Thinking Outside the Box About Pelvic Pain

by Kanisha L. Sierra-Ríos, MD, FACOG –

Chronic pelvic pain (CPP) is pain in the pelvic area that lasts for 6 months or longer. CPP can present a major challenge for health care providers because of its complex nature and numerous etiologies. In the United States, estimated direct costs for outpatient visits for CPP are close to $1 billion per year. An estimated 15-20% of women between the ages of 18-50 have pelvic pain that has been present for more than a year. CPP causes missed days from work or school, anxiety, depression, sexual dysfunction, and overuse of painkillers including narcotics. The numbers are alarming, so we need to address the issue and get the conversation started about pelvic pain.

Some possible causes of pelvic pain include:

Gynecologic

Fibroids, endometriosis, ovarian cysts, dysmenorrhea (pain during your periods), adhesions (scar tissue from prior surgeries), pelvic inflammatory disease, ovulation pain, and pelvic congestion syndrome can all cause pelvic pain.

Urinary:

Kidney stones, interstitial cystitis (inflammation of the bladder wall), recurrent urinary tract infections (UTI), and tumors can all cause pelvic pain.

Gastrointestinal:

Constipation, Irritable Bowel Syndrome, diverticuli-tis, and tumors can cause pelvic pain.

Musculoskeletal:

Disc disease, nerve pain, low back pain, myofascial pain, and being overweight/obese can cause pelvic pain.

Identifying the correct cause of pain will determine the most adequate course of treatment. Because gynecologists are actively involved in the primary care of women, we are typically the starting point for CPP evaluations. We have learned that not all etiologies of CPP are gynecological in nature. For this reason, CPP is a medical issue best managed using a multidisciplinary approach that could include referrals for Gastroenterology, Urology, and/or Pelvic Rehabilitation.

We invite you to open up about pelvic pain so we can better under-stand, diagnose, and manage your symptoms. Make your appointment today, so we can help start you on the path of living a pain-free life!