Chronic pelvic pain (pain between your belly button and upper thighs, including painful intercourse) can be very distressing and many times takes numerous tests and doctors to diagnose. Many times, when patients get to me, they have seen multiple physicians, none of which have been able to help or give them a diagnosis. Through a thorough history and exam, and review of prior testing, we are able to make a diagnosis and come up with a treatment plan. The pain may be constant or intermittent and may have obvious triggers, but sometimes not. It can have origins from your pelvic muscles, pelvic nerves, vaginal skin, bladder, bowel, uterus, and ovaries. Treatment is typically multi-modal including physicians, physical therapists, pain management, and therapists.
Chronic pelvic pain often starts with a trigger, such as a bladder infection, endometriosis, or stress. Even after the initial trigger has been treated, pain can stick around for years. This is due to up-regulation of the pain receptors in the pelvis and brain.
In many cases, there are multiple causes of pain. The goal of treatment is to reduce your pain and other symptoms and improve your quality of life.
The most common causes of pelvic pain are:
- Interstitial cystitis (IC)
- Pelvic floor dysfunction (PFD)
- Ovarian cysts, pelvic masses
- Pudendal neuralgia
- Irritable bowel syndrome (IBS)
- Post-traumatic stress disorder
- Genitofemoral nerve pain
Examples of Treatments:
- Surgeries for endometriosis, fibroids, ovarian cysts, pelvic masses, heavy periods (in conjunction with a gynecologist)
- Trigger point injections into pelvic floor
- Bladder instillations
- Medications for IBS, IC, depression, anxiety, vulvodynia, and vestibulitis
- Nerve block injections for pudendal neuralgia
- Comprehensive education about your pelvic pain
- Physical therapy for pelvic floor