What is Chronic Pelvic Pain?
In general, pain is described as chronic when it has been present continuously for three months, despite treatment of what was thought to be the original cause. Chronic pelvic pain is different for every woman, coming and going, growing or lessening in severity, but remains in a certain area; anywhere below the stomach and into the pelvic area. This pain develops over the course of several years. A common early complaint is a feeling of period pain or cramps that persist long after the period is over. Eventually, this discomfort is present every day, and becomes associated with natural events like bowel movements, ovulation, urination, and sexual intercourse. While chronic pain can never be cured completely, it can be properly managed, treated, and lessened- though as the patient, you should manage your expectations.
How Do You Know if You Have Chronic Pain?
As the nature of chronic pain is that of discomfort without any clear cause, diagnosing it is often done through a process of elimination. Women suffering from apparent chronic pain may have seen multiple health professionals and undergone several surgeries such as laparoscopies and cystoscopies (keyhole surgery and bladder examination respectively). You may feel as though nobody has been able to help.
Unfortunately, diagnosis is done by exclusion, meaning that no obvious cause for the pelvic pain has been found. The physical examinations and investigations aim to make sure that there is no obvious cause that needs to be specifically treated; if there is no obvious cause, it might be chronic pain.
Ultrasound is the best imaging technique for examining the pelvic organs, but in rare cases other tests may be requested to examine other abdominal/pelvic structures, such as the spine.
How Can Chronic Pelvic Pain be Treated?
As with any other chronic health condition, pelvic pain can be managed through a variety of adjustments to everyday life, from work to leisure, as well as through medical and non-medical intervention. The crucial thing to note is that as the patient, you are the driver of these managements and plans.
Chronic pain can be minimised to some degree by catching and treating episodes early. For instance, painful periods in young girls should be taken seriously, and as menstruation is usually predictable, it is advised to take simple over-the-counter medication as soon as possible. For those who want to avoid medication, other means such as herbal remedies, heat packs and acupuncture can provide some relief.
Understanding that pain can be perceived by the brain without an underlying condition (such as endometriosis), is an important step in the management of chronic pain. The most important step then is the acceptance that treatment no linger involves ‘removing’ a cause, or finding a ‘cure’.
Identifying the triggers of pain is a similarly important step of treatment. In the case of chronic pelvic pain, ovulation is an important trigger, as is the menstrual period. Changing your hormone levels with contraceptive pills to suppress these triggers may have a positive impact on your pain. In addition, pacing yourself is important. Avoid excess physical activity that may lead to days when your pain level is higher and will result in reduced activity.
A combination of psychotherapy and physiotherapy can also be beneficial. Learning simple psychological techniques to change your mindset and reduce pain perception can be a potent tool. Consult a psychologist to receive help preparing yourself to tackle this problem. This can be used in conjunction with physical therapy and osteopathy, aimed at identifying muscle and posture issues that can arise as a result of your pain. Together, these can provide a framework of mental and physical exercises to assist with change.
Finally, medication is often required to treat chronic pain. Pelvic pain may respond to non-steroidal medications such as ibuprofen, as well as low-dosage anti-depressants. This classification is just a name; you don’t have to be depressed to gain benefit from these drugs, and you should not be deterred by any stigma. Strong painkillers such as opioids are rarely recommended for chronic pain, as they can actually worsen pain in the long term, or create a dependency. It is best to stay away from opioids, even weak ones, wherever possible.
Though chronic pelvic pain cannot be cured, that does not mean you are without help. Through early diagnosis, a combination of physical and mental changes, and conventional medications, your pain can be managed and minimised, offering you some relief.
For more information on Chronic Pelvic Pain, view The Royal Australian and New Zealand College of Obstetricians and Gynecologists guidelines.
If you are experiencing Chronic Pelvic Pain, make an appointment with Dr.Nicole Stamatopoulos here.