Pelvic Pain

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Pelvic Pain 2016-11-17T09:56:31+00:00

What Is Pelvic Pain?

Pelvic pain is pain that occurs in or around the pelvic bone, which is located at the juncture of the spine and leg bones. This type of pain may arise from the many structures and tissues located in the region of the skeleton. Pelvic pain may be associated with the joints, bones, musculature, or nervous tissue in the area. It may also be related to disorders or damage to the genitals or reproductive systems found within or immediately near the pelvic bone. Therefore, the exact nature of pelvic pain may be difficult to diagnose accurately, and thus to treat effectively.

Pelvic pain may be acute or chronic, and experienced as mild, moderate, or severe. It may be perceived as low-level or intensely sharp. It may be felt in any part of the pelvic region, depending on the actual tissue, organ, or disorder concerned. Pelvic pain may spread into other nearby body parts, such as the lower back or abdomen.

Pelvic pain is a fairly prevalent type of adverse condition. Up to 33% of women may experience some form of pelvic pain at any point in their lives. This may often be perceived or categorized as gynecological conditions, but this pain may also be associated with unrelated regions of the pelvis.

Estimates suggest that approximately 4% of women experience chronic pelvic pain. This type of pain is thought to be linked to up to 40% of consultations at gynecological clinics and centers every year.

Causes Of Pelvic Pain

Hip jointPelvic pain may be associated with a wide range of factors and conditions beyond those of gynecological origin in women. It may also be a result of two or more comorbid (or concurrent and possibly interrelated) conditions, associated with a major multi-organ system located in or near the pelvis.

These may include:

  • The gastrointestinal system, which is affected by disorders such as inflammatory bowel disease, cancer or benign growths, various types of bowel obstructions, diverticulitis, and irritable bowel syndrome
  • The reproductive system, which may develop from painful disorders such as uterine fibroids, endometriosis, ectopic pregnancy, miscarriage, cancer, ovarian growths, pelvic inflammatory disease, vulvodynia, or a history of genital injury that may result from sexual abuse. Another common form of pelvic pain is cramping associated with menstruation, or dysmenorrhea
  • The renal or urinary system, as the kidneys or bladder may develop disorders such as urinary tract infection, stone formation, painful interstitial cystitis, or prostate inflammation

Palvic hip GirdleIn some cases, pelvic pain may be related to other conditions such as fibromyalgia, inguinal hernia, or nerve damage. Chronic pelvic pain may be associated with dysfunction or weakness in the muscles that form the pelvic floor. Acute pelvic pain may be a sign of adverse events such as appendicitis, which may require immediate treatment.

The diagnosis of pelvic pain may entail a series of different tests in order to determine one (or a small number of) underlying cause(s). Your physician will want to know things such as:

  • Pain onset, and whether it may be attributed to recent specific events such as an injury.
  • The location of the pain; e.g. in the front or posterior portions of the region. This may help the doctor forge a link between a specific organ or tissue type and the pain experienced.
  • The frequency, severity, and duration of pain. Regular recurrences of pain may indicate a disorder, such as dysmenorrhea. However, this may be misleading in some cases, as the pain of some conditions such as inflammatory bowel conditions may abate and then reappear with limited predictability.
  • Factors that may be associated with the pain. For example, pain that arises from lying or sitting in a particular position may indicate hip joint pain or bone damage.

Techniques to diagnose pelvic pain may include examination by a physician, and various laboratory tests (of blood, tissue, or urine). Non-invasive imaging techniques such as computed tomography (CT) or ultrasound may also be effective in some conditions.

Treatments For Pelvic Pain

OpioidTreatment for pelvic pain may depend on the type of pain or which related condition is found to be associated with said pain. Mild to moderate pain may benefit from non-invasive treatments such as drug therapy, whereas more severe chronic pain may require clinic-based interventions.

Drugs that may be effective in some cases of pelvic pain include non-steroidal anti-inflammatory drugs (NSAIDs). These are typically recommended for patients in the early stages of arthritis affecting the hip joints or those recovering from injury or other damage. Other drugs that may benefit mild to moderate pain may include antidepressants or anticonvulsants. An example of an anticonvulsant associated with pain relief is gabapentin. This may effectively address the symptoms of nerve damage. Another option is opioid therapy, which is normally reserved for cases of extreme pain or chronic pain that does not respond to other therapies.

Platelet Rich Protein InjectionsA nerve block is a minimally invasive procedure performed in the clinic to relieve moderate to severe pelvic pain. This is done to inhibit chronic pain signals from major nerves or nerve clusters associated with this region of the body. This includes the celiac plexus. A celiac plexus nerve block involves using imaging techniques, so that a needle containing local anesthetic medications can be inserted into the vicinity of the celiac plexus. When administered, these drugs can block the nerve’s ability to send signals about painful conditions to the brain.

Research indicates the efficacy and long-term results of another procedure called spinal cord stimulation. In this case, spinal nerves responsible for overactive signaling in cases of pelvic pain are identified. A small electrode-like device is implanted in an appropriate location near this nervous tissue. The device then emits impulses, similar to those used by nerves to conduct information to the brain, which override pain signals and promote signaling more similar to non-pain impulses. This treatment method may deliver long-term relief from chronic pain.

Conclusion

Pelvis-diagramPelvic pain is noxious stimuli associated with damage or illness in the abdominal, lower back, or pelvic regions. There is a wide range of causative factors or disorders that may differ widely from individual to individual. These may include inflammatory bowel disease, many forms of cancer, direct injury or damage, or uro-genital conditions. Treatments for pelvic pain can vary widely depending on the underlying reason for the pain. Diagnostic processes can give the physician or pain specialist a clearer idea on which treatment is suited to each case.

References

  1. Carinci AJ, Pathak R, Young M, Christo PJ. Complementary and alternative treatments for chronic pelvic pain. Curr Pain Headache Rep. 2013;17(2):316
  2. Fritz J, Chhabra A, Wang KC, Carrino JA. Magnetic resonance neurography-guided nerve blocks for the diagnosis and treatment of chronic pelvic pain syndrome. Neuroimaging Clin N Am. 2014; 24(1):211-34.
  3. Ismail M, Mackenzie K, Hashim H. Contemporary treatment options for chronic prostatitis/chronic pelvic pain syndrome. Drugs Today. 2013;49(7):457-62.
  4. Ortiz DD. Chronic pelvic pain in women. Am Fam Physician. 2008;77(11):1535-1542.
  5. Pontari M, Giusto L. New developments in the diagnosis and treatment of chronic prostatitis/chronic pelvic pain syndrome. Curr Opin Urol. 2013;23(6):565-9.
  6. Rhodin A. Successful management of chronic pelvic pain. J Pain Palliat Care Pharmacother. 2013;27(3):289-91.

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