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Pelvic pain is pain below the belly button. It's chronic if you've had pain for at least 6 months. It may be a mild ache that comes and goes. Or you might have a steady, severe pain that makes it hard to sleep, work, or enjoy life.
Chronic pelvic pain may be caused by problems in the female reproductive system. These include endometriosis, adenomyosis, and uterine fibroids. Other causes include scar tissue in the pelvic area after an infection or surgery, urinary or bowel diseases, and problems with the muscles, joints, and ligaments in the pelvis, lower back, or hips.
Chronic pelvic pain may include severe cramping during periods, pain during sex, or pain when you urinate or have a bowel movement. You may have pain in certain postures or positions. Pain may range from mild to severe or dull to sharp.
Your doctor may do a pelvic examination to check for problems with your reproductive system. The doctor will ask about your health and symptoms. You may be asked if you have depression or a history of sexual abuse. You may have tests, such as blood and urine tests to check for infection.
Treatment for chronic pelvic pain depends on the cause. Common treatments include birth control pills or hormone treatment for problems related to your periods, or surgery to remove a growth, cyst, or tumour. Or you may get medicine to relieve pain or to help treat the problem that's causing the pain.
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Some common causes of chronic pelvic pain include:
Doctors don't really understand all the things that can cause chronic pelvic pain. So sometimes, even with a lot of testing, the cause remains unknown. This doesn't mean that there isn't a cause or that your pain isn't real.
Sometimes, after a disease has been treated or an injury has healed, the affected nerves keep sending pain signals. This is called neuropathic pain. It may help explain why it can be so hard to find the cause of chronic pelvic pain.
Risk factors are things that increase your chances of getting a certain condition or disease. Risk factors for pelvic pain that becomes chronic include:
Chronic pelvic pain may include:
The pain can range from mild to severe or from dull to sharp.
Chronic pain can make it hard to sleep, work, or enjoy life. It can lead to depression. Depression can cause you to feel sad or hopeless, eat and sleep poorly, and move slowly.
It can sometimes be hard to know how long pelvic pain will last and how best to treat it. It's a little different for everyone. But in general:
Call a doctor now if you have sudden, severe pelvic pain, with or without vaginal bleeding.
Call a doctor if:
Watchful waiting is a wait-and-see approach. If you get better on your own, you won't need treatment. If you get worse, you and your doctor will decide what to do next.
During this period, you can keep a daily record of your symptoms and menstrual cycle and any other life events that you consider important. A watchful waiting period may last from a few days to weeks or possibly months.
Your doctor may do a pelvic examination to check for problems with your reproductive system. The doctor will ask questions about your health and your symptoms. You may have tests, such as:
Emotional issues can play a big role in chronic pain. So your doctor may ask questions to find out if depression or stress is adding to your problem. You may be asked about any past or current sexual or physical abuse.
If the first tests don't find a cause, you may have other tests to look at organs in your belly. These may include:
You may also have a type of minor surgery called laparoscopy. This lets the doctor look for problems like growths or scar tissue inside your belly.
If your doctor finds a problem that could be causing your pelvic pain, you'll be treated for that problem. Common treatments include:
Whether or not a cause is found, your doctor can suggest treatments to help manage pain. They include:
You can try these tips at home to ease pelvic pain.
This includes ibuprofen (such as Advil or Motrin) and acetaminophen (such as Tylenol).
Put a heating pad, a hot water bottle, or a warm compress on your lower belly, or take a warm bath. Heat improves blood flow and may relieve pain.
Lie down and prop up your legs by placing a pillow under your knees. When lying on your side, bring your knees up to your chest.
These techniques include:
It may help with pain.
Medicine won't cure pelvic pain. But it can help control the pain and keep it from getting worse or becoming chronic.
Some medicines help with pain by controlling hormones. They include:
Other medicines used for pain include:
Surgery for pelvic pain is most likely to help when it's done for a specific condition, like fibroids or endometriosis.
Hysterectomy (removing the uterus) is sometimes done as a last-resort treatment. It may relieve pain in some cases, depending on what caused the pain.
With any surgery for chronic pelvic pain—such as hysterectomy or cutting of specific pelvic-area nerves—there's a risk of lasting pain or pain that's worse after surgery. And it can have serious side effects.
During surgery, the doctor may remove scar tissue (adhesions) from previous surgery or from pelvic inflammatory disease or endometriosis. But most studies have shown that this doesn't relieve pain.footnote 2
Laparoscopy to diagnose chronic pelvic pain may be done before other treatment. Areas of endometriosis or scar tissue may be removed or destroyed during the procedure.
Counselling and mental skills training can help when you have chronic pelvic pain. They help you gain the mental and emotional tools to help manage chronic pain and the stress that makes it worse. You can combine medical treatment with other treatments, such as counselling. This can increase your chances of success.
Common treatments include:
Alternative pain treatments for chronic pelvic pain aren't well studied. But they may help you to manage stress and learn ways to deal with pain.
Acupuncture and transcutaneous electrical nerve stimulation (TENS) have shown some success in relieving painful menstrual periods. Acupuncture and TENS have also been used as a treatment for non-menstrual chronic pelvic pain, but this hasn't yet been well studied.footnote 1
There are other low-risk alternative treatments that many people use to help manage pain. They include:
CitationsAndrews J, et al. (2012). Noncyclic Chronic Pelvic Pain Therapies for Women. Comparative Effectiveness Review No. 41 (AHRQ Publication No. 11(12)-EHC088-1). Rockville, MD: Agency for Healthcare Research and Quality. Available online http://www.ncbi.nlm.nih.gov/books/NBK84586.Andrews J, et al. (2012). Noncyclic Chronic Pelvic Pain Therapies for Women. Comparative Effectiveness Review No. 41 (AHRQ Publication No. 11(12)-EHC088-1). Rockville, MD: Agency for Healthcare Research and Quality. Available online http://www.ncbi.nlm.nih.gov/books/NBK84586.
Current as of: August 2, 2022
Author: Healthwise StaffMedical Review: Sarah Marshall MD - Family MedicineKathleen Romito MD - Family MedicineMartin J. Gabica MD - Family MedicineKevin C. Kiley MD - Obstetrics and Gynecology
Current as of: August 2, 2022
Author: Healthwise Staff
Medical Review:Sarah Marshall MD - Family Medicine & Kathleen Romito MD - Family Medicine & Martin J. Gabica MD - Family Medicine & Kevin C. Kiley MD - Obstetrics and Gynecology
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