Chronic Pelvic Pain

Dr. Wei-Wei Wee-Stekly

Senior Consultant Obstetrician & Gynaecologist

MBBS (London), MRCOG (United Kingdom), MMed (O&G) (Singapore), FAMS (Singapore), FRCOG (United Kingdom)

Chronic pelvic pain is a condition that affects many women, yet it’s often misunderstood, misdiagnosed, or dismissed. If you’ve been living with persistent discomfort or pain in your lower abdomen or pelvis that lasts for months, please see a doctor. Pelvic pain isn’t always tied to menstruation or a single gynaecological issue. However, with the right diagnosis and management plan, it is possible to reduce symptoms and regain quality of life.

What Is Chronic Pelvic Pain?

Chronic pelvic pain refers to pain in the lower abdominal or pelvic region that lasts for at least six months and occurs on most days. It can range from a dull ache to sharp, stabbing sensations and may be constant or come and go in cycles.

Unlike acute pain (which is typically a sign of injury or infection), chronic pelvic pain is more complex. It may have multiple contributing factors, and the pain can persist even after an initial issue has resolved. It’s both a symptom and a condition in itself.

What Are the Symptoms of Chronic Pelvic Pain?

Symptoms vary from person to person and may be influenced by underlying conditions. Common presentations include:

• Persistent lower abdominal or pelvic pain
• Pain during or after sexual intercourse
• Pain while urinating or having a bowel movement
• Lower back pain
• Pain that worsens when standing or sitting for long periods
• Menstrual pain that is more intense or prolonged than usual
• Pain that interferes with sleep, exercise, or daily activities
• Feelings of bloating or pelvic pressure

For many women, chronic pelvic pain can also lead to fatigue, anxiety, depression, and reduced quality of life.

What Causes Chronic Pelvic Pain?

Chronic pelvic pain may have one or several contributing causes. Common gynaecological causes include:

• Endometriosis
• Adenomyosis
• Ovarian cysts
• Pelvic inflammatory disease (PID)
• Uterine fibroids
• Pelvic adhesions (scar tissue from surgery or infection)

Other possible causes outside the reproductive system include:

• Irritable bowel syndrome (IBS)
• Interstitial cystitis (painful bladder syndrome)
• Musculoskeletal issues (e.g., pelvic floor muscle tension)
• Nerve entrapment or neuropathic pain
• Past trauma or emotional stress
• Previous pelvic surgery or childbirth injuries

In some cases, no obvious cause can be found, and the condition is known as chronic pelvic pain syndrome.

How Is Chronic Pelvic Pain Diagnosed?

Diagnosing chronic pelvic pain requires a detailed and compassionate approach. Your doctor will begin with a comprehensive medical history, including:

• When the pain started and how it feels
• Its location, pattern, and severity
• Triggers or relieving factors
• Menstrual and sexual history
• Past medical or surgical treatments
• Impact on daily activities and emotional well-being

Investigations may include:

• Pelvic examination
• Transvaginal or abdominal ultrasound
• MRI for detailed pelvic imaging
• Laparoscopy (a keyhole procedure to examine the pelvic organs and detect conditions like endometriosis)
• Urine and blood tests
• Gastrointestinal and bladder assessments if non-gynaecological causes are suspected

Because chronic pelvic pain is often multifactorial, a collaborative approach may be needed.

When Should You See a Gynaecologist?

It’s important to seek care if:

• You’ve had pelvic pain for six months or longer
• The pain is interfering with your daily life, work, or relationships
• You’re unable to have comfortable sexual intercourse
• Pain worsens over time or is associated with other symptoms like heavy bleeding or digestive problems

Early evaluation allows for timely diagnosis and treatment, helping you avoid unnecessary suffering and regain control of your life.

How Is Chronic Pelvic Pain Treated?

Treatment depends on the underlying cause (if one is found), the nature of the pain, and how it’s affecting your life. In many cases, a combination of therapies is most effective.

Medical Treatments

• Hormonal therapy (for conditions like endometriosis or adenomyosis)
• Pain relief medications (NSAIDs, nerve pain modulators)
• Antibiotics if infection is present
• Muscle relaxants or antispasmodics
• Treatment of associated conditions (e.g., IBS or bladder issues)

Surgical Treatment

• Laparoscopy to diagnose and treat endometriosis or remove cysts or adhesions
• Hysterectomy in severe cases with identifiable causes, such as adenomyosis or fibroids

Non-Surgical and Supportive Therapies

• Pelvic floor physiotherapy to address muscle tension or dysfunction
• Cognitive behavioural therapy (CBT) for pain coping strategies
• Nerve blocks or pain management procedures
• Dietary changes for gut-related symptoms
• Stress reduction techniques like mindfulness or yoga

Each patient’s journey is unique. Your doctor will work with you to create a plan that not only addresses the pain but also supports your emotional and functional well-being.