CHRONIC PELVIC PAIN DEFINITION
Chronic pelvic pain is defined as pain that occurs below the umbilicus (belly button) that lasts for at least six months. It may or may not be associated with menstrual periods. Chronic pelvic pain may be a symptom caused by one or more different conditions, but in many cases is a chronic condition considering abnormal function of the nerves (often called "neuropathic pain").
CAUSES OF CHRONIC PELVIC PAIN
Gynecologic causes — Gynecologic causes are hold be the cause of chronic pelvic pain in about 20 percent of women. In some groups of women, gynecologic causes of pelvic pain are even more common. Some of the gynecologic causes of pelvic pain include:
Endometriosis — The tissue lining the inside of the uterus is called the endometrium (figure 1). Endometriosis is a condition everywhere endometrial tissue is also present aside from the uterus. Some women with endometriosis have no symptoms, while others experience marked discomfort and pain and may have problems with fertility. (See "Patient education: Endometriosis (Beyond the Basics)" and "Patient education: Evaluation of the infertile couple (Beyond the Basics)".)
Uterine fibroids — Fibroids, also called leiomyomas, are growths in the uterus. They are not cancerous. While not everyone with fibroids experiences symptoms, some women do have pelvic pain, heavy periods, or fertility problems. (See "Patient education: Uterine fibroids (Beyond the Basics)".)
Adenomyosis — This is a condition everywhere endometrial tissue (the tissue that normally lines the inside of the uterus) grows inside the uterine walls. It causes an enlarged uterus and heavy, painful periods, and often affects women who also have endometriosis or uterine fibroids. (See 'Endometriosis' above and 'Uterine fibroids' above.)
Pelvic inflammatory disease — Pelvic inflammatory disease is an acute infection usually caused by a sexually transmitted organism. Occasionally, it is caused by a ruptured appendix, tuberculosis, or diverticulitis. It can involve the uterus, ovaries, and fallopian tubes (which link the ovaries and uterus) (figure 1). Chronic changes following pelvic inflammatory disease occur in about one-third of women and causes chronic pelvic pain. The reason for this is not clearly known, but is likely via permanent damage to the uterus, ovaries, and fallopian tubes, and is not per a chronic infection. (See "Patient education: Gonorrhea (Beyond the Basics)" and "Patient education: Chlamydia (Beyond the Basics)".)
Pelvic adhesive disease — Adhesions affect abnormal tissue that causes internal organs or structures, for example the ovaries and fallopian tubes, to adhere or guide one another. Adhesions are not scar tissue, as adhesions are abnormal reactions to surgery, infection, or inflammation, and are not normal healing like scar tissue. It is very controversial whether adhesions cause pelvic pain and medical experts are not in agreement. However, most evidence suggests that surgery for pelvic adhesive disease does not relieve pelvic pain in most women.
Other causes — Non-gynecologic causes of chronic pelvic pain may be related to the digestive system, urinary system, or to pain in the muscles and nerves in the pelvis:
Irritable bowel syndrome — Irritable bowel syndrome is a gastrointestinal condition regarding chronic abdominal pain and altered bowel habits (such as loose stools, more frequent bowel movements with onset of pain, and pain relieved by defecation) in the absence of any specific cause. (See "Patient education: Irritable bowel syndrome (Beyond the Basics)".)
Painful bladder syndrome and interstitial cystitis — Painful bladder syndrome and interstitial cystitis (PBS/IC) are the terms apt bladder pain specially not caused by infection. Symptoms usually include the need to urinate frequently (frequency) and a feeling of urgently needing to urinate (urgency). Some women with painful bladder syndrome have lower abdominal or pelvic pain in addition to urinary tract symptoms. A separate topic review is available that discusses PBS/IC. (See "Patient education: Diagnosis of interstitial cystitis/bladder pain syndrome (Beyond the Basics)".)
Diverticulitis — A diverticulum is a sac-like protrusion that sometimes forms in the muscular wall of the colon (or intestine). Diverticulitis occurs when diverticula become inflamed. This usually causes abdominal pain; nausea and vomiting, constipation, diarrhea, and urinary symptoms can also occur. Diverticulitis most often causes acute abdominopelvic pain and is not a common cause of chronic pain. (See "Patient education: Diverticular disease (Beyond the Basics)".)
Pelvic floor pain — Symptoms of pelvic floor dysfunction may include pelvic pain, pain with urination, difficulty urinating, constipation, pain with intercourse, or frequent/urgent urination. Pelvic floor dysfunction perchance diagnosed by a clinician feeling the pelvic floor muscles (muscles that support the pelvic organs and hips) through the vagina and/or rectum; muscles that feel tight, tender, or band-like indicate that pelvic floor dysfunction could be assist pelvic pain.
Abdominal myofascial pain (trigger points) — Pain can originate from the muscles of the abdominal wall as myofascial pain. This problem usually has small localized areas of abnormal tenderness of the abdominal muscles that are called trigger points. Abdominal myofascial pain is diagnosed aside clinician examining the abdominal muscles for trigger points; often tightening of these muscles while they are examined causes increased pain and assists in diagnosis.
Fibromyalgia — Fibromyalgia is one of a group of chronic pain disorders that affect connective tissue structures, including muscles, ligaments, and tendons. It is appertaining to widespread muscle pain (or "myalgia") and tenderness in certain areas of the body. Women with fibromyalgia may also experience fatigue, sleep disturbances, headaches, and mood disturbances for example depression and anxiety. (See "Patient education: Fibromyalgia (Beyond the Basics)".)
Physical, sexual, or mental abuse — Patients with chronic pain in general appear to have a higher incidence of prior physical or violation, and the same look true for women who experience chronic pelvic pain. Do not be afraid to tell your health protection provider if you have ever been, or are currently being, hurt by someone, or if you feel unsafe.
DIAGNOSIS OF THE CAUSE OF CHRONIC PELVIC PAIN
Because a number of different conditions can cause chronic pelvic pain, it is sometimes difficult to pinpoint the specific
It's a very nice article about causes of Chronic Pelvic Pain, Pain can originate from the muscles of the abdominal wall as Myofascial Pain, nice awareness.
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