What exactly is chronic pelvic pain?
Pain in the pelvis for more than 3 months duration.
What causes chronic pelvic pain?
Pelvic pain can be caused by a number of reasons, which include gynecologic, gastrointestinal, bladder or kidney problems, neurologic, musculoskeletal, psychosomatic, and systemic. It is important that a complete and thorough exam is performed to determine the cause. If the problem is gynecologic some of the causes may be, but are not limited to:
- Endometriosis
- Adenomyosis (Extra growth of endometrial tissue inside the uterus)
- Adhesions
- Uterine fibroids
- Pelvic prolapse
- Ovarian growths
- Vaginal, cervical or pelvic abnormalities
- Nerve damage (neuropathic pelvic pain)
What are the symptoms of chronic pelvic pain?
The nature, intensity and distribution of pain vary. Yet, as stated before the pain lasts for 3 months or longer.
How is chronic pelvic pain diagnosed?
A combination of history, physical examination, laboratory, and additional diagnostic studies as indicated must be done to determine the cause of pelvic pain. Pain mapping is a procedure used to identify the location of the pain with various diagnostic modalities.
- Ultrasound – Ultrasound is a noninvasive way to diagnose some gynecologic conditions. Ultrasound is a noninvasive pelvic imaging technology. It is generally perceived as being no different than a pelvic exam as far as patient discomfort goes. It can help in finding uterine fibroids, ovarian tumors, pelvic abnormalities, adenomyosis and certain cases of endometriosis and occasionally cancer. It is much more accurate than a simple pelvic examination. Limited pain mapping is possible with ultrasound guidance.
- Transvaginal Hydrolaparoscopy (THL) – THL as previously described is useful for diagnosing infertility and endometriosis. Recently, it has been used for pain mapping. Under local IV sedation the patient is conscious and helps the physician denote where and how extensive the pain is. This permits the physician to adequately address the possible treatment modes for pelvic pain. If the pelvic pain is not identified in the posterior pelvis, laparoscopy may be necessary to evaluate the anterior pelvis and the upper abdomen.
- Diagnostic Laparoscopy – This requires 2-4 small incisions in the abdomen so a scope can be inserted through the belly button to diagnose and possibly treat pelvic pain. A 3-mm fiberoptic scope is inserted through the abdomen while the patient has IV sedation to perform pelvic pain mapping. If pathology is found, then operative laparoscopy can be performed at the same time with a general anesthetic. Return to work should be anticipated in approximately 2 weeks.