PELVIC PAIN

 

Acute pelvic pain can be defined as sudden onset of severe lower abdominal pain assessed to be gynecologic in nature. Acute pelvic pain causes can include infection, ectopic (tubal) pregnancy, ovarian pathology, uterine perforation, trauma, abuse, sexual assault, result of surgery or procedure, urinary tract disorders, bowel disorders and cancer.

Chronic pelvic pain (CPP) is defined as pain in the pelvic area that lasts 6 months or longer. CPP may be episodic or constant in nature. CPP may be caused by endometriosis (result of tissue from uterine lining implanting on other organs and bleeding in response to hormonal changes in menstrual cycle, ovarian cysts or tumors, uterine fibroids, adhesions (scar tissue), adenomyosis (cells that normally line the uterus invade the uterine myometrium), bowel disorders, urinary tract disorders, anatomical congenital disorders, musculoskeletal disorders, chronic infection, prolapse of pelvic organs, menstrual cycle complaints, psychological etiologies, a neurologic origin, or cancer.

 

Dysmenorrhea is pain associated with menstruation. There are two types of dysmenorrhea: primary dysmenorrhea and secondary dysmenorrhea.

Primary dysmenorrhea is pain that comes from having a menstrual period or “menstrual cramps”.  Primary dysmenorrhea is usually caused by natural chemicals called prostaglandins. Pain usually occurs right before menstruation starts; when prostaglandins are released from the uterine lining.  On the first day of the menstrual period, prostaglandin levels are high. As menstruation continues and the uterine lining is shed, the level of prostaglandins and discomfort decrease.

Secondary dysmenorrhea is caused by a disorder in the reproductive system. The pain of secondary dysmenorrhea often lasts longer than normal menstrual cramps and gets worse over time. Common causes of secondary dysmenorrhea include endometriosis, adhesions, adenomyosis, and uterine fibroids.

Diagnosis of pelvic pain begins with a medical history and physical exam, including an abdominal, pelvic and rectal exam. Laboratory tests may include blood, urine and pregnancy tests. X-rays, ultrasound, or MRI testing may also be necessary.  A laparoscopy, cystoscopy, or colonoscopy may occasionally be needed for evaluation. At times, referral to a gastroenterologist, urologist, or mental healthcare specialist is needed.

Treatment of pelvic pain depends on the etiology of the pain. Treatment of acute pelvic pain may include antibiotics, surgery, medical procedures, and pain relievers. Chronic pelvic pain treatment may include medications, physical therapy, lifestyle changes such as exercise or nutritional supplements, surgery or medical procedures. Dysmenorrhea is often treated with nonsteroidal anti-inflammatory drugs (NSAIDS) which decrease prostaglandins that cause cramping. Other medications prescribed include hormonal birth control such as pills, patch, ring, implant, injection, or intrauterine device. Often nutritional supplements, dietary changes, exercise, relaxation techniques are helpful in decreasing dysmenorrhea complaints. More potent  pain medications, surgery, or other medical procedures are occasionally necessary to control pain symptoms. Hysterectomy (surgical removal of the uterus) is an option when pelvic pain is severe and not controlled by other treatment options.