Chronic pelvic pain gives a whole new meaning to having a “gut feeling.”
With so many possible causes, it can be hard to find the source of pain. However, advances in medicine are making diagnoses and treatment more available to the growing number of American men and women reporting this problem.
Jodi Bollenbacher, a physician assistant with Blanchard Valley Health System, practices at Bluffton Hospital’s Pelvic Pain Center. She sheds some light on this too-often discounted condition.
HealthScene Ohio: What are some of the causes of chronic pelvic pain for women?
Jodi Bollenbacher, PA-C: Chronic pelvic pain can have many causes. Pain may be from a single source or from several medical conditions. Symptoms may occur from a gynecologic/obstetric, urologic, gastrointestinal, musculoskeletal, neurologic or psychological source. Some of the most common causes are endometriosis, adenomyosis, musculoskeletal problems, chronic pelvic inflammatory disease, ovarian remnants, fibroids, irritable bowel syndrome, interstitial cystitis (painful bladder syndrome), pelvic congestion syndrome, diverticulitis, pelvic floor dysfunction, fibromyalgia and psychological factors.
HSO: What are some of the complaints that women cite when complaining about chronic pelvic pain?
JB: Patients may present with pain from below the umbilicus (belly button) to between the hips that last for more than six months. They may describe the pain as mild to severe; steady or intermittent; dull, sharp or crampy. They may experience heaviness in the pelvis, pain with intercourse, pain with urination or bowel movements, or pain with prolonged sitting or standing.
HSO: Are there particular age cohorts or demographics that are more susceptible to it?
JB: Chronic pelvic pain affects approximately one in seven women and is one of the most common medical problems among women. Some primary care practices experience a prevalence rate of up to 39 percent of reproductive-aged women with complaints of chronic pelvic pain. Gynecologists may see up to 10 percent of all referrals related to chronic pelvic pain. The U.S. has an estimated direct medical cost for outpatient visits for pelvic pain at $881.5 million per year. The most common age range at presentation is 26-30 years old. A quarter of women with chronic pelvic pain spend two to three days in bed each month, and more than half must cut down on their daily activities one or more days a month.
HSO: What are some of the ways in which pelvic pain can alter a person’s day-to-day activities?
JB: Chronic pelvic pain can alter a person’s activities by making it difficult to sleep, or causing the person to sleep too much. It may also limit daily activities by causing constipation, decreased appetite, slower body movements/reactions, symptoms of depression and reductions in physical activity.
HSO: What are some of the steps taken to determine the nature and cause of the pain?
JB: One of the most important steps to finding the cause of the pain is a complete history and physical, including a pelvic exam. Daily symptom trackers can be very helpful. Lab work, urinalysis and sexually transmitted infection (STI) testing may be useful as well. Imaging studies such as ultrasound, X-ray, CT or MRIs may be utilized.
HSO: What do treatment plans look like?
JB: Treatment plans are sometimes multidisciplinary and can include pharmacotherapy, physical therapy, psychophysiological therapy or surgical care. Treatments are sometimes not curative, but more focused on restoration of normal function with minimal disability, better quality of life and prevention of relapse of chronic symptoms.
HSO: What accounts for some people’s tendency to see pelvic pain as entirely, or at least primarily, psychological?
JB: Chronic pelvic pain can be intertwined with depression, sexual abuse and stress. Emotional distress can increase pelvic pain, possibly by causing the patient to unknowingly contract her pelvic floor muscles, or by causing chemical changes that affect the patient’s ability to cope with pain.
HSO: What are some of the nonsurgical treatments for pelvic pain?
JB: Nonsurgical treatment options may include medications such as over-the-counter pain relievers or non-steroidal anti-inflammatory drugs, antidepressants, anticonvulsants, hormonal treatments, or antibiotics. A physical therapist specializing in the pelvic floor could be very helpful with developing specific stretching exercises, strengthening exercises and relaxation techniques for patients. Psychotherapy can help with cognitive behavioral therapy and biofeedback.
HSO: What about surgical treatments?
JB: Surgical treatments include laparoscopy with the removal of adhesions/endometriosis. A hysterectomy may be indicated in certain patient populations. Trigger point injections or peripheral nerve blocks are options as well.
HSO: What are some of the latest developments in diagnosis and treatment?
JB: Ongoing research continues in studying the pain pathways for chronic pelvic pain. There are new drug developments as well as emerging combinations of several drug options for better symptom control. New treatments include new topical applications, use of specific toxins with analgesic effects, modification of opioid medications, and manipulation of neurotransmitters and hormones responsible for the mediation of pain.
HSO: May chronic pelvic pain be an issue for men, too? What are some of the causes and treatments there?
JB: Chronic pelvic pain in men can be caused by chronic (non-bacterial) prostatitis, chronic orchalgia and prostatodynia. Treatment is not curative, but over time, symptoms can stabilize or improve on their own and a multidisciplinary approach is recommended. Options include medications, myofascial release therapy, and paradoxical relaxation, dietary restrictions, sitz baths, physical medicine/physical therapy evaluation, and psychotherapy.
Garth Bishop is a contributing writer. Feedback welcome at feedback@cityscenemediagroup.com.
About the Expert
Jodi Bollenbacher, PA-C provides care at the Pelvic Pain Center in Bluffton. Bollenbacher received her bachelor’s degree from the University of Findlay. She completed her Master of Science in physician assistant studies at the University of Nebraska.
