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By Dr J Kabyemela, MD

Pelvic pain and more specifically ‘chronic pelvic pain’ is an absolutely vast and complex subject. We are going to try here to summarise it is as much as possible without creating the impression that this is a straight-forward subject with set solutions. That will be misleading.

Chronic pelvic pain: What it is.

The generally accepted definition of chronic pelvic pain is presence of pain, either continuously or recurrent for more than three months. Others use six months as a reference figure. That is probably not very important.

Causes of Chronic Pelvic Pain

A patient can be forgiven in expecting that establishing a diagnosis (the cause) and instituting the correct remedial action will be a swift affair. Sadly, more often than not, this is not the case. A thorough and careful history is required, a detailed examination, properly targeted tests and even invasive surgical diagnostic procedures may be necessary. Even with all this, many times the cause remains elusive. Let's look at some of the potential causes of chronic pelvic pain.

§ Gynaecological: There are several potential causes of chronic pain arising from the female reproductive system. Endometriosis is a fairly common problem that, typically, causes recurrent pain during or around the time of menstruation. It can also cause painful intercourse. Chronic pelvic inflammatory disease (PID) can cause ongoing pelvic pain which can be persistent or have a waxing and waning pattern.  Other gynaecological conditions that might cause chronic pelvic pain include: Cervical stenosis (pain with periods), imperforate hymen (pain with periods and present in the early to mid-teens), adenomyosis (a variant of endometriosis), pelvic congestion, pelvic adhesions (usually an aftermath of surgery or pelvic infection), ovarian retention syndrome (seen several months or years after hysterectomy where ovaries were conserved), fibroid degeneration (quite uncommon) and a few more. A meticulous history and examination is important to get an idea as to what might be the cause.

§ Gastrointestinal: Chronic pelvic pain could be caused by bowel disease. Conditions such as Crohn’s disease, irritable bowel syndrome (IBS), some forms of colitis (inflammation of the large bowel), diverticular disease (normally in the older patient), cancer of the colon and even chronic constipation can cause chronic pelvic pain.

§ Musculoskeletal: What presents as chronic pelvic pain may actually have its origin in the abdominal wall (muscles and ligaments) and/or the spine. Conditions include muscular strains and sprains, compression fractures of the small bones (vertebrae) in the lumbar spine, osteoarthritis affecting the lower spine, some forms of hernias and even a chronic poor posture.

§ Urological: Chronic pelvic pain could have its origin in the urinary tract. Conditions include chronic cystitis, interstitial cystitis, kidney stones (which could be passed into the bladder), recurrent or chronic urinary tract infection (UTI).

§ Neurological: There are neurological conditions which might manifest themselves as chronic pelvic pain. People with a condition called pudendal neuralgia for instance will present with a history of a constant burning-type sensation. It is usually lower down in the pelvis and genital tract. A condition called porphyria tends to have neurological manifestation, usually as pain. However, this is rarely confined to the pelvis. In addition, other symptoms such as vomiting, constipation and/or diarrhoea and even seizures may be present. Causes such as shingles are pretty obvious and easy to diagnose. Rarer conditions include abdominal epilepsy and abdominal migraine.

§ Psychological: pelvic pain may be a prominent feature in an individual with psychological disease. The pain is then said to be psychosomatic. The pain is real enough.

This list might appear long but is by no means exhaustive. There are many other causes of pelvic pain, arguably, not as common. The doctor’s challenge is to establish the cause in the individual patient and that may not be easy. However, that is the only sure way of instituting the correct remedy. This brings us to the measures taken to try to establish the diagnosis.

Diagnosis  and Treatment:: Next Page

Cause of pelvic pain could remain elusive

Chronic pelvic pain, even when not severe, can be quite debilitating due to its persistence. Causes are many and varied and a correct diagnosis is essential in instituting the correct treatment.

Chronic Pelvic Pain