Don't let pain hold you back
Acute pelvic pain starts suddenly and is sharp or dull in character. Sharp pain may be related to a bladder infection, ovulation, an ectopic pregnancy or rupture/twisting of an ovarian cyst. Premenstrual cramps are common and respond to simple analgesics like Ibuprofen or Paracetamol. Pelvic infection with bacteria or viruses (like herpes) can also present with the sudden onset of sharp or throbbing pelvic pain.
Chronic pelvic pain affects about 38 out of 1000 women aged 20-50 years and lasts for more than six months and is not cyclical or related to periods. It can affect the back, the buttocks and abdominal wall as well as the pelvis. It causes distress, and can be a negative impact on mental and physical health. A laparoscopy is often needed to make the diagnosis and exclude pathology.
The commonest causes of chronic or longstanding pelvic pain are:-
- Endometriosis 38%
- Adhesions 28%
- No cause found 34%
When endometriosis is treated by medical or surgical means, the pain improves. (Oral contraceptives, anti-inflammatory drugs and hormone suppressing implants).
Surgery to destroy the abnormal deposits of endometrial tissue in the pelvis has good results. When adhesions are found at laparoscopy they can be removed and this may reduce pain. There is still some debate about adhesions causing pain. Pelvic congestion can arise if the veins are congested – like varicose veins. This may cause pelvic throbbing and discomfort and treatment by stress reduction and suppressing the ovaries can help.
Chronic pelvic infection leads to distortion of tubes and ovaries and bowel. If this is diagnosed and is severe then surgery to remove the affected organs may be indicated but fertility will be compromised if the tubes or ovaries need to be removed.
A third of women with chronic pelvic pain do not have a specific cause diagnosed. As with all pain conditions the longer it is present the more it causes an emotional and psychological response.
Many women who have suffered pain for years find exercise, intercourse and long work hours difficult and their pain can start to rule their lives.
A consultation with a gynaecologist is recommended and an ultrasound scan and laparoscopy may be needed to exclude pathology and help plan a course of management.
