Dealing with Chronic Pelvic Pain

Women can experience chronic pelvic pain due to a number of very serious and potentially life threatening medical conditions. These can include endometriosis, uterine cancers, fibroids, complications with pregnancy, interstitial cystitis, kidney stones, diseases of the bowel or bladder as well as chronic types of pain. Chronic pain may be associated with conditions such as fibromyalgia, which is typically diagnosed based on pain that has no specific origin or pathology.

As there are so many different causes of pelvic pain, it is essential for a woman to set an appointment with her doctor and have the necessary tests to rule out cancer, endometriosis, and other medical conditions. It is estimated that approximately a significant percentage of all chronic pelvic pain for females, including teens and adults, is related directly to endometriosis.

Talking About Pain

Seeking medical assistance from your family physician, OB/GYN, nurse practitioner or another qualified health care provider is the first step in getting a diagnosis. It is a good idea to jot down notes about the pain that you are experiencing including how it relates to your menstrual cycle, if you are on any types of medications, what factors seem to trigger the onset of pain or what factors seem to decrease or alleviate the pain. It is also important to attempt to accurately describe the pain. Some specific information that can help your doctor to make a diagnosis includes:

  • Type of pain – sharp, shooting, dull, pervasive, throbbing or burning
  • Pain on a rating scale – 1 to 10
  • Location of the pain – throughout the pelvis, closer to the back and kidneys or more centralized
  • When the pain is worse – during menstruation, ovulation, bowel movements, sex or urination
  • Duration of pain – how long has the pain existed (days, weeks, months or years)
  • Any history of reproductive diseases, miscarriages or abortions
  • Family history of cancers, chronic health conditions or a diagnosis of fibromyalgia or other chronic pain conditions in an immediate family member or in the extended family
  • Any atypical or problematic pregnancies including ectopic pregnancies
  • Changes in digestive functioning
  • Any irregularities in your menses
  • Any other health related changes including menopause, perimenopause, migraines, other acute or chronic pains in the body and details about this pain

The more information that can be provided to the doctor, the more specific the tests and possible diagnosis options are for the physician. It is essential to share details and to ask for a second opinion if you are concerned that your doctor does not understand the significance of the pain you are experiencing. Most women will work with approximately 4 (per the study it’s 3.7 to be exact) different medical professionals before they are diagnosed with fibromyalgia, and it may take two or more years until a correct diagnosis is made. 1

Symptoms of Chronic Pelvic Pain

Chronic pelvic pain occurring with or as a part of fibromyalgia tends to have a multitude of symptoms for women. Some women will experience several of these symptoms which may change slightly based on environmental factors and overall health conditions. It is also important to understand that, when the body is under stress, infections are more common since the immune system response may be compromised. If you have any concerns about bladder, kidney, or reproductive infections, including yeast infections, it is essential to immediately seek medical help from your doctor or health care provider.

Typical symptoms include:

  • Increased frequency of urination
  • Difficulty in holding urine once the urge to urinate occurs
  • Bladder incontinency
  • Pain during urination or when the bladder feels full
  • Dyspareunia – pain during sexual intercourse or painful sensations in the external or internal genital area
  • Burning sensation while urinating (dysuria)

Since these symptoms are also typically with urinary and reproductive tract infections it is important to avoid self-treatment if you are not absolutely certain that it is an infection. Typically any women or man with urinary or reproductive problems, pain and discomfort, along with any of the other symptoms of fibromyalgia, should meet with their doctor and explain all symptoms, not just the urinary or reproductive system pain.

Women and men may fail to connect chronic pain in the pelvis to other pains within the body if they simply assume a yeast, bladder or kidney infection is occurring. Misdiagnosis may also be a problem if you fail to explain all symptoms to your doctor.

Causes of Chronic Pelvic Pain

The causes of chronic pelvic pain not related to a specific disease or condition may be linked to the development of fibromyalgia syndrome. In one study, researches found that there was no significant hormonal changes noted in women with chronic pelvic pain without fibromyalgia, but with fibromyalgia there was a lower total cortisol release when there was a stressor. 2 In addition researchers found that there was overall reduced adrenal reaction in women with fibromyalgia, which may indicate that the body has adapted to chronic high circulating levels of cortisol in those with fibromyalgia.

Although less common in men, they can also develop chronic pelvic pain that is typically reported as urological in nature. Testing these men as to their overall pain thresholds and tenderness has found some interesting correlations between pain and chronic pelvic pain. Researchers using a small group of men with urological chronic pelvic pain syndrome found that those diagnosed with the condition had lower overall pain thresholds over the entire body than men not diagnosed. 3

This finding supports similar findings in women with fibromyalgia and chronic pelvic pain in that the high stress that the body is under during times of chronic pain tends to lower overall body thresholds for pain. This is believed to occur from a process known as central sensitization where the body become hyper attuned to very minute changes in stress hormones because of the chronic elevated levels.

References

1 Choy, E., Perrot, S., Leon, t., Teresa, & etal. (2010). A patient survey of the impact of fibromyalgia and the journey to diagnosis. BMC Health Services Research.

2 Wingenfeld, K., Heim, C., Schmidt, I., & etal. (2008). HPA Axis Reactivity and Lymphocyte Glucocorticoid Sensitivity in Fibromyalgia Syndrome and Chronic Pelvic Pain . Psychosomatic Medicine , 65-72.

3 Davis, S. N., Maykut, C., Binik, Y., & etal. (2011). Tenderness as Measured by Pressure Pain Thresholds Extends Beyond the Pelvis in Chronic Pelvic Pain Syndrome in Men. The Journal of Sexual Medicine , 232-239.

This article was originally published on July 11, 2012 and last revision and update of it was 9/7/2015