Chronic Pelvic Pain In Women

WHAT YOU SHOULD KNOW:

Chronic pelvic pain, or CPP, is a discomfort in the pelvic area that lasts a long time. The pelvic area is the area between your hips from the umbilicus (belly button) to the groin. CPP is pain that worsens, or keeps coming back for at least six months, or does not go away for at least three months. The pelvic area contains organs of the digestive, reproductive and urinary systems. These organs may include the intestines (bowels), bladder, and uterus (womb). CPP is usually a symptom of an illness, infection, or other condition. One or more of these may affect any of the organs or other tissues in the pelvic area.

INSTRUCTIONS:

Causes of chronic pelvic pain:

A disease or condition affecting any part of the pelvic area can cause CPP. These include conditions that affect the organs, skin, muscles, bones, ligaments, and nerves. CPP is often caused by more than one problem. Any of the following may cause CPP or make it worse:

• Gastrointestinal conditions: Several disorders of this type can cause CPP. The most frequent gastrointestinal system cause is:
  
  
  • Irritable bowel syndrome: This is a problem of the intestines that causes food to move through the bowels faster or slower than normal. This condition can cause pain and bloating.
    
    
  
  
• Gynecologic conditions: Pain may come from a problem in your reproductive tract, such as the uterus, fallopian tubes, and ovaries.
  
  
  • Chronic pelvic inflammatory disease: This is a long-term pelvic infection, also know as PID, that affects the reproductive organs. It can cause inflammation (swelling) and scarring to these organs. It often occurs when a sexually transmitted disease (STD) is not treated.
    
    
  • Endometriosis: This condition occurs when the tissue that lines the inside of your uterus grows in another area. These tissues growing outside your uterus also thicken and shed during menstruation. This can cause pain when shed blood and tissue are trapped in your pelvic area and scar tissue forms.
    
    
  • Ovarian remnant: This happens when a piece of your ovary develops into cysts. This may occur when a small piece of the ovary gets left behind after having a hysterectomy. Hysterectomy is surgery to remove the uterus and ovaries.
    
    
  • Pelvic adhesions: These are bands of scar tissue that can form between pelvic organs. Adhesions can cause organs and surrounding tissues to become twisted, pulled out of place, or stuck together. These may occur after an infection, trauma, or surgery.
    
    
  • Pelvic congestion: This is caused by swelling of veins in the pelvis. This can lead to increased pressure on organs and other structures in the pelvis.
    
    
  • Uterus muscle changes: These include adenomyosis (uterus lining grows into the uterus muscle) and fibroids (non-cancerous tumors of the uterus).
  
  
• Mental or emotional problems: Psychological (mental) problems may also lead to CPP or worsen your pain. You may be more likely to have CPP if you are depressed (very sad), feel stressed, or have trouble sleeping. CPP is also more likely to occur if you have been physically or sexually abused, or you abuse alcohol or drugs.
  
  
• Muscle and nerve conditions:
  
  
  • Chronic muscle inflammation: The muscles in the abdomen or pelvis can have inflammation (swelling). This can lead to the fascia tissue covering these muscles to overgrow and get stiff. This is called fibromyositis. This can lead to having pain in the area, called abdominal wall myofascial pain. This is a condition where you get trigger points (areas that trigger pain when pressed) that can become very painful.
    
    
  • Nerve problems: Nerves in the pelvic area can be pinched by scar tissue or fascia tissue. Spinal nerves for the pelvis can be pinched by too small openings in the vertebrae (bones of the spine).
    
    
  • Pelvic floor muscle problems: The pelvic floor muscles help support the hips and hold the pelvic organs in place. Pain may occur when these muscles become short, tight, or tense.
  
  
• Urinary conditions: Several disorders of this type can cause CPP. The most frequent urinary system cause is:
  
  
  • Interstitial cystitis: This is a problem where there is inflammation of the bladder. The bladder is swollen, causing pain as it fills with urine.
    
    

Telling caregivers about your chronic pelvic pain:

Tell your caregiver when you last had pelvic pain, and how it started. Show him where you feel pain and how your pain feels. Tell him how bad it is and how long it lasts. Tell your caregiver what you were doing before it happened. Tell him what things make your pain feel better or worse. Tell your caregiver about other signs and symptoms that you have. Tell him if you have other diseases, infections, surgeries, or procedures in the past. Tell him about changes to your period, or if you know or think you might be pregnant.

Signs and symptoms that may be related to chronic pelvic pain:

You may feel pain on one or both sides of your pelvis, or all over the pelvic area. The pain may occur with certain body positions or activities, such as when having sex or with bowel movements. It may worsen during your menstrual period or after standing for a long time. Other common signs and symptoms include:

• Changes in bowel movements, such as diarrhea (loose, watery stools). You may also have constipation, which is when you have hard, dry stools that are difficult to pass.
  
  
• Loss of appetite for food or weight loss.
  
  
• Numbness, burning, or tingling feeling of thighs and knees.
  
  
• Pressure or heaviness in the pelvis.
  
  
• Trouble starting to urinate, or passing urine more often than usual or passing little or none at all. You may feel pain when passing urine or that the bladder has not completely emptied after passing urine.

Treatment:

You may need one or more of the following:

• Medicines:
  
  
  • Analgesics: This is a group of medicines that includes most pain relievers, including non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs are a group of medicines that include aspirin and ibuprofen. Analgesics may help decrease pain and swelling. Some analgesics may also be used to decrease fever.
    
    
  • Antibiotics: Pain caused by infections may be treated with antibiotic medicine to kill the germs.
    
