Chronic pelvic pain in women aged 18 to 50 years accounts for direct medical costs of approximately $881.5 million per year in the United States.

Chronic pelvic pain is pain that occurs below the navel, lasts for at least six months and may not be related to menstrual periods. Unfortunately, the cause of chronic pelvic pain is often difficult to diagnose as many different conditions involving the uterus, ovaries, bladder, bowel or pelvic floor muscles and nerves can cause this problem.

Many patients may also have associated problems such as depression, anxiety, and sexual dysfunction. Hence, it is important that a multidisciplinary approach is used to deal with chronic pelvic pain. Dr Cherylin Fu, Senior Consultant from the Department of Colorectal Surgery at Singapore General Hospital, a member of the SingHealth group, shares more.

Causes of chronic pelvic pain

A wide variety of conditions can cause chronic pelvic pain. Some of the more common causes include:

Gynaecologic causes

Chronic pelvic pain is thought to be caused by gynaecologic issues in about 20 percent of women.

Endometriosis - One of the most common gynaecologic causes is endometriosis, a condition where the tissue normally lining the inside of the uterus can also be found outside of the uterus. Women with this condition may experience severe menstrual cramps or pain since their early teens or twenties, painful intercourse or difficulty getting pregnant.

Pelvic inflammatory disease - This acute infection is usually sexually transmitted. It can affect the uterus, ovaries, and fallopian tubes. About a third of women suffer from complications which may cause chronic pelvic pain.

Pelvic adhesions - Adhesions is the term for abnormal tissue that makes internal organs or structures, such as the ovaries and fallopian tubes, stick to one another. Surgery, infection, or inflammation can lead to the development of such abnormal tissue. Whether adhesions cause pelvic pain and whether surgery for pelvic adhesions actually relieves pelvic pain for most women remain controversial.

Urological causes

Painful bladder syndrome and interstitial cystitis - Painful bladder syndrome (PBS) and interstitial cystitis (IC) are terms used to describe bladder pain not caused by infection. Typical symptoms include the need to urinate frequently or urgently.

Gastrointestinal causes

Irritable bowel syndrome - Irritable bowel syndrome (IBS) is a gastrointestinal condition characterised by chronic abdominal pain, cramps, bloating 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.

Musculoskeletal causes

Levator ani syndrome, proctalgia fugax (anorectal pain) and coccygodynia (pain at the coccyx) - These are examples of “functional” pelvic floor disorders that cause chronic pelvic pain. Patients may experience recurrent episodes of pain in the region of the pelvis, rectus, anus or tailbone, which may occur suddenly at night, lasting for more than 20 minutes before disappearing.

The cause is unknown, but thought to be related to abnormal tightening or overactivity of the pelvic floor muscles. During examination, the doctor may feel the pelvic floor muscles through the rectum or vagina as a tight band that is tender when pressing on it.

Pudendal nerve entrapment (Alcock’s canal syndrome) - The pudendal nerve is responsible for sensation around the anus, the base of the scrotum (in males) and vagina (in females). Rarely, it may get compressed, resulting in pain, numbness or burning sensation around the perineum on one side. These symptoms may occur in the sitting position and worsen with bicycle riding. Treatment involves injection of local anaesthetic or steroids.

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