Pelvic Pain

Pelvic pain is a common problem especially in the female sex. Its origin is often unknown, as it can have many causes. It can be acute or chronic. Acute pelvic pain is of sudden onset and in many occasions of severe presentation. Chronic pelvic pain is pain that comes and goes or lasts for months or longer.

Pelvic pain that lasts longer than six months and does not improve with treatment is called chronic pelvic pain. Pelvic pain may start in the genital organs or other organs in and around the pelvis (digestive, reproductive or urinary tract). It can sometimes have a psychological background, which can worsen the pain, or trigger it, especially when no physical problem is detected.

Epidemiology

In the United States, about 15% of women of reproductive age report pelvic pain that lasts for at least six months. Many of these women report that the pain can be so severe that it prevents them from performing adequately in their jobs.

Causes

Pelvic pain can have many causes in both women and men. The most common causes in women include:

-Ectopic pregnancy
-Pelvic inflammatory disease
-Torsion of ovarian cyst
-Miscarriage or threatened miscarriage
Urinary tract infection
-Ruptured fallopian tube

Some of the causes that can trigger pelvic pain of chronic course in women include:

-Menstrual colic (dysmenorrhea)
-Endometriosis
-Uterine fibroids
-Presence of scar tissue in the pelvic cavity organs (usually due to surgical adhesions).
-Endometrial polyps
-Cancer of the reproductive organs
-Pain in the vulvo-vaginal area (vulvodynia)
-Digestive, urinary or nervous system disorders

Causes of pelvic pain in both sexes

Some of the common causes of pelvic pain in men and women include:

-Nerve inflammation or irritation caused by injury, fibrosis, pressure, or peritonitis.
-Muscle cramps
-Appendicitis
-Colon cancer
-Ulcerative colitis
-In men (prostatitis)
-Constipation
-Crohn’s disease
-Diverticulitis
-Fibromyalgia
-Inguinal hernia
-Painful bladder syndrome
-Intestinal occlusion
-Irritable colon
-Kidney stone

Symptoms

The discomfort of pelvic pain varies from woman to woman. On some occasions, it may present with great intensity to the point of interfering with daily activities such as work, physical activity or during intercourse. It may be constant or intermittent. Some women only have pain during the menstrual period. In some cases, the pain may occur when going to the bathroom or when lifting a heavy object. In some women, there may be pain at the vulva, known as vulvodynia, or when inserting a tampon.

Diagnosis

The Gynecologist will take a medical history including questioning with questions about when and where the pain occurred, how long it has lasted, whether the pain is related to the menstrual cycle, urination or sexual activity, and whether the pain is acute or chronic. In addition, the physician should perform a detailed physical examination, focusing especially on the abdomen and lower abdomen.

Tests include: blood tests, pregnancy test, urinalysis, culture of cervical cells.

Imaging Studies

The most useful imaging studies in the diagnosis of pelvic pain include:

Ultrasound

It is very useful in the study of the abdominal and pelvic organs, to determine the possible cause that is causing the pain. Ultrasound can be of the abdomino-pelvic or intravaginal type. Other imaging tests include:

-CT scan
-Magnetic resonance imaging
-Laparoscopy
-X-ray
-Colonoscopy
-Sigmoidoscopy

Treatment

Treatment of pelvic pain should include:

-Hormonal treatment that can help relieve pain related to conditions such as endometriosis and menstrual disturbances.
-Pain medications (analgesics and anti-inflammatory drugs).
-If appropriate, a method of contraception should be included.
-In certain cases it will be necessary to perform a surgical procedure.
-Physical therapy
-Relaxation exercises
-Changes in dietary and nutritional habits in general.

William Bonifaz, M.D.

References

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