Chronic Pelvic Pain

Overview

Symptoms

Symptoms and types of pelvic pain vary, including that with:

• intercourse or other sexual activities
• tampon usage
• gynecologic examination
• activities like sitting, standing, bending or walking
• bowel movement difficulty
• urinary urgency, frequency or retention
• pain in the back, groin or buttocks
• shooting pain in the legs
• abdominal pain
• eating

Cause

A variety of disorders may cause your chronic pelvic pain, including conditions related to the reproductive organs, urinary tract, bowel, muscles or nerves. Some possible causes of your chronic pelvic pain include:

• Endometriosis (occurs when uterine lining tissue grows outside the uterus)
• Adenomyosis (occurs when uterine lining tissue grows into the muscular wall of the uterus)
• Menstrual cramps
• Vulvodynia (chronic pain in the area around the vagina opening)
• Pelvic floor myalgia (pain from muscles in the lower part of your abdomen)
• Myofascial trigger points (overly irritable spots in your muscles)
• Irritable bowel syndrome (IBS)
• Painful bladder syndrome

Diagnosis

Your IU Health physician will ask you questions about your pain and medical history and will give you a thorough physical exam. Your physician may refer you to and collaborate with several other IU Health specialists including: a gynecologist (specializes in the female reproductive system), a gastroenterologist (specializes in the digestive tract) and/or a urologist (specializes in the urinary tract).
Depending on your symptoms, you will probably have one or more diagnostic tests which could include:

• a pregnancy test
• blood tests
• urinalysis
• imaging tests such as ultrasound or pelvic laparoscopy (physician inserts a thin tube with a tiny camera through a small incision in your belly to examine the pelvic area)

Treatment

At IU Health, experts trained in the specialized area of pelvic pain and dysfunction will assist you and provide a convenient and comfortable environment for your care.

Your IU Health physician will work with you to help you decide on the best course of treatment for your condition. Available treatments for chronic pelvic pain include:

• Pain management. Pain management includes a wide range of topical, injectable and oral medications tailored to the cause(s) of the pain. Due to their side effects and addictive potential, your physicians will not recommend opioid medications unless other treatments do not help.
• Physical therapy. IU Health physical therapists treat your musculoskeletal system (muscles, joints, ligaments, tendons and connective tissue) safely and effectively.
• Counseling. Chronic pain takes a toll on psychological health and many patients find counseling or psychotherapy helpful. Cognitive-behavioral therapy equips patients with strategies to reframe the pain and decrease the distress it causes.
• Surgery. Physicians commonly treat chronic pelvic pain with laparoscopy, which uses small incisions and aids in diagnosis as well as treatment. Removal of the uterus, and potentially the tubes and ovaries, stops some causes of chronic pelvic pain, but physicians do not recommended it unless the pain revolves around specific organs and non-surgical treatments have failed.