FAQ’s on Pelvic Pain

The pelvis seats many of our vital visceral organs, such as the bladder, intestines, rectum, as well as the reproductive organs. Pain from this area can come from a wide variety of causes, and can present with a wide spectrum of severity. The pain can be sudden and acute, or can be chronic (if it lasts for more than 6 months).

How is pelvic pain diagnosed?

Pelvic Pain Doctors in San DiegoThe diagnosis of pelvic pain will depend on the underlying cause. Your physician will conduct 

a complete medical history and physical examination to elicit information that will help him differentiate the condition causing the pain. You will be asked questions to characterize the pain, including questions about its severity, its character, aggravating circumstances, or other associated symptoms. Several clinical examinations will be conducted, focusing on your abdominal and pelvic area.

If the clinical consult does not provide definite diagnosis, then additional imaging studies may be requested. These include X-rays, Computerized Tomography (CT) scans, Magnetic Resonance Imaging (MRI) scans, and ultrasound scans. Other techniques have also been shown to help identify the cause of the pelvic pain, like hysteroscopy, endoscopy, among others.

What conditions can cause pelvic pain?

Any disease or condition that negatively affects the organs in the pelvis can cause pelvic pain. Pelvic pain treatment San DiegoNumerous conditions that present as pelvic pain include:

  • Cystitis/urinary tract infection – this often presents as hypogastric (below the belly button) pain, accompanied by dysuria (painful urination), and tenderness
  • Proctitis – infection or inflammation of the anus/rectum
  • Abnormalities of the reproductive organs and the genital tract
  • Appendicitis – severe pain that is normally located in the right lower area of the abdominal area, and is associated with tenderness and feeding intolerance. If this is suspected, immediate referral to a surgeon is recommended.
  • Nephrolithiasis (Kidney stones) – can present as difficulty urinating, as well as severe pain in the sides/pelvic area.

Women are also prone to conditions that cause pelvic pain. These include diseases such as:

  • Dysmenorrhea – this is pain associated with the menstrual period. The severity varies widely, from mild to debilitating.
  • Menstrual cramps
  • Endometriosis
  • Ectopic pregnancy
  • Pelvic inflammatory disease

What are the signs to watch out for?

It is suggested that you seek a physician if you note the following symptoms along with your pelvic pain:

  • Blood seen in the stool/vomit
  • Black, tarry stools
  • Decreasing diameter of stools
  • Pain during intercourse or urination
  • Abnormal vaginal bleeding or discharge
  • Difficult urination

How is pelvic pain treated?

Pelvic Pain Clinics San DiegoThe exact treatment of pelvic pain will depend on the underlying cause. The therapy ranges from conservative, nonsurgical management, to surgical interventions.

Conservative, non-surgical management is usually done through oral anti-inflammatory medications, or analgesics such as opioid medications. Complementary alternative medicine modalities such as acupuncture and chiropractic sessions may be of benefit, although larger studies are still needed to evaluate their effectiveness.

Minimally invasive surgical techniques, such as nerve blocks, have found use in the management of chronic pelvic pain. Temporary blocks are achieved with local anesthetic and corticosteroid injections, although longer-term relief may be achieved with radiofrequency ablation and chemical neurolysis.

Open surgery is normally an option reserved for the more severe cases, or for cases that are not responsive to non-surgical management. Risks of surgery include infection, damage to muscles and other tissues, among others.

Outcomes depend on the underlying cause of pelvic pain as well as the procedure used for treatment.

References

Davis SN, Binik YM, Amsel R, Carrier S. A subtype based analysis of urological chronic pelvic pain syndrome in men. J Urol. 2013 Jul;190(1):118-23. doi: 10.1016/j.juro.2013.01.020.

Demir F, Ozcimen EE, Oral HB. The role of gynecological, urological, and psychiatric factors in chronicpelvic pain. Arch Gynecol Obstet. 2012 Nov;286(5):1215-20. doi: 10.1007/s00404-012-2443-y.

Gyang A, Hartman M, Lamvu G. Musculoskeletal causes of chronic pelvic pain: what a gynecologist should know. Obstet Gynecol. 2013 Mar;121(3):645-50. doi: 10.1097/AOG.0b013e318283ffea.