Dr Arun

NEWS

August 15, 2016 News

Living with Chronic Pelvic pain in women and the origin can be elusive

Although many women experience pelvic pain, a Health study indicates that only a small fraction of these women report their symptoms to their doctors and seek treatment, leaving some health problems unresolved.

It’s important that women get treatment for pain, because aside from the obvious effects, pain also affects women’s overall health and how they feel about themselves. The researchers found that women who reported higher levels of pain also reported having a lower overall quality of health.

What is chronic pelvic pain?

Chronic pelvic pain is pain in the area below your bellybutton and between your hips that lasts six months or longer.

It is common and affects around 1 in 6 women. It can be distressing and affect a woman’s ability to carry out everyday activities

What are the symptoms?

When asked to locate your pain, you might sweep your hand over your entire pelvic area rather than point to a single spot. You might describe your chronic pelvic pain in one or more of the following ways:

Severe and steady pain
Pain that comes and goes (intermittent)
Dull aching
Sharp pains or cramping
Pressure or heaviness deep within your pelvis
In addition, you may experience:

Pain during intercourse
Pain while having a bowel movement or urinating
Pain when you sit for long periods of time
Your discomfort may intensify after standing for long periods and may be relieved when you lie down. The pain may be mild and annoying, or it may be so severe that you miss work, can’t sleep and can’t exercise.

When to see the specialist?

With any chronic pain problem, it can be difficult to know when you should go to the specialist. In general, make an appointment with your specialist if your pelvic pain disrupts your daily life or if your symptoms seem to be getting worse.

What causes chronic pelvic pain?

Chronic pelvic pain is usually caused by a combination of physical, psychological and/or social factors rather than a single underlying condition, although for many women a cause cannot be found.

Some common causes include:

endometriosis, a condition where the lining of the womb (endometrium) is found elsewhere in the body, usually in the pelvis – endometriosis and adenomyosis
(a condition where the endometrium is found in the muscle of the womb) can
cause pain around the time of a period and during sex
Bladder pain Syndrome/interstitial cystitis (bladder inflammation)
For example, a woman might have both endometriosis and interstitial cystitis, both of which contribute to chronic pelvic pain. This is called evil twins of Pelvic Pain.

80% women with Pelvic pain may have one or other or both of these conditions.

pelvic inflammatory disease, which is an infection in the fallopian tubes and/or pelvis
irritable bowel syndrome (IBS)
musculoskeletal pain (pain in the joints, muscles, ligaments and bones of the pelvis)
Pelvic congestion syndrome. We believe enlarged, varicose-type veins around your uterus and ovaries may result in pelvic pain.

Psychological factors. Depression, chronic stress or a history of sexual or physical abuse may increase your risk of chronic pelvic pain. Emotional distress makes pain worse, and living with chronic pain contributes to emotional distress. These two factors often become a vicious cycle.

What happens when you see a specialist?

Figuring out what’s causing your chronic pelvic pain often involves a process of elimination because many different disorders can cause pelvic pain.

In addition to a detailed interview about your pain, your personal health history and your family history, your specialist may ask you to keep a diary of your pain and other symptoms.

What tests or exam I would need?

Pelvic exam. This can reveal signs of infection, abnormal growths or tense pelvic floor muscles.
Lab tests. During the pelvic exam, your specialist may order labs to check for infections, such as chlamydia or gonorrhea. Your specialist may also order bloodwork to check your blood cell counts and urinalysis to check for a urinary tract infection.
Ultrasound. This test uses high-frequency sound waves to produce precise images of structures within your body. This procedure is especially useful for detecting masses or cysts in the ovaries, uterus or fallopian tubes.
Other imaging tests. Your doctor may recommend abdominal X-rays, computerized tomography (CT) scans or magnetic resonance imaging (MRI) to help detect abnormal structures or growths.
Laparoscopy. During this surgical procedure, your specialist makes a small incision in your abdomen and inserts a thin tube attached to a small camera (laparoscope). The laparoscope allows your specialist to view your pelvic organs and check for abnormal tissues or signs of infection. This procedure is especially useful in detecting endometriosis and chronic pelvic inflammatory disease.
Cystoscopy.This involves passing a small telescope (cystoscope) into your bladder through your urethra (the tube that carries urine from the bladder to outside the body)
Finding the underlying cause of chronic pelvic pain can be a long process, and in some cases, a clear explanation may never be found.

With patience and open communication, however, you and your specialist can develop a treatment plan that helps you live a full life with minimal discomfort.

What treatment may help?

If your specialist thinks that your pain is due to a particular cause then you should be offered treatment for that condition:

Bladder pain syndrome – several therapies are available.
Endometriosis- Following laparoscopy, you may be offered hormonal treatment.
irritable bowel syndrome (IBS) – medication and changes to your diet may help
infections should be treated (usually with antibiotics)
Some women find acupuncture or complementary therapies, or changing diet, helpful. 
Whatever your situation, you should be offered pain relief.

Chronic pelvic pain can be very difficult to live with and can cause emotional, social and economic difficulties. You may experience depression, difficulty sleeping and disruption to your daily routine.

For Treatment enquiries, please contact

Dr. A S Arun MD DNB CCST, FRCOG, FRANZCOG

Waikiki Specialist Centre
221 Wilmott Drive
Waikiki 6169
WA

Tel: 08 95500300
Fax: 08 95929830
Email: specialists@waikikiprivatehospital.com

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