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Exploring the Hidden Truths About Women’s Chronic Pelvic Pain|4 Little Known Facts

May 30, 2024

Chronic pelvic pain (CPP) is responsible for 10 to 20% of gynaecological referrals. One in 7 women has this condition – and you might be one of them – either right now or in the future.

In this post, I will share some facts you may not be told about CPP, which may help you understand and deal with it. If you’re interested, keep reading!

Image of the female anatomy in dark background with the pelvis highlighted and icon of a magnifying glass indicating the need to uncover aspects of chronic pelvic pain

What is Chronic Pelvic Pain?

Have you been experiencing continuous, hourly, daily pelvic pain – pain that happens regardless of whether you are on your menstrual period or not?

It might be pain that has been going on for more than 3-6 months and is located in the pelvis. Your pelvis connects your trunk and legs.

It is the part of your body encompassing your pubis/pubic bone in the front, extending to the bones of the hips at the sides and the sacrum at the back.

Within you, the lower part of the pelvis is called the pelvic floor. It has no top covering or roof, so the organs in the pelvis can grow into the abdomen. This is what happens in the female pelvis as the womb enlarges during pregnancy.

Apart from pain directly in the pelvis, CPP can also affect that part of the abdomen around or below the umbilicus, as well as pain around the lower back and buttocks.

Women with CPP describe experiencing pain so severe they can’t function normally. And it’s not just the experience of pain. 

A large number of women with CPP may have other problems related to the pain.

Examples include:

  • Painful sex and reduced libido,
  • Bladder and bowel problems.
  • Psychological issues may develop – depression and anxiety – to further complicate the condition.

So, it is affecting the quality of life, and women with it have to cut corners to cope with this pain – failing to enjoy life as they should as a result.

When people think of the causes of pelvic pain, we mostly assume the main reason is reproductive – related to the womb, ovaries and so on.

However, this is not really the case.

image of the female pelvis indicating possible muscles and bones involved in chronic pelvic pain

Challenges of Managing Chronic Pelvic Pain

Experiencing CPP can be frustrating and lonely. Sometimes, failure to communicate between the doctors and the patient may lead to this.

So here, let’s look at a few facts doctors may not remember to explain – and which could make a difference in long-term care.

Here’s fact number one.

While reproductive organs are responsible in many cases of CPP, you also have causes related to the gastrointestinal tract, the kidneys and bladder, and related organs, as well as those related to damaged nerves/muscles and the skeleton. 

Here are some more numbers to chew on: in 50-90% of cases where there is CPP, the cause is related to muscle and skeletal dysfunction.

Before we talk about the causes of CPP, it’s good to spend a moment looking at the type of challenge women with this condition may experience.

One of them is the challenge and delay in getting the correct diagnosis.

Most people may feel waiting 3 months (or longer) to diagnose CPP is not appropriate.

But it’s only a way of allowing us to establish a diagnosis for the problem, not that you will not receive care, painkillers or other necessary support during that time.

That way, we could differentiate it from other types of pelvic pain – like acute pain from PID infection.

Next – associated factors like bowel problems or difficulties with sex may make finding the diagnosis a challenge.

Time and care are necessary to explore each woman’s experience and establish the cause.

So this is fact number two: you may not be told why it’s taking so long to get a diagnosis of CPP.

It’s not ideal, but women may visit the doctor several times and use painkillers for a lengthy period before they reach a diagnosis.

If a woman is experiencing pelvic for more than 3 months, it could be from gynaecological reasons like:

  • Adhesions, polyps in the cervix or womb, endometriosis, fibroids, ovarian conditions, disease of the blood supply to the pelvis, and pelvic floor disorders.
  • It could also be from urinary problems, such as chronic or recurring UTIs, Kidney stones or chronic urethral syndrome.
  • But that’s not all; it could also be from gastrointestinal problems, i.e. affecting the stomach and bowels. 
    • Examples here include conditions like Colitis, Chronic constipation, Diverticular disease, Inflammatory bowel disease, Irritable bowel syndrome and more.
  • Sadly, we’re still not done! Nerve and muscle inflammation/ injuries and malformations create syndromes that lead to chronic pelvic pain. What about posture? Or Cancer? Mood-related problems, drug side effects or substance abuse.

