Chronic Pelvic Pain

A large percentage of my practice is women’s imaging and one of the most common complaints that I see on patient requisitions is “Chronic pelvic pain.”

Chronic pelvic pain is diagnosed when pelvic pain lasts for more than 6 months duration. It is a common problem and affects approximately 1/7 women. It is responsible for 10-20 % of all gynecologic visits and is most common in women in the reproductive age group, particularly 26-30 years of age.
In the US, the estimated medical costs for chronic pelvic pain evaluation (women aged 18-50 years) is approximately 881.5 million dollars per year. (medscape.com)

Some causes of chronic pelvic pain include:
Gynecologic: Fibroids, adenomyosis, endometriosis, pelvic congestion syndrome (related to posture and worse at the end of the day), cancer of the uterus and ovaries, scarring or adhesions due to previous surgery.
Urologic causes include: Interstitial cystitis or inflammation of the bladder which is also associated with urgency and frequent urination.
Gastrointestinal: Sigmoid colon adhesions or scarring, inflammatory bowel disease (ulcerative colitis), diverticulits and cancer of the colon.
Musculoskeletal: Vertebral or pelvic fractures, disc herniation, nerve entrapment, abdominal or groin hernias, pelvic floor abnormalities related to child birth and episiotomies.
Neurologic: Constant burning pain can be associated with dysesthesia (distorted or burning sensation) and vulvodynia (vulvar pain).
Psychological: Secondary to sexual abuse.

Helpful information that you can provide your doctor includes:
Location of pain
Quality of pain
Pain Distribution
Intensity or severity of pain.

Various lab tests:
Complete blood count (CBC), to look for signs of infection, anemia, and blood cell abnormalities.
Erythrocyte sedimentation rate (ESR), which if elevated, can indicate infection.
Pap smear, tests for cervical cancer and cervical precancer (dysplasia).
Urinalysis and urine culture, which can pick up signs of infection and kidney stones.
Pregnancy test (human chorionic gonadotropin, or hCG) and ultrasound to check for signs of a tubal (ectopic) pregnancy.
Tests for sexually transmitted infections; chlamydia, gonorrhea, and genital herpes.
Stool analysis, to check for blood.

Various types of imaging (ultrasound, MRI, CT scans) can be useful in determining the anatomical location and cause of chronic pelvic pain.

Laporoscopy, cystoscopy and urodynamic studies may also be required to confirm the cause of chronic pelvic pain.

Diagnosing and managing chronic pelvic pain is possible. Consult a trusted and qualified health advisor to find the source of your pain today.

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