Pelvic Pain
Most women experience pelvic pain at some time during their lives. Many
times pelvic pain is just the normal functioning of the reproductive or
other organs. Other times pelvic pain may indicate a serious problem that
needs urgent treatment. Here we look at the causes of pelvic pain, and how
the cause of pelvic pain is determined.
Causes of Pelvic Pain
Many organs live in the pelvis, including the uterus, ovaries, fallopian
tubes. The bladder and intestine, and appendix also live next to the
reproductive organs, and sensations from these organs can feel like pain
from the uterus or ovaries. To further confuse things, pain from the
kidney and pain from muscles and from the abdominal wall can also seem to
come from the pelvis.
I find it most helpful in explaining pain to my patients to explain my
approach to finding the cause of their pelvic pain, rather than just to
give a "diagnosis." I'll go into more detail after I explain my
"Categories of Pelvic Pain. From my standpoint, pelvic pain falls into
three classifications:
Pelvic pain that indicates a serious problem and that needs urgent surgery
or hospitalization. Examples of this type of pelvic pain would be a
ruptured tubal pregnancy or appendicitis.
Pelvic pain that indicates a problem that may need treatment, but not on
an urgent basis. Examples of this would include pain from endometriosis,
or a growing fibroid tumor. Chronic pelvic pain also falls into this
category.
Pelvic pain that is caused something that is part of the normal
functioning of the reproductive organs, and will probably resolve without
treatment. This pain can be severe, but is self-limited. A frequent cause
of this is a "functional" ovarian cyst. (More about that later.) It is
easy for a doctor to fall into the trap of doing surgery for such problems
because the patient wants the problem solved, and feels that surgery will
offer a quick "fix."
Treatment
Ovarian cysts. A cyst is anything filled
with fluid. Most ovarian cysts are part of the normal functioning of the
ovary. Other cysts are growths that need to be removed. Some ovarian cysts
(endometriomas) are lined by the same type of tissue that lines the
uterus. This can cause painful bleeding into the ovary.
Endometriosis. Endometriosis is a condition in which the type of tissue
that lines the uterus implants in locations outside the uterus. This
typically cause pelvic pain around the time of the menstrual period, but
can cause pain at other times in the cycle.
Fibroids. Fibroids are benign growths in the muscle of the uterus.
Fibroids are very common, and usually are not painful. Some fibroids can
cause pelvic pressure and pain. Click here to learn more about fibroids.
Infection. Most pelvic infection is cause by Chlamydia and/or Gonorrhea.
Infection can also be caused by other bacteria. Infection of the lining of
the uterus (the endometrium) is called endometritis. Infection of the
fallopian tubes is called salpingitis. Often pelvic infection is given the
term Pelvic Inflammatory Disease, or PID. Sometimes pelvic infection can
cause severe pelvic pain and a fever, but a chlamydia infection may not
cause any pain at all. If pelvic infection is suspected, it is important
to treat with antibiotics, since severe damage to the tubes and ovaries
can result if treatment is delayed.
It is often difficult to tell for sure if pelvic infection is present. For
that reason, if a woman has recurrent episodes of pelvic pain, laparoscopy
may be necessary to accurately determine the cause of pain. (Laparoscopy
is an examination usually done under anesthesia, which involves looking at
the pelvic organs through a tiny telescoped inserted through the navel.)
Dysmenorrhea. This means pain with menstrual period. Some cramping with
the menstrual period is normal, but it is not normal to have pain that
interferes with a woman's normal activities. Prostaglandins are compounds
in menstrual blood that cause the uterus to contract, and cause cramping.
Common medicines used to treat dysmenorrhea, such as aspirin, ibuprofen,
or naproxen sodium help by interfering with the production of
prostaglandin. Birth control pills may also decrease cramping with
periods.
Other conditions causing pain with periods are abnormal, and may require
treatment.
Sub mucous mommas are fibroid tumors on the inside of the uterus. They can
act as a foreign body, cause the uterus to contract to try to expel them.
They can often be removed without major surgery using an instrument called
a electroscope.
Adenomyosis is common cause of severe menstrual pain, and is often
confused with fibroids.
Pelvic adhesions. An adhesion is where two organs stick together. This is
often caused by pelvic infection (PID), endometriosis, or previous
surgery. Pelvic pain can occur when adhesions are stretched. For example,
if an ovary is stuck to the intestine, ovulation may stretch these
adhesions and cause pain. On the other hand, many adhesions cause no pain
at all.
Unless adhesions cause the intestines to be blocked (a bowel obstruction)
they usually cannot be diagnosed without doing laparoscopy and actually
looking inside the abdomen. Most adhesions can be freed during
laparoscopy, but they can reform. Freeing the adhesions may or may not
relieve pain.
Pain from other organs
The colon sits next to the uterus and ovary. Pain from irritable bowel
syndrome can seem like it is coming from the ovary. Usually this is a
crampy pain. Constipation and inflammation of the intestine can also cause
pelvic pain. As endometriosis can involve the intestines, evaluation of
the intestinal tract and laparoscopy may necessary to determine whether
the pain is coming from the intestine or from a gynecologic problem.
Bladder. Inflammation of the bladder is felt in the lower abdomen. A
bladder infection usually also causes burning with urination and frequent
urination. Interstitial cystitis is an inflammation of the bladder not
caused by infection, but can cause severe symptoms. Kidney stones also can
cause pelvic pain.
Abdominal wall pain. Nerves in the abdominal wall can be trapped, and
cause severe pain. Often this is near a previous surgical incision. It is
important to distinguish pain from the abdominal wall from problems inside
the abdomen. Often this can be done by numbing areas of the abdominal wall
with local anesthetics, which will eliminate pain coming from the wall,
but not from internal organs.
