Chronic Pelvic Pain
24th Jul

2016

Chronic Pelvic Pain

Chronic pain affects 20% of adults and although back pain is a common culprit, for many women it is chronic pelvic pain which is the problem. Chronic pelvic pain is defined as pain which occurs in the pelvic region and is present on most days for more than six months. The pain may be constant or intermittent and may present as a generalised pain or be more localised and involving certain functions such as bladder or bowel filling or emptying, having sexual intercourse or dysmenorrhoea (painful periods). Chronic pelvic pain has a significant cost to both the women who suffer with it, as well as society in general.

There are a number of organs located in the pelvis and any of them can trigger pelvic pain. Pain may relate to the bladder, bowel, uterus or ovaries and can be caused by a variety of conditions which include endometriosis, irritable bowel syndrome, painful bladder syndromes, ovarian cysts and many more. This complexity can unfortunately lead to a delay in diagnosis for many women.

Endometriosis is a condition where tissue similar to that found in the lining of the uterus is present outside of the uterus, causing inflammation. It is a common disease, affecting approximately 10% of women in their reproductive years. For many women this disease causes significant pain, as well as difficulties conceiving, however for some women the disease is completely silent and they may not suffer from either pain or infertility. While we may have a clinical suspicion of endometriosis based on symptoms, examination findings and in some cases ultrasounds (endometriosis cysts can be diagnosed by ultrasound, or severe bowel endometriosis but the majority of endometriosis is too small in volume to be seen on ultrasound – so a normal ultrasound does not rule this disease out!), the only way to actually diagnose endometriosis is to perform a laparoscopy (keyhole surgery) and visually identify the disease with pathological diagnosis to confirm. Treatment of endometriosis may be commenced based on suspicion alone and is often in the form of hormonal treatments (such as the oral contraceptive pill or hormonal intrauterine device) or pain medication. If surgery is required then the endometriosis is diagnosed and treated at the same time with surgical resection.

A key factor in the development of chronic pain is thought to be a process called central nervous system sensitisation. This amplified transmission of signals to the brain occurs over time in response to a chronic pain stimulus and means that the pain volume is turned up. Signals that shouldn’t be painful such as light touch on the skin, movement of the bladder and bowel, ovulation and sexual intercourse can cause excruciating pain for the sufferer. This process creates a pain cycle which is difficult to break.

Following on from central sensitisation, many women also develop chronically overactive pelvic muscles. This occurs due to a reflex of the body which causes muscle contraction in response to pain. Imagine you put your hand down on a hot plate on the stove – your reflex will cause an automatic contraction of the arm muscles to withdraw from the pain. In this circumstance the muscle contraction reflex is helpful, but in the pelvis there is nowhere for the muscles to go and the pain is not relieved by contraction. Due to a chronic pain state, the muscles contract and cause a spasm or cramp which then further contributes to pain in the area. Working those muscles physically with core strengthening exercises such as yoga or pilates can further exacerbate this spasm. Overactive pelvic floor musculature may cause generalised pain, pain with certain activities such as sitting down for prolonged periods or sexual intercourse. Treatment of this pain is multifactorial. Obviously removing the original trigger (eg. endometriosis) is important, but so is pelvic floor physiotherapy which will stretch and massage the contracted muscles. In severe cases injections may be used to relax the muscles, allowing further physiotherapy.

There are many psychological aspects to chronic pain. We know that chronic pain sufferers are more likely to have associated mental health difficulties as well such as anxiety and depression, but it is a case of the chicken and the egg! Obviously being in a state of pain most of the time can have a negative effect on your mental health, but the reverse is also true. Women who are already suffering from high stress states, anxiety and depression are more likely to develop chronic pain. As such it is vital that we consider chronic pain in a holistic manner and part of the treatment is likely to involve an assessment of psychological well being as well as developing strategies for coping with chronic pain.

Pain which has a significant negative impact on your ability to live your life is not normal. It is very important that you seek help from your GP and a specialised team of gynaecologists (such as those at Alana Healthcare for Women) who deal with pelvic pain on a regular basis.

For more information about National Pain Week, please visit their website.

For more information about our services, please visit our Gynaecology, Obstetrics and Fertility main pages.

Share This :

No comments so far!

Leave a Comment

Your email address will not be published.