Chronic pelvic pain, is pain that lasts more than a few months. It is not sexy or sexist, men have chronic pelvic pain too, but it is not frequently discussed.
Chronic pelvic pain can be constant or come and go with a flare up of symptoms. Symptoms can be mild to severe and can vary in intensity during the day or with a flare. The character of pelvic pain can be different too. For instance, someone with painful bladder syndrome or prostatitis has a symptom in common, burning with urination (dysuria), but pain associated with irritable bowel syndrome is described as cramping or churning. Symptoms vary depending on the underlying cause of their pain. That’s why it is important to know how to report your symptoms.
Diagnosing the Source of Chronic Pelvic Pain
Expect your doctor to do certain things to find the underlying cause of your pain.
- Medical history
- Review of symptoms
- Blood tests
- A urinalysis
- A biopsy (possibly)
- Scans, such as an MRI or CT scan
- Ultrasound, abdominal or transvaginal
- Cystoscopy (look inside the bladder)
- Hysteroscopy (look inside the uterus)
- Pelvic laparoscopy
- Exams and tests by a gastroenterologist (A physician that specializes in the digestive system)
Your doctor will also want to know what makes your symptoms better and what makes them worse. Some perpetuating factors to chronic pelvic pain include:
- Anatomical abnormalities
- Physical trauma, surgeries, or scarring
- Stress, tension, and fatigue
- Consuming caffeine, carbonated beverages, too much alcohol, sugar or artificial sweeteners
- Poor sleep habits
- Poor nutrition
- Holding postures or sustaining muscle contraction when trigger points are present.
- Poor posture
- Overuse or repetitive use of unconditioned pelvic muscles
- Neglect of co-existing conditions
- Poor coping strategies
- Other illness
Chronic Pelvic Pain Treatment
Treatment goals are always the same, restore function, and manage the condition. This can include anything from treating cancer or organ dysfunction to treating dysfunctional muscles.
A physical therapist or nurse that specializes in pelvic function will evaluate and treat chronic pelvic pain with specific therapies and interventions and will teach you things you can do at home to minimize your pain. Treatments for chronic pelvic pain might include:
- Bladder instillations
- Botulinum A injections (under investigation)
- Electrical stimulation – sacral, pudendal, and suprapubic nerves
- Spinal cord stimulator
- Injections - trigger point injections, external and intravaginal
- Injections - local anesthetic
- Nerve blocks
- Massage, external
- Massage, internal (transvaginal or transanal)
- Pain medications and/or muscle relaxants
- Medications that target the primary problem
- Nutritional supplements
- Manual trigger point therapy for the muscles around the vagina, rectum, vulva, and prostate
- Surgical procedures for treating adhesions, obstructions, or repairing the hammock
- Topical preparations for painful genitalia
- Physical therapy guided exercise
Things You Can Do
It is important to track symptoms. We can do this by keeping a chart of symptoms and anything we do that aggravates or alleviates symptoms. Other things include:
- Address perpetuating factors
- Follow diet suggestions for IBS and painful bladder syndrome
- Wear loose clothing
- If sitting is painful, try using an inflatable doughnut
- Heat or cold to the abdomen or pelvic floor, whichever is most helpful (20 minutes on, 20 minutes off)
- Train pelvic muscles
- Stick with your therapy
Finding the Right Doctor
Having the right doctor pain is as important as having the right treatment. Not all urologists use the latest technology for treating the muscles of the pelvis, but they are likely to know someone who does. If you are female, you may be referred to a specialized gynecologist with advanced training in urology, called a urogynecologist.
It is important to know how to track your symptoms and how to describe them to your doctor and therapist. And, finding the right doctor and therapist is equally important.
Addressing perpetuating factors, treating the underlying cause, and keeping pelvic muscles in good shape, will improve how we feel.