Help for Chronic Pelvic Pain

woman with hot water bottle on stomach

Contributor: Joseph Abdelmalak, MD, Department of Pain Management

Most patients with chronic pelvic pain (CPP) stand to benefit from seeing their condition for what it really is — a chronic disease, not a symptom. So says Joseph Abdelmalak, MD, a physician in Cleveland Clinic’s Department of Pain Management with a special interest in CPP.

“Many patients come to me with deep-seated pelvic pain expecting that their pain will go away with a simple injection,” says Dr. Abdelmalak. Instead, he explains, patients are better off if they accept CPP as a condition like hypertension or diabetes that may require a long-term relationship with a physician who understands it. That is because various treatments often need to be tried, sometimes in combination. Once an effective treatment is found, it may need to be used on an ongoing basis.

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“That’s the approach we use at Cleveland Clinic for patients with this complex condition whose causes often are hard to pinpoint,” Dr. Abdelmalak adds.

What is chronic pelvic pain?

Chronic pelvic pain (CPP) is defined as nonmenstrual pain in the pelvis that lasts more than three months, interferes with daily life and requires medical therapy. It is typically a deep-seated, aching pain that disrupts sleep and work. In many cases, it causes pain with sex and/or urination and leads to feelings of frequently needing to urinate. Between 70 and 80 percent of CPP cases are in women, but men can be affected too, especially if they have chronic prostatitis. Many factors can contribute to CPP, and identifying the cause(s) is often difficult. In fact, 30 to 50 percent of CPP cases are classified as having no obvious cause, which can make effective management a challenge.

Teamwork often needed

In up to half of cases, the underlying cause of CPP is not clearly identified. That makes a careful examination extremely important so that all potential factors are explored thoroughly by physicians with the right expertise.

“Depending on a patient’s symptoms and medical history, I may refer her or him to one of my colleagues in another specialty — such as urology, gynecology or gastroenterology — to look for an underlying cause of the pelvic pain,” says Dr. Abdelmalak.

Psychiatrists are among the specialists Dr. Abdelmalak consults with, as psychiatric disorders are sometimes associated with CPP.

Intensive rehab program

Some patients with CPP may be candidates for Cleveland Clinic’s Chronic Pain Rehabilitation Program, an intensive hospital-based program that runs five days a week for three weeks. Patients participate in physical, occupational and group therapies to learn to better manage their pain and they meet with a psychiatrist every day. Education is offered for family members as well. Cleveland Clinic is one of only a few health centers in the nation with a rehabilitation program of this type for patients with CPP.

Wide range of therapies available

For less severe cases or patients who cannot attend the three-week program, Dr. Abdelmalak has a range of therapies to offer. “I often start with conservative measures such as lifestyle modifications, dietary changes, exercise or pelvic floor muscle relaxation therapy taught by one of our specialized physical therapists,” he says.

He may consider medications as well, ranging from anti-inflammatory drugs to anticonvulsants to hormonal therapies. The next options are minimally invasive procedures, including various nerve blocks. 

Additional options, if needed, include surgical approaches such as implanting a spinal cord stimulator, which delivers an electrical current to control the pain, or a special pump to deliver small doses of powerful opioid painkillers. Cleveland Clinic is one of only a few medical centers that use spinal cord stimulators for CPP, and results have been good in well-chosen patients.

Regardless of the therapy, treatment goals are to restore normal function, improve quality of life and prevent relapse of chronic symptoms.

“If you have deep-seated pelvic pain for more than a few months without relief, consider seeing a pain management physician,” Dr. Abdelmalak advises. “There are many options for treating CPP that your primary doctor may not be fully familiar with.”

Dr. Abdelmalak sees patients at Cleveland Clinic’s main campus and Fairview Hospital. To schedule an appointment with him, call 216.445.7370.

  • T. Hopper

    My son has CRPS and completed the pediatric pain rehab program in April of last year. It was life-changing for him and restored the function to his leg. Amazing program run by amazing people!

