If you’re frustrated with chronic pelvic pain that hasn’t responded to treatment, you’re not alone. Many women suffer from chronic pelvic pain, and it is often difficult to diagnose because there are so many potential causes.
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“Pelvic pain can sometimes be a sign of a gynecological problem, such as cysts on the ovaries, endometriosis, pelvic inflammatory disease or uterine fibroids,” says OB/GYN and Director of Cleveland Clinic’s Chronic Pelvic Pain Program M. Jean Uy-Kroh, MD. “It could also be a sign of a musculoskeletal problem, a gastrointestinal problem, a urinary problem, or even a problem with the neurological or vascular system.”
Getting to the right diagnosis
A thorough history and physical are vital for doctors to determine what is causing your pelvic pain.
“Before women come for their first appointment, we send them an extensive questionnaire to fill out in advance,” says nurse practitioner Abigail Smith, CNP. “We also request any outside records if they’ve been seen previously by another provider.”
Ms. Smith says you should expect to spend up to an hour and a half at your first appointment. “The first appointment takes some time and effort, but we want to be thorough to make sure patients have the best outcome,” she says. After the exam, patients may have visits the same day with other specialists in the areas of gynecology, pain management or pain psychiatry to help the pelvic pain provider team form a unified treatment plan.
How you can help your doctors
According to Dr. Uy-Kroh, you can help doctors more easily diagnose the cause of your pelvic pain by keeping track of what seems to affect your pain. “For example, does your pain get worse when you exercise or feel better when you’re lying down? Is it worse at certain times of the day? Also, the quality of the pain is important: Is it sharp? Stabbing? Burning? Does it related to your menstrual cycle?”
Consider keeping a journal to track what seems to ease or flare up the pain so that you can bring this information to your appointments.
Treating your pain
The type of treatment you need will depend on what’s causing your pain. “Treatment is tailored to each patient,” says Dr. Uy-Kroh. “Some conditions may require surgical treatment while others are treated medically. We discuss the options with patients and together, with their input, we figure out the best treatment for their particular diagnosis and situation.We partner with our patients and take into account their lifestyle and concerns.”
There can be many different treatment options for one diagnosis, she adds.
Ms. Smith says a lot of people who have chronic pelvic pain feel like there’s no hope.
“We do our best to come to a diagnosis, but there are times when we just don’t know what’s causing the pain,” she says. “That can be frustrating, especially for people who have been to multiple doctors trying to find answers. But even if the cause is unclear, there’s still hope. Our team works to develop a pain management plan that can restore patients to a level of functioning that will allow them to have a meaningful life.”
Participating in your care
Although you may feel like you’ve already been through a lot, Dr. Uy-Kroh says it’s important to actively participate in your care.
“We understand people’s frustration, but in some cases, there are things you can actively change in your life that will allow you to see huge gains,” she says. “Even if you’ve already seen multiple specialists and tried a variety of treatment options, try to keep an open mind.”