You Don’t Have to Live With Chronic Pelvic Pain

Learn about diagnosis and various treatment options

Chronic pelvic pain is not a symptom. It is a disease, stresses Joseph Abdelmalak, MD, a specialist in Cleveland Clinic’s Department of Pain Management.

“I compare it to hypertension or diabetes,” he says. “It is chronic but treatable.”

More than 80 percent of patients with chronic pelvic pain are women, says Dr. Abdelmalak. In fact, about 15 percent of women of childbearing age in the United States have it, according to the National Institute of Child Health and Human Development.

Defining the pain — and the cause

For some women, the pain is constant. For others, it is intermittent. Some describe it as a deep, dull, aching pain. Others report it as a severe, sharp, burning pain. For some, the pain comes when using the bathroom, during menstruation or during sexual activity.

Regardless, chronic pelvic pain is any pelvic pain that:

  • Lasts longer than three months
  • Is severe enough to interfere with normal activities

Pelvic pain can be caused by various diseases of the reproductive, urinary tract, digestive, vascular or neurological systems.

According to Dr. Abdelmalak, the three most common causes are:

  1. Scar tissue formation following pelvic surgery or infection.
  2. Endometriosis, when stray cells from your uterus grow in other areas of your body. This can cause pain, heavy bleeding, bleeding between periods and infertility.
  3. Interstitial cystitis, also called painful bladder syndrome. This disease has symptoms similar to a urinary tract infection, including pelvic pain and a continual strong urge to urinate.

If you have chronic pelvic pain, first see your primary care physician. He or she will try to identify the cause and may refer you to a specialist, such as a gynecologist, urologist or gastroenterologist.

How pain management specialists help

If the pain continues even after treating its apparent cause, it’s time to treat the nerve pain.

Your doctor may refer you to a pain management specialist, who can recommend:

  • Medication, such as nerve stabilizers and antidepressants.
  • Physical therapy or aqua therapy (exercise in a heated swimming pool). Some pain can be eased through muscle stretching, strengthening and other exercise. Special pelvic exercises can help patients learn to relax or control pelvic muscles.
  • Nerve block, an injection of numbing medication around the affected nerve. A nerve block can be repeated as needed.

“Treatment is ongoing and adjustable,” says Dr. Abdelmalak. “If medication and physical therapy work well, there is no need to repeat the nerve block.”

Lifestyle modifications, such as the following, also can help relieve pain:

  • Quit smoking — Nicotine in cigarettes can inflame nerves and trigger pain.
  • Lose weight — Shedding extra pounds may help release pressure on small branches of peripheral nerves.
  • Exercise — Physical activity may help decrease muscle pain while improving function.

“Even if pelvic pain is chronic, it is not a hopeless condition,” says Dr. Abdelmalak. “Pain management experts can help you find relief and restore your quality of life.”

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