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Pelvic pain is pain that occurs in the lower abdomen and pelvis. The pelvic region is the area between the umbilicus (belly button) and the groin in the front and between the buttocks at the back. The pelvic area mainly consists of reproductive, urinary and digestive organs such as uterus, bladder, and intestines.

Pelvic pain can be acute or persistent (chronic). Acute pelvic pain occurs suddenly and stays only for a short period of time. Persistent pelvic pain lasts for more than six months and does not show any improvement with treatment.

Symptoms

Pelvic pain may be dull or sharp; persistent or intermittent; mild to severe and can extend to your lower back or thighs.

The common symptoms with pelvic pain are:

  • Pain in the hip and groin area
  • Pain and cramps during menstruation
  • Pain during urination, bowel movements, and intercourse
  • Fever or chills
  • Constipation or diarrhoea

Causes
The common causes of acute pelvic are:

  • Twisted or ruptured ovarian cyst
  • Pelvic inflammatory disease (infection of the reproductive organs)
  • Urinary tract infection
  • Appendicitis (inflammation of the appendix)
  • Ectopic pregnancy (pregnancy that occurs outside the uterus)
  • Ruptured fallopian tube
  • Miscarriage or threatened miscarriage
  • Congestion or abscess (collection of pus) in the pelvic region

Persistent Pelvic Pain:

The common causes of persistent pelvic pain are:

  • Endometriosis (abnormal growth of uterus lining)
  • Chronic pelvic inflammatory disease
  • Adhesions from previous surgery
  • Interstitial cystitis (inflammation of the urinary bladder)
  • Irritable bowel syndrome

Diagnosis of Persistent Pelvic Pain

Persistent pelvic pain is diagnosed based on your medical history and pelvic examination. Certain tests such as ultrasound, laparoscopy, cystoscopy, colonoscopy, and sigmoidoscopy may be performed to find out the cause of your pain.

Treatment of Persistent Pelvic Pain

There are several treatment options to manage persistent pelvic pain (PPP) and these are best managed with a multi-disciplinary team, consisting of a gynaecologist, a pain specialist, a pain psychologist and a pelvic floor physiotherapist with an interest in pelvic pain. Dr Whittaker has experience working with the multidisciplinary Persistent Pelvic Pain team at the Mater Public hospital. She is closely connected with colleagues with an interest in PPP and can form such a team for you.

Treatment strategies include lifestyle changes, physical therapy, psychological therapy, medication, and rarely surgery.

Lifestyle changes: Lifestyle changes such as maintaining a balanced diet, mindfulness meditation, yoga and regular gentle exercise/ stretching help reduce pain. To avoid flares, pace yourself and the intensity of activities you undertake.

Diet: Seeing a gastroenterologist and a dietician or nutritionist may guide you to manage your diet better. Many people with PPP have IBS or Painful Bladder Syndrome (PBS). Following a FODMAP diet can help with IBS and therefore your pain, just as a diet suitable for PBS can make a big difference to your pain.

Mental Wellbeing: PPP can have a large impact on your mental wellbeing, and mental strategies can aid you in better managing your pain. A pain psychologist is highly trained in this area.

Menstrual Suppression: Pain from the menstrual cycle can aggravate PPP. “Switching off” the menstrual cycle with the oral contraceptive pill, Mirena, Implanon or Depo is usually recommended. Sometimes oral progestins are used instead/ as well, such as Primolut, Provera or Visanne.

Pain Medications: Pain medications such as Amitriptyline (tablets or cream), Gabapentin, Pregabalin or Duloxetine may be used to better manage your pain, in addition to Vitamin B1 and magnesium supplements. While simple painkillers such as paracetamol and non-steroidal anti-inflammatory tablets are encouraged, opioid pain medication should be discouraged. Rectal diazepam can be useful for acute flares.

Pelvic Floor Physiotherapy: A pelvic floor physiotherapist with an interest in PPP can help you with overactivity/ spasm of the pelvic floor muscles. Sometimes devices are used to help with this or to control pain, including dilators, bio-feedback and TENS machines. If pelvic floor muscle spasm is a contributing factor to your pelvic pain, and it is not resolving with pelvic floor physiotherapy, your doctor may discuss Botox injections to the pelvic floor.

Surgery: Most people with a diagnosis of persistent pelvic pain will usually have had at least one diagnostic laparoscopy to assess for endometriosis and other problems that could be causing the pain. If endometriosis was found, it should be removed in its entirety, if possible. Some women will choose to have a hysterectomy. Sometimes a repeat laparoscopy is required a few years later; however, we discourage multiple repeat laparoscopies as this can have risks and is not always helpful.

Other resources:

The Pelvic Pain Foundation of Australia has excellent resources on the topic of persistent pelvis pain, including this moving article: https://www.pelvicpain.org.au/one-womans-story-of-pelvic-pain/

Book: “Endometriosis and Pelvic Pain” by Dr Susan Evans, available here (eBook $22, print copy $27.50 https://www.pelvicpain.org.au/shop/)

Links:

Related Topics

  • Mater Health
  • UroGynaecological Society of Australasia
  • ANZ Vulvovaginal Society