dysuria)
- Pain in the abdomen, groin, or lower back
- Pain in the area between the scrotum and rectum (perineum)
- Pain or discomfort in the penis or testicles
- Painful orgasms (ejaculations)
- Difficulty urinating, such as dribbling or hesitant urination
- Frequent urination, particularly at night (nocturia)
- An urgent need to urinate
- Flu-like symptoms (with bacterial prostatitis
How Is Pelvic Pain Syndrome Diagnosed?
Figuring out what’s causing your chronic pelvic pain often involves a process of elimination because many different disorders can cause pelvic pain. In addition to a detailed interview about your pain, your personal health history and your family history, your doctor may ask you to keep a journal of your pain and other symptoms.
Tests or exams your doctor might suggest include:
- Pelvic exam. This can reveal signs of infection, abnormal growths or tense pelvic floor muscles. Your doctor checks for areas of tenderness. Let your doctor know if you feel any discomfort during this exam, especially if the pain is similar to the pain you’ve been experiencing.
- Lab tests. During the pelvic exam, your doctor may order labs to check for infections, such as chlamydia or gonorrhea. Your doctor may also order bloodwork to check your blood cell counts and urinalysis to check for a urinary tract infection.
- Ultrasound. This test uses high-frequency sound waves to produce precise images of structures within your body. This procedure is especially useful for detecting masses or cysts in the ovaries, uterus or fallopian tubes.
- Other imaging tests. Your doctor may recommend abdominal X-rays, computerized tomography (CT) scans or magnetic resonance imaging (MRI) to help detect abnormal structures or growths.
- Laparoscopy. During this surgical procedure, your doctor makes a small incision in your abdomen and inserts a thin tube attached to a small camera (laparoscope). The laparoscope allows your doctor to view your pelvic organs and check for abnormal tissues or signs of infection. This procedure is especially useful in detecting endometriosis and chronic pelvic inflammatory disease.
How Can I Manage Pelvic Pain Syndrome?
The goal of treatment is to reduce symptoms and improve quality of life.
Depending on the cause, your doctor may recommend a number of medications to treat your condition, such as:
- Pain relievers. Over-the-counter pain remedies, such as aspirin, ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others), may provide partial relief from your pelvic pain. Sometimes a prescription pain reliever may be necessary. Pain medication alone, however, rarely solves the problem of chronic pain.
- Hormone treatments. Some women find that the days when they have pelvic pain may coincide with a particular phase of their menstrual cycle and the hormonal changes that control ovulation and menstruation. When this is the case, birth control pills or other hormonal medications may help relieve pelvic pain.
- Antibiotics. If an infection is the source of your pain, your doctor may prescribe antibiotics.
- Antidepressants. Some types of antidepressants can be helpful for chronic pain. Tricyclic antidepressants, such as amitriptyline, nortriptyline (Pamelor) and others, seem to have pain-relieving as well as antidepressant effects. They may help improve chronic pelvic pain even in women who don’t have depression.
Your doctor may recommend specific therapies or procedures as a part of your treatment for chronic pelvic pain. These may include:
- Physical therapy. Stretching exercises, massage and other relaxation techniques may improve your chronic pelvic pain. A physical therapist can assist you with these therapies and help you develop coping strategies for the pain. Sometimes physical therapists target specific points of pain using a medical instrument called transcutaneous electrical nerve stimulation (TENS). TENS delivers electrical impulses to nearby nerve pathways. Physical therapists may also use a psychology technique called biofeedback, which helps you identify areas of tight muscles so that you can learn to relax those areas.
- Neurostimulation (spinal cord stimulation). This treatment involves implanting a device that blocks nerve pathways so that the pain signal can’t reach the brain. It may be helpful, depending on the cause of your pelvic pain.
- Trigger point injections. If your doctor finds specific points where you feel pain, you may benefit from having a numbing medicine injected into those painful spots (trigger points). The medicine, usually a long-acting local anesthetic, can block pain and ease discomfort.
- Psychotherapy. If your pain could be intertwined with depression, sexual abuse, a personality disorder, a troubled marriage or a family crisis, you may find it helpful to talk with a psychologist or psychiatrist. There are different types of psychotherapy, such as cognitive behavioral therapy and biofeedback. Regardless of the underlying cause of your pain, psychotherapy can help you develop strategies for coping with the pain.
To correct an underlying problem that causes chronic pelvic pain, your doctor may recommend a surgical procedure, such as:
- Laparoscopic surgery. If you have endometriosis, doctors can remove the adhesions or endometrial tissue using laparoscopic surgery. During laparoscopic surgery, your surgeon inserts a slender viewing instrument (laparoscope) through a small incision near your navel and inserts instruments to remove endometrial tissue through one or more additional small incisions.
- Hysterectomy. In rare complicated cases, your doctors may recommend removal of your uterus (hysterectomy), fallopian tubes (salpingectomy) or ovaries (oophorectomy). There are important health consequences to having this procedure. Your doctor will discuss the benefits and risks in detail before recommending this option.
How Can I Prevent Pelvic Pain Syndrome?
Whether your chronic pelvic pain can be prevented or avoided depends on what is causing the pain. There are many different causes. Some of them can be prevented. Others cannot be prevented, but can be alleviated with medications.
Chronic pain is never an easy thing to live with. If traditional methods of pain relief do not work for you, there are alternatives. Your doctor can work with you to find a way to manage your pain. Sometimes chronic pain responds to a nerve block that can block the pain for an extended period of time. Sometimes physical therapy or weight loss can help. Just know that things aren’t hopeless. Keep exploring pain management options until you find the one that works for you.