Dr Cherylin Fu, Consultant, and Dr Mark Wong, Senior Consultant from the Department of Colorectal Surgery at Singapore General Hospital explain how chronic pelvin pain is tested and treated.
Continued from previous page.
Investigations are aimed at excluding serious medical conditions which may cause pelvic pain such as tumours, cancer or infections of the reproductive organs, bladder or bowel.
Apart from a detailed history taking and physical examination, some common tests may be performed.
Tests for chronic pelvic pain
Tests for chronic pelvic pain may include any of the following:
Ultrasound of the pelvis - to look for growths such as ovarian cysts and uterine fibroids
Computed Tomography scan - A CT scan can provide detailed high-resolution scan of the abdomen and pelvis to look for abnormal masses or tumours
MRI of the pelvis - A magnetic resonance imaging scan (better known as an MRI scan) of the pelvis will be used to look for pelvic floor abnormalities such as pelvic organ prolapse
Endoanal ultrasound - ultrasound scan of the anal sphincter muscles and pelvic floor muscles to exclude abscesses or fistulas
Laparoscopy - a surgical procedure done under general anaesthetic which may be helpful in diagnosing some causes of chronic pelvic pain such as endometriosis and chronic pelvic inflammatory disease
A laparoscopy involves inserting a thin telescope with a camera through a small incision just below the navel.
The telescope allows the surgeon to see inside the abdomen, especially the reproductive organs. If the findings are normal, the physician can then further investigate non-gynaecologic causes of pelvic pain.
If the laparoscopy reveals areas of endometriosis or abnormal tissue, they may be treated or biopsied on the spot.
Treatment of chronic pelvic pain
Treatment of chronic pelvic pain often involves different specialists including surgeons, physiotherapists, pain specialists and even psychologists. If a specific cause is found, treatment will be directed accordingly. For example, patients with gynaecologic conditions such as endometriosis will often need medications such as hormonal therapy. In some cases, surgery may be required.
After thorough investigation, no physical abnormality or disease may be found. In such cases, dysfunctional pelvic floor muscle states as interstitial cystitis or levator ani syndrome may be the cause. Physical therapy may then help to relax and normalise pelvic floor function and to alleviate pain.
Treatment options available to chronic pelvic floor patients include:
Biofeedback therapy with surface electromyography - More than just pelvic floor exercises, biofeedback aims to teach patients to identify, relax or contract the various muscle groups in the pelvis. It is safe, non-invasive and often highly effective when used appropriately.
Myofascial therapy - This type of therapy aims to relieve specific muscle tightness through digital massage of acutely painful “trigger points” located in the abdomen, vagina, hips, thighs, and lower back.
A physiotherapist can also teach various
muscle relaxation and digital massage techniques that patients can do on their own at home.
In some instances,
psychological counselling may also be offered to help patients manage their pelvic pain. There are several types of psychosocial support and psychotherapies which may involve meeting with a psychologist, psychiatrist and/or social worker.
If medications are not effective in relieving the pain, patients may be referred to see an anaesthetist specialised in pain management.
Patients with chronic pelvic pain need not suffer in silence
If you have pelvic pain that seems more complicated than just period pain, do seek medical attention and visit your doctor or GP. It may take more than one health professional to help you. Management of chronic pelvic pain requires a multidisciplinary pelvic floor team that may include a gynaecologist, urologist, colorectal surgeon, pain specialist, psychologist, specialist pelvic physiotherapist and nursing professionals, among others.