  • ornurse32

    My son is 11 years old and is suffering terribly from a leg injury that caused CRPS. We are being treated by local physicians but NOTHING has helped. It has only been 7 weeks today but he is in CONSTANT intractable pain 24/7. Our insurance says they will not cover the Cleveland Clinic until all treatments have failed here in Michigan. Any advice? Two failed nerve blocks and max meds haven’t touched it.

    • Patient

      You should call Cleveland clinic and ask to speak with their financial department. You may find a loophole in your insurance or you may find you can cover the cost without your insurance (letting the doctors and staff know your situation, who your insurance provider is and what they told you may result in them lowering the treatment costs in your specific case) I am in no way affiliated with Cleveland clinic and am not saying they will do this but it is worth a shot! I am a patient there and can tell you they are amazing and I am no doubt alive today because of them. I hope your son is able to get the treatment he needs and can be rehabilitated and enjoy hos life. Pain is a horrible and debilitating issue and when the patient is a child its even worse. Good luck!

    • Sheila Atkinson

      Have you tried mirror therapy. The same kind they do for phantom limb pain. There are videos on YouTube showing how to make a simple one. It’s non invasive and with no side effects. You could also consider Bowen therapy as it is good for children. I also take anti epileptic medication which helps to dampen down the burning nerve pain. Hope things calm down for him. It’s hard enough trying to deal with it as an adult x

  • Elisha Wooden

    My husband has been dealing with this for 4 yrs. We drive 5 hrs to see a specialist in San Francisco who experiment on him with different meds..spinal blocks and therapy. With not much success. He cant walk far and requires a cane for assistants as his knee will just let out from under him. The meds are mostly neurologic so hes not always himself. I wish we had someone who could help him function better and be apart of our family activitys again, we have 5 kids still at home and he just cant function.

    • Sheila Atkinson

      Physical therapy and exercises in water help me. I go to a special swimming pool made for handicapped people. It has ramp access and is as warm as a bath. Walk in showers and wet rooms help with bathing. You can get inflatable bath chairs to get in and out of the bath. I have one. It’s called a Mangar. I have to use a stick now as my CRPS has spread from an arm injury 5 years ago. The first year was all about what I couldn’t do any more. The second was about what I can still do. Now I try new things and if I can’t do them at least I know I gave it a go. I don’t lose anything by trying as I know what I can still do. It’s more a case of mentally accepting that your old life has gone and saying RIP to it. I found I had to reinvent myself. It stopped me in my tracks from being who I thought I was. Dealing with the pain and physical limitations is only one part of the condition. Getting family and friends to understand that one day you may be fine to do something and the next you can’t get out of bed is difficult. Even over the day things can change. My example is when I was invited to the cinema. It was cold outside and I was travelling in a car. Even before I got in the car I had to think about whether my pain meds would last through the film, what coat to wear as I may be too hot in the car and cinema. Would I be able to take my coat off in the restricted space because of my arm restrictions. Would I get knocked by people increasing my pain. Would I be able to sit in the seat for that length of time. How would I cope with the vibrations of the car and cinema sound track. All these things are the kind of issues that go through the head of a CRPS sufferer. It makes life difficult for the person with the condition feel part of things. Whether that is family outings, social gatherings or work events. That is if you have managed to keep your job. I lost mine after collapsing at work a year after diagnosis. A positive attitude and keeping mobile is the best treatment. Break tasks down into smaller parts and rest in between. Don’t overdo things when you feel well as you will pay for it in pain later. Set realistic goals. Don’t set a deadline for things. If you have things to do don’t assign a day. Plan a list of things to do over the week. That way you don’t build in failure if you have bad days. I hope you find this useful. Many blessings for less pain in your lives, both physical and emotional x

  • TheRiddleClass

    Can this be from an injury from years ago?

    • Sheila Atkinson

      There could be more incidents where there is already a weakness but the weakness or historical injury itself is not likely to be the cause alone. A simple sprain can cause it. I had a dislocation of my shoulder when I was 17. At 44 my shoulder was dislocated again and it set off crps. I had no symptoms of crps previously. High doses of vitamin c prior to surgery have shown to reduce risk of developing crps.