Chronic pelvic pain is a common gynaecological cause for women to see their doctor. In many cases there is no clear cause for the chronic pain, making it difficult to cure or manage. It is estimated that approximately 15 to 20% of women aged 18-50 years have chronic pelvic pain of greater than one year’s duration.

Dr. Brett Hodge

What is chronic pelvic pain?
Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is always subjective. Chronic pelvic pain is usually defined as pain in the pelvic region (including lower back and anterior abdominal wall) for the duration of six months or more. The pain is usually noncyclic in nature and is of sufficient severity to cause functional disability or lead to medical care.

What are the common causes of chronic pelvic pain?
Causes of chronic pelvic pain may be varied and can be classified as gynaecological and non-gynaecological. Chronic pelvic pain may result from psychological disorders or neurological diseases.

Common gynaecological causes include the following:
• Endometriosis
• Cancers
• Pelvic congestion
• Pelvic inflammatory disease
• Adhesions
• Cysts
• Fibroids

Non-gynaecological causes include:
• Irritable bowel syndrome
• Chronic urinary tract infection
• Cystitis
• Musculoskeletal disorders
In many patients with chronic pelvic pain no cause can be clearly identified.

Diagnosis
A detailed history and physical examination are very important in making a diagnosis of chronic pelvic pain. The experienced doctor must rule out a number of potentially life threatening conditions. Very often referral to a number of specialists may be required before a diagnosis can be made. An ultrasound scan is very useful for evaluation of the pelvis. Other tests may be done if required.

Treatment
Treatment is usually directed to specific diseases that cause chronic pelvic pain. In many patients no cause can be identified and treatment must be directed to alleviating the symptoms. A variety of medications are available for treating chronic pelvic pain. Non-medical approaches to its treatment include exercise and physical therapy. A number of surgical procedures can be used in the treatment of chronic pain as well.

Up to 50% of women with chronic pelvic pain have a history of physical or sexual abuse and these women may benefit from counseling and psychotherapy.

Conclusion
In Anguilla chronic pelvic pain is a common reason for women to see a doctor. In many cases the pain can be very severe and persists for many months. There are a number of diseases that cause or associated with chronic pelvic pain. In many women no cause can be clearly identified. A number of treatment approaches are available for women with chronic pelvic pain and these individuals should see a qualified and experienced physician for a full evaluation and treatment.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. Dr. Brett Hodge is an obstetrician/gynaecologist and family doctor who has over twenty years in clinical practice. Dr. Hodge has a medical practice in the Johnson Building in The Valley.

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