Pelvic Pain

What is pelvic pain?

Pelvic pain occurs in the area between the belly button and the pelvic floor. The organs that can cause or be affected by this type of pain include:

• Uterus, ovaries, and fallopian tubes
• Prostate
• Rectum
• Bladder
• Appendix

Approximately 33% of all women experience pelvic pain at least one time in their lives. For 12-20% of these women, pain becomes chronic. Men are less commonly affected by chronic pelvic pain, but they can experience it with advanced prostatitis.

What are the major pelvic pain causes?

There are many different causes of pelvic pain, including

• Infection
• Ectopic pregnancy
• Ovarian cysts
• Endometriosis
• Pelvic inflammatory disease (PID)
• Sexually transmitted infections (STIs)

One of the most common types of pelvic infection is pelvic inflammatory disease (PID). PID is an infection of the uterus, ovaries, or fallopian tubes. A potential cause of PID is sexually transmitted infections (STIs). The bacteria from an STI travels into the reproductive organs and causes infection. This cause of pain often has no symptoms until the later stages of infection.

Other infections of the kidneys, bladder, or urethra can also cause pelvic pain.

In women, ectopic pregnancy can also cause severe pain in the pelvic. This type of pregnancy occurs when a fertilized egg implants outside of the uterus, most often in the fallopian tubes. In addition to causing pain, ectopic pregnancy can lead to serious complications and requires surgical intervention.

Endometriosis is a chronic condition in which uterine tissue grows on other reproductive organs. This causes severe pain and cramping during menses. It can also cause fatigue and widespread pain during the rest of the month. Certain medications and surgical procedures may lessen the pain associated with endometriosis.

Another less serious cause of pain originating in the reproductive organs is ovarian cysts. Ovarian cysts are fluid-filled sacs within the ovaries that typically cause pain during the menstrual cycle. These cysts usually dissolve on their own when menstruation occurs but sometimes require surgery for removal.

The most common cause of pelvic pain in men is an infection of the urinary tract. Other potential causes include kidney stones, sexually transmitted infection, and hernia.

It is important to note that some forms of pain in the pelvis are neuropathic, which means it does not come with a specific cause.

Diagnosis

Diagnosing this type of pain can be challenging, but an accurate diagnosis is crucial for effective treatment. Your doctor will take a complete medical history that includes the incidence and duration of the pain and where it is located.

For women, an OB/GYN may conduct a pelvic examination, lab testing, and ultrasounds or CT-scans of the abdomen and pelvis. Male pelvic pain is diagnosed in much the same way, with a urologist conducting a physical exam if necessary.

5 pelvic pain treatments

Treatments vary, depending on the underlying cause. Common treatment options include:

1. Medications
2. Physical therapy
3. Biofeedback
4. Nerve blocks
5. Spinal cord stimulation

Medications

Common types of medications used to treat pain include non-steroidal anti-inflammatories, antidepressants, and neuropathic medications. Opioids are no longer indicated in chronic pain management.

For infections, treatment with antibiotics may be necessary.

Physical therapy

Physical therapy for pelvic pain includes pelvic floor therapy, hot and cold applications, ultrasound therapy, and stretching.

Pelvic floor therapy is the standard of care for unexplained pain in the absence of infection or other obvious cause.

Biofeedback

Biofeedback is a technique in which a person learns to control pain through their bodily processes. It can be very helpful for treating this type of pain.

A licensed therapist can teach biofeedback, relaxation techniques, and guided imagery. These techniques help patients to better manage chronic pain and can be helpful when combined with other treatments.

Nerve blocks

Neuropathic pelvic pain is challenging to treat but may respond well to nerve blocks. Nerve blocks are determined by the location of pelvic pain and symptomatology.

A study in 2016 found that 95% of women found relief from a pudendal nerve block. Another study in 2018 found that the pain of endometriosis was drastically reduced with a superior hypogastric plexus block. Another type of nerve block that can treat pain is an ilioinguinal nerve block. This is especially useful in treating pain in the lower pelvic region and groin.

Spinal cord stimulator

For pain that does not respond to more conservative treatment modalities, a spinal cord stimulator may be beneficial.

Spinal cord stimulation (SCS) is essentially a “pacemaker for pain.” This treatment uses groundbreaking technology that introduces an electrical current into the epidural space near the source of chronic pain impulses.

After administering a local anesthetic and minimal sedation, your doctor then places the trial SCS leads into the epidural space. These soft, thin wires remain for five to seven days. If the trial successfully relieves your pain, your doctor will place a permanent SCS.

If you suffer from chronic pelvic pain, Arizona Pain can help. We can create a comprehensive treatment plan that relieves your pain.