What is chronic pelvic pain?

Pelvic pain is pain below the belly button. Chronic pelvic pain means you've had this pain for at least 6 months. The pain can range from a mild ache that comes and goes to a steady pain that makes it hard to sleep, work, or enjoy life.

It can be hard to know what causes this pain. You may need some tests to find the cause. Some common causes include problems with your reproductive system and diseases of the urinary tract or bowel. Sometimes the pain may be related to past or current physical or sexual abuse. But doctors can't always find the cause. This does not mean the pain isn't real or that it's "in your head." It is real pain, and you need to treat it.

If your doctor finds the cause of the pain, you treat the cause. For example, if the cause is hormonal, you might need to take birth control pills. But if the tests don't show a cause, you can take steps to help with the pain.

It can sometimes be hard to know how long pelvic pain will last and how best to treat it. It's a little different for everyone. But in general:

• When a cause is found and treated, such as an ovarian cyst, the pain will most likely go away.
• When it's hard to find a cause, your doctor can do a number of tests and try certain treatments to see if they work.
• Symptoms that are caused by hormone fluctuations often go away without treatment when menopause occurs.
• If your pelvic pain is caused by neuropathic pain, your doctor may try certain treatments. Sometimes with neuropathic pain, your nerves still send pain signals long after an injury or disease has healed.
• If your pelvic pain isn't getting better after treatment, you may be referred to a pain management clinic for treatment.

Chronic pelvic pain may include severe cramping during periods, pain during sex, or pain when you urinate or have a bowel movement. You may have pain in certain postures or positions. Pain may range from mild to severe or dull to sharp.

Treatment for chronic pelvic pain depends on the cause. Common treatments include birth control pills or hormone treatment for problems related to your periods, or surgery to remove a growth, cyst, or tumor. Or you may get medicine to relieve pain or to help treat the problem that's causing the pain.

Your doctor may do a pelvic exam to check for problems with your reproductive system. The doctor will ask questions about your health and your symptoms. You may have tests, such as:

• Blood and urine tests to look for infection and other problems.
• A pregnancy test.
• Tests for sexually transmitted infections (STIs).

Emotional issues can play a big role in chronic pain. So your doctor may ask questions to find out if depression or stress is adding to your problem. You may be asked about any past or current sexual or physical abuse.

If the first tests don't find a cause, you may have other tests to look at organs in your belly. These may include:

• Transvaginal ultrasound.
• MRI.
• CT scan of the pelvis.

You may also have a type of minor surgery called laparoscopy. This lets the doctor look for problems like growths or scar tissue inside your belly.

Medicine won't cure pelvic pain. But it can help control the pain and keep it from getting worse or becoming chronic.

Some medicines help with pain by controlling hormones. They include:

• Hormonal birth control. This may be used for menstrual pain or pain from endometriosis.
• High-dose progestin. It's sometimes prescribed for pain from endometriosis.
• Gonadotropin-releasing hormone agonists. These may help relieve pain from problems such as endometriosis.

Other medicines used for pain include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). They help relieve pain caused by inflammation or menstruation.
• Tricyclic antidepressant medicines. These are sometimes used to treat chronic pain in other areas of the body. They may help relieve chronic pelvic pain in some cases.
• Anticonvulsant medicines, such as gabapentin. They are sometimes used to treat chronic pelvic pain.

• Be safe with medicines. Read and follow all instructions on the label.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If you have back pain, lie down and elevate your legs by placing a pillow under your knees. When lying on your side, bring your knees up to your chest.
• Put a warm water bottle, a heating pad set on low, or a warm cloth on your belly. Or take a warm bath. Don't go to sleep with a heating pad on your skin.
• Relax. Try meditation, yoga exercises, or breathing.
• Exercise regularly. It improves blood flow and reduces pain.
• Keep a diary. Track your symptoms, menstrual cycle, sexual activity, and physical activity. Track stressful events or illnesses. This can help your doctor find the cause or treat it.

Surgery for pelvic pain is most likely to help when it's done for a specific condition, like fibroids or endometriosis.

Hysterectomy (removing the uterus) is sometimes done as a last-resort treatment. It may relieve pain in some cases, depending on what caused the pain.

With any surgery for chronic pelvic pain—such as hysterectomy or cutting of specific pelvic-area nerves—there's a risk of lasting pain or pain that's worse after surgery. And it can have serious side effects.

During surgery, the doctor may remove scar tissue (adhesions) from previous surgery or from pelvic inflammatory disease or endometriosis. But most studies have shown that this doesn't relieve pain.

Laparoscopy to diagnose chronic pelvic pain may be done before other treatment. Areas of endometriosis or scar tissue may be removed or destroyed during the procedure.

Risk factors are things that increase your chances of getting a certain condition or disease. Risk factors for pelvic pain that becomes chronic include:

• A history of pelvic inflammatory disease.
• A history of physical or sexual abuse. People with chronic pelvic pain are more likely to report abuse in their past.
• A history of radiation treatment or surgery of the abdomen or pelvis. This includes some surgeries for urinary incontinence.
• A history of depression. Pain and depression seem to be related.
• Substance use disorder.
• A problem with the structure of the organs.
• Pregnancy and childbirth that put stress on the back and pelvis. Examples include having a large baby, a difficult delivery, or a forceps or vacuum delivery.

Counseling and mental skills training can help when you have chronic pelvic pain. They help you gain the mental and emotional tools to help manage chronic pain and the stress that makes it worse. You can combine medical treatment with other treatments, such as counseling. This can increase your chances of success.

Common treatments include:

• Cognitive-behavioral therapy. It focuses on changing the way you think about and mentally manage pain. A psychologist, licensed counselor, or clinical social worker who specializes in pain management skills can help.
• Biofeedback. This is the conscious control of body function that you normally control unconsciously.
• Interpersonal counseling. It focuses on managing your life events, stressors, and relationships.

Alternative pain treatments for chronic pelvic pain aren't well studied. But they may help you to manage stress and learn ways to deal with pain.

Acupuncture and transcutaneous electrical nerve stimulation (TENS) have shown some success in relieving painful menstrual periods. Acupuncture and TENS have also been used as a treatment for nonmenstrual chronic pelvic pain, but this hasn't yet been well studied.

There are other low-risk alternative treatments that many people use to help manage pain. They include:

• Relaxation and breathing exercises.
• Hypnosis.
• Guided imagery.
• Aromatherapy.
• Meditation.
• Yoga.
• Massage therapy.

Chronic pelvic pain may be caused by problems in the female reproductive system. These include endometriosis, adenomyosis, and uterine fibroids. Other causes include scar tissue in the pelvic area after an infection or surgery, urinary or bowel diseases, and problems with the muscles, joints, and ligaments in the pelvis, lower back, or hips.

Pelvic pain is pain below the belly button. It's chronic if you've had pain for at least 6 months. It may be a mild ache that comes and goes. Or you might have a steady, severe pain that makes it hard to sleep, work, or enjoy life.