A Migraine Headache In the Pelvis-What Can Be Done About Chronic Pelvic Pain?

Pelvic pain in women is a common problem that wrecks havoc on so many women. The suffering can be unyielding requiring constant use of analgesic medication making daily life nearly impossible. This blog will discuss the causes of chronic pelvic pain and the treatment options.

Pelvic pain may be a symptom of infection or may arise from pain in the pelvic bone or in non-reproductive internal organs, such as the bladder or colon. In women, however, pelvic pain can very well be an indication that there may be a problem with one of the reproductive organs in the pelvic area (uterus, ovaries, fallopian tubes, cervix, or vagina).

Possible causes of pelvic pain in both men and women may include:

  • Appendicitis
  • Bladder disorders
  • Sexually transmitted diseases
  • Kidney infection or kidney stones
  • Intestinal disorders
  • Nerve conditions
  • Hernia
  • Pelvis disorder
  • Broken pelvis
  • Psychogenic pain

Possible causes of pelvic pain in women only may include:

  • Ectopic pregnancy
  • Miscarriage
  • Pelvic inflammatory disease
  • Ovulation
  • Menstrual cramps
  • Ovarian cysts or other ovarian disorders
  • Fibroids
  • Endometriosis
  • Uterine cancer
  • Cervical cancer

What Symptoms Suggest a Problem?

  • Worsening of menstrual cramps
  • Menstrual pain
  • Vaginal bleeding, spotting or discharge
  • Painful or difficult urination
  • Constipation or diarrhea
  • Bloating or gas
  • Blood seen with a bowel movement
  • Pain during intercourse
  • Fever or chills
  • Pain in the hip area
  • Pain in the groin area

How Is the Cause of Pelvic Pain Determined?

To determine what is causing pelvic pain, your doctor will first ask you several questions about your symptoms and past medical problems. He or she will also perform a physical exam and may offer you tests to determine what is causing your pain. Other tests that may be given include:

  • Blood and urine tests
  • Pregnancy tests in females of reproductive age
  • Vaginal or penile cultures to check for sexually transmitted diseases such as gonorrhoea and/or chlamydia
  • Abdominal and pelvic X-rays
  • Bone density screening (special type of X-ray to determine the strength of bone)
  • Diagnostic laparoscopy (procedure allowing a direct look at the structures in the pelvis and abdomen)
  • Hysteroscopy (procedure to examine the uterus)
  • Stool test (checking a stool sample for microscopic blood)
  • Lower endoscopy (insertion of a lighted tube to examine the inside of the rectum and part or all of the colon)
  • Ultrasound (test that uses sound waves to provide images of internal organs)
  • CT scan of the abdomen and pelvis (scan that uses X-rays and computers to produce an image of a cross-section of the body)

How Is Pelvic Pain Treated?

The treatment of pelvic pain varies depending on the cause, how intense the pain is, and how often the pain occurs. Sometimes, pelvic pain is treated with medications including antibiotics if there is an indication of an infection. If the pain results from a problem with one of the pelvic organs, the treatment may involve surgery or other procedures.

Any woman who makes the rounds of doctors without getting relief or even a diagnosis for chronic pelvic pain might begin to question if her pain is real. Experts know that it’s real, and they’re coming to a new understanding of this baffling syndrome that affects 15% of American women aged 18 to 50, the majority of whom go undiagnosed.

Chronic pelvic pain includes a cluster of conditions some of which seem improbable because they don’t involve the pelvic region. Endometriosis and interstitial cystitis (IC) are among the most common conditions that place women at risk for chronic pelvic pain. Related conditions include vulvodynia, pelvic inflammatory disease, irritable bowel syndrome, scarring after abdominal surgery, fibromyalgia and chronic fatigue syndrome. Many studies have even suggested that women who have suffered physical or sexual abuse are also at risk for chronic pelvic pain. Women with chronic pelvic pain may also have a normal physical exam.

Many women who have these conditions are treated successfully and do not go on to experience chronic pelvic pain. According to the International Pelvic Pain Society, pelvic pain is considered chronic when:

  • It has been present for at least six months.
  • Conventional treatments yield little relief.
  • The degree of pain perceived seems out of proportion to the degree of tissue damage detected by conventional means.
  • Physical appearance of depression is present, such as sleep problems, poor appetite, constipation, and slowed body movements.
  • Physical activity is extremely limited.
  • Emotional roles in the family are altered, and the patient is displaced from her accustomed role, such as wife, mother, or employee. WebMD talked to experts in chronic pelvic pain and pain management about the latest developments in understanding and treating chronic pelvic pain.

Chronic Pain Treatment

Certain antiepileptic drugs — especially Neurontin but also Pregabalin, Depakote, and others — are effective in treating chronic pelvic pain.

It’s important to treat depression in chronic pelvic pain. Some studies have shown that antidepressants can improve pain levels and pain tolerance in women who have chronic pelvic pain.

80% to 90% of CPP patients have depression.

The best results with for depression and neuropathic pain are Cymbalta and Effexor. 

Perry adds that for most patients, opioid drugs should be avoided. “That’s not an absolute, because some patients can’t function without them. But the danger of opiods is you can end up with two problems: chronic pelvic pain and dependency.”

Chronic pain can take over a woman’s life, but experts now advise staying active, working, and engaging in physical activity.

Metzger has found that many patients test positive for allergies to foods, such as wheat, soy, corn, rice, and baker’s yeast. When women stop the food they’re allergic to, their pain goes away. She adds that vulvar pain may be related to allergies to skin fungi.

Cognitive-behavioral therapy, including stress management and relaxation techniques, has been used for some time to help patients cope with chronic pain.

Bottom Line: Pelvic pain is a common problem and often very difficult to treat. I suggest you contact a doctor who has experience treating women with this problem or ask for a referral to a doctor in your area who has knowledge about managing this disorder.

Contact our office for more information.