Doctor Armando Librino M.D.— Photo courtesy of Hanoi French Hospital
by Doctor Armando Librino M.D.*
Chronic pelvic pain is pain that occurs in the pelvic area (below the belly button) and lasts for at least six months. It may or may not be associated with menstrual periods.
While chronic pelvic pain can be a symptom caused by one or more different conditions, in many cases, it is a chronic condition related to how the central nervous system processes threat perception (often called centralised pain).
When this happens, the nervous system overreacts to various triggers, and the person experiences more pain than would normally be expected.
Causes of chronic pelvic pain
A variety of gynecologic, gastrointestinal, urologic, musculoskeletal, and body-wide disorders can cause chronic pelvic pain.
Gynecologic causes — Chronic pelvic pain is thought to have gynecologic causes (originating in the female reproductive tract) in approximately 20 per cent of women. Some of the gynecologic causes of pelvic pain include:
Endometriosis — The tissue lining the inside of the uterus is called the endometrium. Endometriosis is a condition in which endometrial tissue is also present outside of the uterus. Some women with endometriosis have no symptoms, while others experience marked discomfort and pain and may have problems with fertility
Uterine fibroids — Fibroids, also called leiomyomas, are growths in the uterus. They are not cancerous. While not everyone with fibroids experiences symptoms, some women do have pelvic pain, heavy periods, or fertility problems.
Adenomyosis — This is a condition in which endometrial tissue (the tissue that normally lines the inside of the uterus) grows inside the uterine walls. It causes an enlarged uterus and heavy, painful periods, and often affects women who also have endometriosis or uterine fibroids.
Pelvic inflammatory disease — Pelvic inflammatory disease (PID) is an acute infection usually transmitted through sexual activity. Occasionally, it is caused by a ruptured appendix, tuberculosis, or diverticulitis. PID can involve the uterus, ovaries, and fallopian tubes (which link the ovaries and uterus). Chronic changes following pelvic inflammatory disease occur in approximately one-third of women and cause chronic pelvic pain. The reason for this is not clearly known, but is likely because of permanent damage to the uterus, ovaries, and fallopian tubes, and not because of a chronic infection.
Pelvic adhesive disease — Adhesions refer to abnormal tissue that causes internal organs or structures, such as the ovaries and fallopian tubes, to adhere or stick to one another. It is very controversial whether adhesions cause pelvic pain, and medical experts are not in agreement. However, most evidence suggests surgery for a pelvic adhesive disease is not a reliable or long-lasting treatment for pelvic pain in most women.
Other causes — Non-gynecologic causes of chronic pelvic pain may be related to the digestive system, urinary system, or irritation in the muscles and nerves in the pelvis:
Irritable bowel syndrome — Irritable bowel syndrome is a gastrointestinal condition characterised by chronic abdominal pain and altered bowel habits (such as loose stools, more frequent bowel movements with the onset of pain, and pain relieved by defecation) in the absence of any identifiable cause.
Painful bladder syndrome and interstitial cystitis — Bladder pain syndrome and interstitial cystitis (PBS/IC) are the terms given to bladder pain that is not caused by infection. Symptoms usually include the need to urinate frequently and a feeling of urgently needing to urinate. Some women with bladder pain syndrome have lower abdominal or pelvic pain in addition to urinary tract symptoms.
Diverticulitis — A diverticulum is a sac-like protrusion that sometimes forms in the muscular wall of the colon (or intestine). Diverticulitis occurs when diverticula become inflamed. This usually causes abdominal pain; nausea and vomiting, constipation, diarrhoea, and urinary symptoms can also occur. Diverticulitis most often causes acute abdominopelvic pain and is an uncommon cause of chronic pain.
Pelvic floor pain — Symptoms of pelvic floor dysfunction may include pelvic pain, pain with urination, difficulty urinating, constipation, pain with intercourse, or frequent/urgent urination. Pelvic floor dysfunction can be diagnosed by a clinician feeling the pelvic floor muscles (muscles that support the pelvic organs and hips) through the vagina and/or rectum; muscles that feel tight, tender, or band-like indicate that pelvic floor dysfunction could be contributing to pelvic pain.
Abdominal myofascial pain (trigger points) — Pain can originate from the muscles of the abdominal wall due to myofascial pain. This problem usually has small localised areas of abnormal tenderness of the abdominal muscles called trigger points. Abdominal myofascial pain is diagnosed by the clinician examining the abdominal muscles for trigger points; often tightening these muscles while they are examined causes increased pain and assists in diagnosis.
Fibromyalgia — Fibromyalgia is one of a group of chronic pain disorders that affect connective tissue structures, including muscles, ligaments, and tendons. It is characterised by widespread muscle pain (or myalgia) and tenderness in certain areas of the body. Fibromyalgia itself may cause heightened sensitivity to pain in the pelvic area. However, in people whose central nervous system is not functioning normally, this likely contributes to both chronic pelvic pain and fibromyalgia-related pain. Women with fibromyalgia may also experience fatigue, sleep disturbances, and mood disturbances such as depression and anxiety.
Physical, sexual, or mental abuse — People with chronic pain in general appear to have a higher incidence of prior traumatic experiences, such as procedures at an early age, familial instability in childhood, or physical or sexual abuse; the same appears to be true for women who experience chronic pelvic pain. Do not be afraid to tell your health care provider if you have ever been (or are currently being) hurt by someone or if you feel unsafe at home or in your relationship. They can help you. — Hanoi French Hospital
To be continued on Monday 17
*Doctor Armando Librino is a Specialist in Obstetrics & Gynecology at Hanoi French Hospital.
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