Having pelvic pain is bad enough. But when pain down there lasts for months, and you can’t figure out what’s causing it, well, that’s pretty much a recipe for despair.
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But there’s reason for hope, says Ob/Gyn Mark Dassel, MD, Director of the Center for Endometriosis & Chronic Pelvic Pain.
It’s true that chronic pelvic pain can often be challenging to diagnose. But challenging doesn’t mean impossible. Finding the right diagnosis is the first step toward lasting relief.
What is chronic pelvic pain?
Chronic pelvic pain is a catch-all term for pain in the lower abdomen, pelvis or genital area that lasts longer than six months, Dr. Dassel says. It can be cyclic (meaning it comes and goes during your menstrual cycle) or not.
And it’s surprisingly common: One in seven women in the U.S. experiences chronic pain in the pelvic area.
For many women, the pain can be traced to the reproductive organs. But chronic pelvic pain is a tricky beast. It can also stem from the bladder, the gastrointestinal system, the nerves or the pelvic or abdominal muscles, Dr. Dassel says.
Causes of pelvic pain
With so many possible sources of pelvic pain, it can be challenging to figure out what’s going on. Doctors typically start by considering these usual suspects:
- Endometriosis occurs when the tissue that lines the uterus grows in other places, such as on the ovaries or the fallopian tubes. It’s most common in women between the ages of 25 to 40 and can be a major source of chronic pelvic pain.
- Pelvic floor dysfunction is a problem that prevents the muscles of the pelvis from relaxing normally. “The muscles stay tight and become tender and cause pain,” Dr. Dassel says.
- Interstitial cystitis is a chronic condition that causes the bladder walls to become inflamed and sensitive.
- Irritable bowel syndrome is a disorder of the colon and bowel that causes abdominal pain and cramps.
- Vulvodynia is chronic pain of the vulva, often without a clear cause.
To complicate matters, chronic pelvic pain often comes from multiple causes at once, Dr. Dassel says. Women with endometriosis, for instance, are more likely to develop vulvodynia, interstitial cystitis or irritable bowel syndrome. And living with chronic pain can cause nerves to become hypersensitive and overact in ways that make pain worse.
“One of the most difficult things about chronic pelvic pain is that there’s often more than one condition going on at a time,” Dr. Dassel says.
Treatment for pelvic pain
With so many possible causes, treating pelvic pain isn’t always straightforward. “When there are multiple factors, if we treat just one condition at a time, we sort of miss the boat,” Dr. Dassel says.
That’s why it’s helpful to see a pelvic pain specialist, he says. They can act as a team quarterback, managing the situation and bringing in specialists as needed — such as physical therapists who deal with pelvic floor issues, urologists to help with bladder problems or gastroenterologists for bowel problems.
Treatments for chronic pelvic pain vary depending on the underlying problems. In some cases, women find a cure, and the pain goes away completely.
In other cases, pelvic pain is a chronic disease that requires long-term management. But even in those situations, there are ways to treat the symptoms and keep pain in check, Dr. Dassel says.
Treating the pain: What you can do
You can help your doctors arrive at the right diagnosis, Dr. Dassel says.
“Describe your pain as specifically as possible — its location, intensity, timing, and factors that make it better or worse,” he says.
Is it related to your period or ovulation? Does exercise make it worse? Does it strike on both sides of your abdomen or just one? Consider keeping a journal with these details to help your doctor spot patterns.
And don’t put off seeing a doctor. The longer you live with the pain, the more likely it is that you’ll develop secondary pain syndromes — and the harder it will be to treat, Dr. Dassel says. “The longer the walk into the woods, the longer the walk out.”
Real solutions for real pain
Unfortunately, even women who seek out doctors and describe their pain clearly can still have trouble getting a diagnosis, Dr. Dassel says. “It can be hard to get answers, and that takes a toll on people,” he acknowledges. “That can lead to anxiety and depression, which then increase pain.”
Treating those mood issues is important, too, but he stresses that women — and their doctors — shouldn’t assume the problem is “in their heads.”
He encourages women to advocate for themselves and keep trying until they find someone who gets it. If your doctor seems stumped or isn’t taking your pain seriously, then get another opinion.
Chronic pelvic pain can be tricky, but it is treatable, he says: “Our goal is to help you get your quality of life back, and make sure you can do everything you want to do.”