What is Chronic Pelvic Pain?
It is defined as pain between the bottom of the belly button and the pelvis that lasts longer than 6 months. Chronic Pelvic Pain is one of the most common medical problems among women. 25% of women with Chronic Pelvic Pain spend 2-3 days in bed each month. Approximately half of these women may have to take a break from their daily activities for 1 day or longer each month. 90% of people feel pain during intercourse. Chronic pelvic pain can have many causes. If chronic pelvic pain occurs due to another health problem, treating this problem will be sufficient to relieve the pain.
What is Seen in Chronic Pelvic Pain?
Severe pain may persist for a long time. It causes physical, mental and psychological fatigue. The patient makes emotional and behavioral changes in his daily life to cope with the pain. The following conditions may occur in Chronic Pelvic Pain:
Pain persisting for 6 months or longer
Custom treatments do not relieve the pain or provide little relief
The patient has difficulty sleeping or sleeps too much, constipation, decreased appetite, sluggish movements or reactions and other symptoms of depression, being constantly sad and tearful
Continuously decreasing physical activity
A partner, Difficulty in fulfilling her duties as a mother and employee
What are the Most Common Causes of Chronic Pelvic Pain?
Endometriosis: The layer lining the uterus (endometrium) is located outside the uterus. Due to hormonal changes, these tissues thicken, shed and bleed, just like the endometrium. However, since these tissues cannot be expelled through the vagina, as in the uterus, They can cause chronic pelvic pain by causing painful cysts or adhesions in the abdomen. It can cause very serious adhesions around the ovaries and uterus. While endometriosis may not cause any complaints, it may also present with severe pain during menstruation, painful urination, painful defecation, and painful sexual intercourse.
Painful Pelvic Floor Muscle Spasm: Seen in the same leg. Like cramps, it is a condition in which there is contraction in the pelvic floor muscles that hold the uterus, bladder and rectum in the pelvis and the resulting severe pain. It can be seen unilaterally or bilaterally. Diagnosis is made through gynecological examination. The examination must be performed by a physician trained in this field, otherwise the diagnosis can be easily missed.
Pelvic Inflammatory Disease (Chronic): Diseases transmitted through sexual intercourse, long-lasting, ongoing It can cause infections and severe adhesions in the pelvic organs, around the ovaries and uterus. For this reason, the patient may experience pain.
Myomas: These are benign tumors of the uterus. They can cause a feeling of heaviness and pressure in the lower abdomen.
Irritable Bowel Syndrome: Symptoms such as bloating, constipation, and diarrhea may be associated with irritable bowel syndrome, which can cause pelvic pain and pressure
Painful Bladder Syndrome (Interstitial Cystitis): this condition may be associated with recurring pain in the bladder and a frequent need to urinate. You may experience pain when your bladder is full and the pain temporarily improves when you empty it. In diagnosis, the inside of the bladder is examined with a camera and a series of tests are performed.
Pelvic Congestion Syndrome: Enlarged, varicose veins around the uterus and ovaries can cause pain. Varicose veins may also be seen in the legs, calves and perineum in these patients.
Anterior abdominal wall pain: Neuropathic pain, especially due to old surgeries (the same complaints seen in the feet in diabetes), can also be seen here. Its diagnosis and treatment are quite different from all other causes.
Psychological factors: depression, chronic stress or sexual physical abuse can increase the risk of chronic pelvic pain. Emotional stress worsens pain, living with chronic pain causes emotional stress and a vicious cycle occurs.
Despite these, in many cases, it is not possible to attribute chronic pelvic pain to a single cause. In such cases, the aim of treatment should be to improve the quality of life by reducing pain and other symptoms.
How is Chronic Pelvic Pain Diagnosed?
When your doctor takes your history, it is very important that you describe the problem completely and in detail. However, you should inform your doctor about your medical history, family history, and medications you use. Gynecological examination, blood tests and imaging methods (Ultrasonography, MRI) are used in diagnosis.
Is Gynecological Examination in Pelvic Pain Different from General Gynecological Examination?
It is quite different. The entire vaginal wall, the ligaments that suspend the uterus, whether there are any specific pain trigger points, and the pelvic nerves are examined in detail. A pain map of the vagina is created. It is investigated whether the pain is limited here or whether it extends. Especially if pelvic nerve involvement is suspected, special tests are performed for these. Methods that temporarily stop pain can be used in diagnosis.
Which Tests Are Requested?
To exclude infections, vaginal culture, blood and Urine analysis may be requested.
Which Imaging Methods Can Be Used?
Ultrasonography is used as standard. Ultrasound is used to detect the presence of any cyst or myoma.
Other Imaging Methods: Especially Magnetic Resonance Imaging (MRI) may be requested. Standard MRI is not sufficient here. This MRI must be able to take very sensitive images and special equipment must be used to increase the image quality in the relevant area during shooting. These features are available at a very limited number of imaging centers. It is also very important that the interpreting Radiologist is experienced in these matters.
Is Laparoscopy Used in Diagnosis?
Nowadays, Laparoscopy is generally used rather than diagnosis. is used for treatment. In this surgical method, a small camera is inserted into your abdomen through a small incision and the pelvic organs are examined for abnormal tissue or signs of infection. This method is especially important in the diagnosis of endometriosis and chronic pelvic infection.
Treatment
If your doctor can identify the condition that causes chronic pelvic pain, determine the cause. directed treatment is given. However, if the cause cannot be found, treatment is aimed at relieving the pain. It is not always possible to completely treat pain. The success of the treatment is to increase the quality of life by minimizing pain.
Some methods used in treatment:
Painkillers:They can partially relieve pain, but it alone is not enough to solve the problem.
Antibiotic: It may work if the cause of the pain is infection.
Hormone therapy:associated with the menstrual cycle. birth control pills for pain or other hormone medications may work. Dienogest, a type of progesterone specific to endometriosis, is also a frequently used medication. Injections that induce temporary menopause for 1 month or 3 months can be used in treatment.
Antidepressants:Some antidepressants may help with chronic pain. It has been shown to work even in women who are not depressed.
Local anesthetic: It can be used alone or with steroids in diagnosis and treatment.
Botox: In special cases (Painful Pelvic Floor Muscle Spasm) it can be performed by physicians trained in this field. Blocks can be made especially on the pudendal nerve, which also provides sensory stimulation to the muscles and pelvic area. It can also be used for anterior abdominal wall pain. It is often necessary to repeat.
Surgery: If there is endometriosis, adhesions can be opened and endometriosis foci can be removed with Laparoscopic or Robotic surgery. Surgery is beneficial in cases such as nerve involvement and vascular entrapment, which are specific causes of pain. In some rare complicated cases, removal of the uterus and ovaries (hysterectomy) may be recommended for women who have achieved fertility.
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