Chronic Pelvic Pain
Reviewed by: HU Medical Review Board | Last reviewed: June 2018 | Last updated: October 2020
Chronic pelvic pain is described as pain lasting at least three to six months that is centralized below the bellybutton and between the hips. Chronic pelvic pain is thought to be a neuropathic condition, meaning it's related to the nerves. Chronic pelvic pain may be the result of nerves that are overly sensitive and are constantly perceiving pain when they normally shouldn't be. Chronic pelvic pain may be a symptom of another underlying condition, such as endometriosis, irritable bowel syndrome, or fibromyalgia, however, it can also occur on its own without an identifiable cause.1-3
Pain severity and perception may vary greatly from person to person. Some individuals may experience unrelenting, severe pain at all times, while others may experience a dull ache that comes and goes. In some cases, chronic pelvic pain may be sharp or cramp-like, but in others, it may be more of a constant pressure. There is no one type of pelvic pain that everyone with chronic pelvic pain experiences.
Possible causes of chronic pelvic pain
Chronic pelvic pain can have no apparent cause, or it may be directly related to another underlying condition. Examples of conditions that may cause chronic pelvic pain are numerous, and can be broken out into the following groups:
- Gynecological: Endometriosis, adenomyosis, pelvic inflammatory disease (PID), post-surgical complications, chronic cervical infection, ovarian cysts, uterine fibroids, or pelvic adhesions (bands of scar tissue within the pelvis).
- Urological:Interstitial cystitis, urological surgery complication, kidney or urinary stones, or painful bladder syndrome.
- Gastrointestinal: Diverticulitis, irritable bowel syndrome, or inflammatory bowel disease.
- Vascular: Pelvic congestive syndrome where blood flow within the pelvis is affected
- Musculoskeletal: Abdominal myofascial pain, fibromyalgia, dysfunction within the pelvic floor muscles, hernia, or inflammation within the pubic joint.
- Psychological: Depression, anxiety, other mental illness, or history of trauma and/or abuse.
- Neurological: An overall issue in the way the nerves within the pelvis, spinal cord, and brain process pain in this area of the body.1,2,4,5
In the case of endometriosis, chronic pelvic pain may be caused by the active building, breaking down, and bleeding of endometriosis lesions, changes in the local cellular environment around endometriosis lesions (including an increase in inflammation due to certain immune system-related chemicals), and infiltration or irritation of nerves within the pelvis by endometriosis lesions.6
Evaluating chronic pelvic pain can be challenging, as a main focus is to determine the underlying cause of the pain among many similarly presenting conditions. In order to do this, your provider will take a full medical history from you, including information on your current pain experience, sexual history, past traumas, any medications you are currently taking, and more. By learning more about your pain, when it happens, and what events have led up to the pain starting (if it wasn't always present), your provider may be able to start narrowing down the list of potential causes. Your provider will also perform a pelvic exam to look for any obvious signs of an underlying issue. Subsequent exams and diagnostic tests such as blood tests, imaging, or minimally invasive surgery like laparoscopy may be performed based on what your doctor suspects the cause of your pain is.1-3
Chronic pelvic pain can be treated in a variety of ways, each of which centers around the underlying cause of the pain. For example, if a woman's chronic pelvic pain is due to pelvic inflammatory disease, which is an infection within the pelvis, she may receive medication to treat the infection and reduce her pain. If a woman's chronic pelvic pain is thought to be related to a mental illness or past trauma, she may be referred to therapy or counseling. If a woman's pain is thought to be related to endometriosis, she may undergo treatment for endometriosis in order to help relieve her pain. This may include medication therapy or removing endometriosis lesions via laparoscopy, a minimally invasive surgical technique.1,2
Managing chronic pelvic pain
In addition to the treatment options your doctor outlines for you pain based on what the underlying cause is, there are some other potential lifestyle and behavioral changes you can make that may be able to relieve some of your pain. Some of these include physical therapy, acupuncture, stress-relieving practices, neurostimulation techniques, counseling, support groups, or meditation.1,2