Chronic pelvic pain is a common problem and presents major challenges to the health care provider. In many cases there is no clear cause for this, 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.

What is chronic pelvic pain?
Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It is always subjective. Chronic pelvic pain is usually defined as pain in the pelvic region (including lower back and anterior abdominal wall) for 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. Despite many years of research the cause of chronic pain is still unclear.

What are the common causes of chronic pelvic pain?
Causes of chronic pelvic pain may be varied and can be classified as gynaeclogical and non-gynaecological. Chronic pelvic pain may result from psychological disorders or neurological diseases. In many cases no cause can be found for the chronic pelvic pain.

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. 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. Based on the patient’s history, pelvic examination and test results the doctor may find one or more conditions that could cause or worsen the pelvic pain.

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 include exercise and physical therapy.

A number of surgical procedures as well can be used in the treatment of chronic pain . 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.

Prognosis
Many individuals with chronic pelvic pain suffer for many years before going to see a doctor. Indeed, many refuse to visit their doctor for this disorder. Anyone with such pain should visit their doctor as failure to make the correct diagnosis can lead to prolonged suffering, marital and family problems and loss of employment. Some individuals with pelvic pain do have a poor response to therapy, but with the various modern treatments now available many of them can receive some benefit from therapy.

Conclusion
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 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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