Pelvic Pain

Causes of Chronic Pelvic Pain

Chronic pelvic floor pain occurs in the lower abdomen and is generally noticeable for at least six months. This problem should be discussed with your OB/GYN or primary health care provider. While chronic pelvic pain often is caused by an abnormal function of the nervous system, it may be linked to other types of conditions, including:

Diagnosing the Causes of Pelvic Pain

In addition to a complete medical history and physical exam, your doctor may order other tests for an accurate diagnosis, including:

• Blood tests: A routine blood test checks for a possible infection.
• Colonoscopy: Gastrointestinal specialists perform a colonoscopy procedure to view the lining of the colon, remove tissue for further exam and possibly determine other gastrointestinal issues. This exam can often help identify abnormal growths, inflamed tissue, ulcers or bleeding which are possible causes of pain.
• Computed tomography (CT or CT scan): This test uses X-rays and a computer to make detailed images of the body. A CT scan shows details of the bones, muscles, fat and organs as well as any abnormalities that may not show up on an ordinary X-ray.
• Laparoscopy: The laparoscopy procedure is a minor surgical procedure in which a gynecologist inserts a laparoscope, or a thin tube with a lens and a light, into a small incision in the abdominal wall. Using the laparoscope to see into the pelvic area, your doctor can determine the locations, extent and size of any endometrial growths, which may be the source of pelvic pain.
• Magnetic resonance imaging (MRI): A noninvasive procedure that produces a two-dimensional view of an internal organ or structure, an MRI can help identify the source of chronic pelvic pain.
• Pap smears: A pap smear test takes a culture of cells from the cervix and looks for changes in cervical cells that could be precancerous or cancerous.
• Pregnancy test: A pregnancy test can narrow down the cause of pain such as an ectopic or tubal pregnancy.
• Sigmoidoscopy: A short, flexible, lighted tube called a sigmoidoscope is inserted into the intestine through the rectum. By blowing air into the intestine to inflate it, the sigmoidoscope makes viewing the inside easier. A sigmoidoscopy is helpful in identifying the causes of abdominal pain, constipation, diarrhea, abnormal growths and bleeding.
• Ultrasound: A diagnostic imaging technique, ultrasound uses high-frequency sound waves to create an image of the internal organs to determine any abnormalities.
• Urinalysis: A urinalysis test determines if a urinary tract infection (UTI) or a sexually transmitted disease is the source of pelvic pain.
• X-ray: This imaging test uses electromagnetic energy to produce x-ray images of bones and internal organs onto film.

Treating Pelvic Pain

Treatment of chronic pelvic pain varies by the cause, how intense the pain is and how often the pain occurs. Pain relief measures can include medications, physical therapy, nutritional therapy and surgery. Also, because living with chronic pelvic pain can be stressful and upsetting, counseling may be helpful as part of an overall treatment plan. Your healthcare team can provide more information about various treatments, including therapies that will address a specific cause of pain, once the cause is identified.

Chronic pelvic pain specialists at UH have the advanced expertise needed to provide comprehensive evaluation and treatment plans, which may include:

• Pain management, including alternative therapies
• Medications, including antibiotics, anti-inflammatories and oral contraceptives
• Minimally invasive surgery
• Behavioral therapy for psychological causes of pelvic pain

Pelvic Floor Therapy

If the cause of chronic pelvic pain is pelvic floor muscle dysfunction, University Hospitals provides expert physical therapy for pelvic floor muscle dysfunction through our rehabilitation services. Treatment for pelvic floor muscle dysfunction is different for every woman. We work with patients to help them achieve improvement in daily function and quality of life.

The goal of physical therapy is to alleviate chronic pelvic floor symptoms by restoring awareness, mobility and motor control of the pelvic floor muscles. Your therapy may include any of the following types of treatment:

• Behavioral strategies for daily living: Pain and muscle dysfunction of the pelvis can be affected on a daily basis by many of the habitual choices that we make. This may include what you eat or drink, your physical activities, your level of stress and how you respond to your symptoms. Increasing awareness of behaviors and their results is an important step to regaining healthy function.
• Exercise and movement re-education: Therapeutic exercise techniques are taught to increase pelvic floor strength, awareness and coordination. Improving posture and reducing muscle strain is very important for efficient muscle function. Patients may also benefit from strengthening and flexibility exercise for areas that are closely interrelated with pelvic floor function, such as the abdomen, back and lower extremities.
• Manual therapy: A number of approaches to manual therapy may be used. The therapist may use her hands to mobilize the joints of the spine and pelvis, improving symmetry and comfortable motion.
• Myofascial release therapy: When pelvic muscles and nerves are damaged after pregnancy or trauma, this therapy eliminates painful trigger points within the muscles and improves mobility and circulation in the tissues. Unrestricted, pain-free movement is the goal of myofascial release. When comfort and resiliency are restored to the muscles, strength and coordination can begin to improve.