New Treatments For Chronic Pelvic Pain

Newer techniques are improving the treatment of chronic pelvic pain in women.  The National Pain Foundation estimates that about 20 percent of women have chronic pelvic pain. For 25 percent of them, the symptoms are severe enough to require bed rest for three days a month.

Chronic pelvic pain is a continuous or recurrent type of pain in the pelvis or lower abdominal area that lasts for at least six months. Sometimes the pain is described as sharp, steady, cramping, pressure or heaviness. Women may complain of pain during intercourse, when having a bowel movement or while sitting.

Michael Hibner, M.D., Ph.D., Gynecological Surgeon with St. Joseph’s Hospital and Medical Center in Phoenix, AZ, says one common cause is endometriosis. In this condition, some tissue that normally lines the uterus (the endometrium) grows elsewhere in the body. The Office on Women’s Health estimates the condition affects about 5 million American women.

The most common sites of endometriosis are the ovaries, fallopian tubes, supporting structures outside the uterus and the lining of the pelvic cavity. When the body signals for the uterine lining to be shed during menstruation, the patches of endometriosis also try to shed. But the blood has nowhere to go. Eventually, the endometrial patches can lead to inflammation, pain and scarring in the affected areas.

Other causes of chronic pelvic pain include: irritable bowel syndrome (bloating, cramping, diarrhea, constipation and other changes in bowel function), interstitial cystitis (chronic inflammation of the bladder), pelvic congestion syndrome (like varicose veins of the uterus, ovaries and/or vulva), fibroids (benign uterine growths), spasms of the pelvic floor muscles (the muscles that hold up and support the pelvic organs) and nerve injury (can occur during childbirth or surgery).

Treatment for chronic pelvic pain depends on the cause of the symptoms. For endometriosis, doctors may try pain medications, hormone treatments or surgery (removal of the abnormal patches of endometrium). Surgery can also be used to remove the swollen veins associated with pelvic congestion syndrome.

For spasms of the pelvic muscles, BOTOX injections and/or physical therapy may be helpful. Injury to the nerve may be treated with injections of a steroid or anesthetic. Hibner says the injections will reduce swelling and inflammation, which compresses the surrounding tissues and causes pain.

When other treatments aren’t effective in relieving nerve pain, Hibner may recommend surgery to cut away scars and ligaments that are pressing on the affected nerve. Since surgery itself can cause more scarring, Hibner places a special sheath, or tube, around the nerve to keep scar tissue from forming.

According to the National Pain Foundation, more than 60 percent of women with chronic pelvic pain aren’t properly diagnosed for the symptoms. Hibner says diagnosis can be difficult because chronic pelvic pain is often caused by a combination of problems in the lower abdominal/pelvic area. There isn’t one physician who takes care of all the possible conditions leading to the pain.

Dr. Hibner recommends that women who are having trouble getting help for pelvic pain seek a physician associated with the International Pelvic Pain Society. You can find a provider through their website.

For general information on chronic pelvic pain or endometriosis:
American Congress of Obstetricians and Gynecologists.