Friends, this is NOT an exhaustive list.

I only share them to explain some challenges patients and their doctors experience when managing CPP.

But despite these challenges, there is hope. This condition can be managed – but it has to be a joint specialist approach.

And that brings us to fact or point number three.

A definite treatment may not come from the first doctor you see. It may require multiple specialists to bring things under control. 

Please don’t feel weary or tired when the answer doesn’t emerge straightaway from one specialist or team.

We are still trying to understand this condition, but it can be managed with good integration and knowledge of the different systems involved, like the muscular, neurological, psychological, urinary, etc.

Treatment depends a lot on the cause. 

And here we have fact number four!

Both medication and surgery could be necessary. 

When it comes to drugs, treatment needs to consider what will support a long-term return to normal function.

In respect of painkillers, they can include over-the-counter (OTC) drugs like paracetamol and NSAIDs (non-steroidal anti-inflammatory drugs) like Ibuprofen, Asprin, and Naproxen.

There are prescribed medications, for example, certain antidepressants or other, more potent painkillers.

We often avoid long-term use or overuse of very strong painkillers like opiates or barbiturates when possible. This is because they can lead to more complications like dependence and abuse.

So then I hear you say- what can I use for pain if OTC drugs don’t help?

Other options include physical therapy.

Several examples of physical therapy have shown some benefits in studies:

An essential type of therapy you should also have with CPP is psychological therapy.

  • This includes counselling, relaxation therapy, and stress management, which may all help reduce the severity and frequency of chronic pain.
    • These, alongside simple reassurance or biofeedback, may be helpful with medication or surgery.

Pregnant women may also experience CPP.

Treatment includes both drug and non-drug measures that we’ve talked about, like OTC drugs and physical therapy, where they are safe for mum and baby. 

Chronic Pelvic Pain Syndrome and Advocacy for Prompt Diagnosis

So, these are some of the issues related to CPP that you may not hear about.

  • The challenges with diagnosis and why.
  • A need for several specialists to be involved – e.g., a urologist, gynaecologist, bowel surgeon, and psychologist.
    • This is not because each specialist isn’t skilled enough but because they need to work together to help get the treatment right.
  • The range of treatments – and why some doctors may discourage requests for powerful pain relief long-term- and the alternative options.

Chronic pelvic pain syndrome (CPPS) is pain in the pelvic area that lasts over six months and is severe enough to limit functioning.

It’s also pain that is unrelated to your menstrual cycle, pregnancy, injury to the lower trunk/pelvic area, or pelvic surgery. 

Recognising the need for a specialist approach (often from gynaecology and urology) and the need to care for both mental and physical health appear to be cornerstones for treating the condition.

If you or someone you know is experiencing symptoms of CPP or CPPS, I hope this post helps to encourage and motivate you to:

  • Question your generalist or specialist if you are not clear about aspects of your care
  • Ask about referrals. 
  • Not accept a diagnosis for months or years on end when the treatment is making no difference or to seek a second opinion.

Are you going through CPP (or did so in the past) and feel comfortable sharing some of your experience? Please do so in the comments section; it will be awesome to hear from you.

If you’ve been going through similar symptoms, please seek help from your doctor.

More Reading

Editing by  AskAwayHealth Team

Disclaimer

All  AskAwayHealth articles are written by practising Medical Practitioners on a wide range of healthcare conditions to provide evidence-based guidance and to help promote quality healthcare. 

The advice in our material is not meant to replace the management of your specific condition by a qualified healthcare practitioner.
To discuss your condition, don’t hesitate to get in touch with a health practitioner or reach out to us directly.

Image Credits: Canva

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