    
  • Antidepressants: Chronic pain treatment often includes antidepressant medicines, even if you are not depressed.
    
    
  • Hormone medicines: Hormone medicines, such as birth control pills, may be given if CPP occurs along with your menstrual cycle. These medicines help adjust the levels of hormones in your body.
    
    
  • Muscle relaxants: Pain from muscle spasm may be eased with medicine that helps your muscles relax. In addition to oral medicines for spasms, botox injections may be used to treat spasticity. Spasticity is increased muscle tone that can cause frequent or ongoing spasms.
    
    
  • Other medicines:
    
    
    • Trigger point injections: Abdominal wall myofascial pain with trigger points may be treated with injections. Medicine is injected through the abdomen into the trigger points. The medicine used for this is usually a local anesthetic to make the area numb for a short time. A steroid medicine may also be injected at the same time. This medicine will reduce the inflammation in the area over time.
      
      
  
  
• Physical therapy: Physical therapy (PT) includes different ways to help decrease your pain. It may include applying heat, cold, pressure and massage to painful areas, and special exercises. These exercises may help stretch and strengthen your pelvic floor muscles, or make you feel relaxed.
  
  
• Other treatments:
  
  
  • Acupuncture: Acupuncture is a treatment based on a belief that fluids flow through channels in our bodies. Caregivers insert very thin needles just under your skin. This is believed to open the channels, allowing fluids to flow better. This treatment may decrease pain and improve healing. Always see a caregiver for acupuncture. Do not try to give this treatment to yourself.
    
    
  • Biofeedback training: Biofeedback is a special way to control how your body reacts to things like stress or pain. The first step in this training is to use electrodes (wires) to monitor your body responses. These electrodes are placed on different parts of your body, such as your chest. The electrodes are attached to a TV-type monitor which gives a paper tracing of your heart beating. You will learn how to control body changes, such as slowing your heart rate, when you become upset.
    
    
  • Nerve stimulator: A transcutaneous electrical nerve stimulator (TENS) unit is a small battery-powered device used for chronic pain. It attaches with wires to patches placed on the skin over the painful area. The patches deliver very mild electrical current to the skin. This acts to block pain from the nerves below and increases your body's own pain relievers. This may help decrease or control your pain when used over a painful body part.
    
    
  • Relaxation therapy: Stress may cause pain, lead to illness, and slow healing. Relaxation therapy teaches you how to feel less physical and emotional stress. Deep breathing, muscle relaxation, and music are some forms of relaxation therapy.
  
  
• Surgery: If other treatments do not relieve your pain, your caregiver may do surgery to help relieve it. Your caregiver may remove adhesions or tissues, or organs that are causing your pain.
  
  
• Counseling: CPP may affect many areas of your life. It can affect your appetite for food, how well you sleep, and your energy and ability to do things. It can also affect your mood (how you feel about things) and your relationships with others. Meetings may be held for you, your family, and people close to you. These meetings can help everyone better understand your health condition and how to manage it.

Self-care:

• Change your diet if you have irritable bowel disease. If caregivers have told you that you have irritable bowel disease, avoid food or drinks that contain caffeine. Caffeine may be found in coffee, tea, soda, and chocolate. You may need to stop drinking milk or eating milk products for a period of time. You may also need to avoid foods that increase gas in your stomach, such as cabbage or grapes. Ask your caregiver if you need to follow a special diet.
  
  
• Keep a pain diary. It may be easier to answer your caregiver's questions by making a pain diary or book. A pain diary will help you remember exactly what happened each day because it is all written down. This will help you tell caregivers about your pain and may help them figure out what is causing it. Write down all the words that come to you to describe your pain. A diary also helps track pain cycles. This may make you more aware of when and how the pain may start and end.
  
  
• Learn new ways to relax. Deep breathing, meditation, relaxation exercises, and biofeedback are some ways to help you relax. Talk to someone about things that upset you.

Appointments with other caregivers:

You may need to see a specialist depending on the condition that seems to be causing your CPP. If your pain is related to your monthly period, you may need to see a gynecologist. You may need to see a gastroenterologist if you have symptoms of a bowel problem. If you have problems passing urine, you may need to see a urologist. A surgeon may need to check on you if your abdomen feels tender and tight. You may also need to see him if you feel pain when taking deep breaths or coughing. If your pain does not get better even with treatment you may need an appointment with a pain management specialist.

What to expect with time or treatment:

Relief from CPP depends on the disease or condition that is causing it. All conditions causing the pain will need to be treated. Treatment of one or some of them may only give short term relief. Some causes of CPP cannot be completely cured. The aim of chronic pain management is to decrease pain to allow you to do your usual activities. These include going back to work, attending school, and exercising.

CONTACT A CAREGIVER IF:

• You are having vaginal bleeding after having sex or blood in your stool.
  
  
• You develop new symptoms or your symptoms are worse than before.
  
  
• You feel very anxious or irritable after you take your medicines.
  
  
• You have problems sleeping or thinking clearly, or feel so depressed that you cannot cope.
  
  
• You have trouble urinating or emptying your bladder completely.
  
  
• Your periods are early, late, or more painful than usual.
  
  
• You have questions or concerns about your pain, condition, treatment, or care.

SEEK CARE IMMEDIATELY IF:

• You have heavy or unusual vaginal bleeding, and you feel lightheaded or faint.
  
  
• You have severe (very bad) pelvic pain that does not go away after taking medicine.
  
  
• You have severe chest pain and trouble breathing all of a sudden.