Finding answers for persistent pelvic pain

Pelvic pain is pain in the area of your pelvis, below your belly button and between your hips. Pelvic pain can be acute or chronic. The type of pain can range from sharp pains to a dull ache. It can range from cramping to pressure or tingling, and may be experienced in the bladder, bowel, uterus, and ovaries.

Pelvic pain has a broad range of potential causes. These include issues with nerves, organs, joints, or muscles, and can be linked to infections (UTIs), pregnancy-related pain, or organ problems (endometriosis, fibroids).

Sufferers may experience the pain constantly, or it may come and go. There are other symptoms which may accompany pelvic pain such as pain during sexual intercourse, abnormal vaginal bleeding or discomfort during bowel movements.

Persistent pelvic pain (PPP)

PPP is characterised by pain in the pelvic area that lasts for 6 months or more and is present on most days. There are many and varied causes of PPP, and may include conditions such as uterine fibroids, pelvic inflammatory disease, or endometriosis.

There may also be non-gynaecological causes including irritable bowel syndrome (IBS), nerve entrapment, musculoskeletal pains or pelvic floor spasm.

Common symptoms can include:

• Sharp, stabbing, or aching pain

• Pain that comes and goes, or that is continuous

• Pain triggered by certain activities, like sex, exercise, or urination

• Pressure or a heavy, dragging feeling

• Cramps or throbbing

• Tingling or a tight, knotted feeling

Some possible causes of persistent pelvic pain may include:

• Adenomyosis

• Diverticulitis

• Fibroids

• Nerve damage

• Central sensitisation

• Endometriosis

• Irritable bowel syndrome (IBS)

• Interstitial cystitis

• Pelvic floor tension and spasm

• Uterine fibroids

• Musculoskeletal issues

PPP can be a complex condition that begs a multidisciplinary approach. Typically, this will involve a combination of pain management strategies, such as mindfulness-based stress reduction, addressing poor sleep patterns, physiotherapy, and medications.
Identifying and addressing any underlying physical causes of the pain, is also an important aspect of treatment and may include surgery.