Chronic pelvic pain - what women need to know

What is chronic pelvic pain, and why is it important to talk about it?

How often has your pain been chalked up to “that time of the month” or just a normal part of being a woman? Female pelvic pain occurs below the belly button and above the hips. When symptoms continue for 6 months or more, it may be considered a chronic issue.

Some estimates show that between 14% to 32% of women of childbearing age in the US live with chronic pelvic pain.1 Of these women, 13% to 32% of them have pain that interferes with their ability to go to work or school.¹

For as long as I can remember, I’ve been told by women friends, family, and doctors alike that pain comes with the territory and there isn’t much reason for concern. But I want to let you know that pain, especially pain that does not get better, may be worth sounding the alarm.

What are some possible causes of pelvic pain?²

Endometriosis -This happens when tissue (similar to the tissue that lines the uterus) grows outside of the reproductive organs. It sticks to the ovaries and other nearby structures, leading to painful menstrual cycles as it bleeds and sheds monthly.

Fibroids - These are benign tumors that grow in or around the uterus that can cause heavy bleeding and pain as they grow in size.

Pelvic floor dysfunction - This happens when there is difficulty relaxing and coordinating the muscles that make up the pelvis, lower back and hips, which can affect bowel and bladder control.

Adenomyosis - This happens when tissue that normally lines the uterus moves into the uterus’ muscular wall. This tissue then continues to shed and break down each month and causes severe pain.

Irritable bowel syndrome (IBS) - This is a digestive issue that may cause painful cramping, bloating and constipation or diarrhea.

What are the symptoms?

• Severe menstrual cramps
• Pain or discomfort with sex
• Pain or discomfort with bowel movements or urination
• Pain while sitting or standing
• Pain that may be persistent or occasional and may be unrelated to a monthly period.

What tests can be done to diagnose the cause of pelvic pain?³

Your healthcare provider can:

• Perform a pelvic exam
• Screen for STIs and STDs
• Perform an ultrasound
• Order an MRI to get a more detailed picture of the pelvic structures
• Perform a simple surgery called a laparoscopy to visualise the organs in the pelvis to check them for abnormalities

What are some treatments to improve pelvic pain?

• Medication - Over the counter drugs for pain may help relieve some symptoms. Medications prescribed for pelvic pain will depend on the root cause and may be different from person to person.
• Physical therapy - Seeing a physical therapist that specializes in the pelvic floor may help diagnose some musculoskeletal disorders. Sessions may also help patients learn to relax and coordinate their muscles to reduce their pain.
• Surgery - Based on the diagnosis a doctor may recommend surgery to remove growths or tumors to help with pain relief.
• Behavioral therapy - Therapy may help lower stress levels, addressing past traumas and developing coping skills with techniques such as mindfulness.

How can I advocate for myself at appointments?

• Write it down - Keeping a log of your symptoms and what makes them better (or worse) can help your healthcare provider see potential patterns that may help with making a diagnosis. I also recommend writing down any questions you may want to ask before your visit to make the most of your time together.
• Bring someone for support - A big part of advocating for yourself is letting people you love support you and be your voice. Having a trusted friend or relative join may make a conversation with your healthcare provider easier.
• Don’t consent to treatment you don't fully agree with or understand - When it comes to making decisions about your reproductive health, be sure treatments are being explained to you clearly and in simple terms. If you need time to think about it or would like to explore other options, it's okay to let your provider know this.
• Consider a second opinion - Getting a second opinion can be helpful for many reasons. One of them is if your pain and symptoms continue even with treatment, it may be worth it to see a specialist and seek their advice. A second opinion also may help you find other treatment options that may not have been mentioned the first time. This way you are able to make a more informed decision about which course of treatment may be best for you.

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References:

1. “How Many Women Have Pelvic Pain?” https://www.nichd.nih.gov/heal.... Accessed 28 Jan. 2022.

2. Dydyk, Alexander M., and Nishant Gupta. “Chronic Pelvic Pain.” PubMed, StatPearls Publishing, 2020, www.ncbi.nlm.nih.gov/books/NBK554585/. Accessed 20 June 2020.

3. Chronic Female Pelvic Pain | Michigan Medicine.” Www.uofmhealth.org, www.uofmhealth.org/health-library/tv2262.