Chronic Pelvic Pain - Diagnosis and Treatment

Diagnosis

Doctors start by asking patients about their symptoms and how long they have lasted. They also collect information about family medical conditions, such as a history of endometriosis or painful bladder syndrome.

Doctors often recommend keeping a pain journal. This lets patients track symptoms, frequency, triggers, and how much the pain disrupts daily activities.

Common steps in identifying chronic pelvic pain include:

Physical Examination: Doctors perform a pelvic and bimanual exam to check for tenderness, growths, or tense pelvic floor muscles.
Lab Tests: Blood and urine tests check for infections. Doctors may take swabs to test for sexually transmitted infections like chlamydia or gonorrhea.
Imaging: Ultrasound tests examine the pelvic organs for cysts, fibroids, or other abnormal changes. If needed, doctors use a CT scan or MRI to get more detail about the reproductive organs, gastrointestinal system, and nearby tissues.
Laparoscopy: Doctors perform this minimally invasive surgery to directly see inside the pelvic region. They use it to detect endometriosis, adhesions, or chronic pelvic inflammatory disease that may not show up on imaging alone.

Doctors consider several possible causes during diagnosis:

Possible Cause	Key Features Identified in Exams or Tests
Endometriosis	Lesions found on pelvic organs or tissues
Pelvic inflammatory disease	Signs of infection and inflammation
Ovarian cyst or ruptured ovarian cyst	Cyst detected by ultrasound or sudden pain
Interstitial cystitis/painful bladder	Chronic bladder pain, normal urine tests
Uterine fibroids	Growths seen by ultrasound or MRI
Pelvic congestion syndrome	Dilated veins found via imaging
Irritable bowel syndrome	GI symptoms with no visible pelvic changes
Appendicitis, ectopic pregnancy	Acute symptoms, confirmed by imaging
Malignancy (cancer)	Lump or mass, abnormal imaging results
Nerve entrapment, myofascial pain	Localized pain, response to physical exam
Adhesions	Tissues stuck together, seen with laparoscopy
Primary dysmenorrhea	Pain linked to menstrual cycle

Doctors consider both physical and psychological factors. Stress, anxiety, and depression can worsen chronic pelvic pain or make it harder to manage.

Talking openly with doctors helps in choosing the best treatment options. Sometimes, the direct cause is unclear, but identifying major contributors such as urinary tract infection, adhesions, or inflammation guides care.

Doctors may need several visits, repeated tests, and input from specialists to reach a diagnosis and manage symptoms so patients can continue with daily life.

Treatment

Medicine Options

Doctors use a variety of medicines to help manage chronic pelvic pain. Treatment depends on what causes the pain, and sometimes more than one type of medicine is needed.

Pain Medicines

People often start with over-the-counter pain relief, such as ibuprofen, aspirin, or acetaminophen.
Doctors may prescribe stronger pain medications for more severe cases.
Pain medicine alone usually does not remove all pain connected to pelvic problems.

Hormone-Based Treatments

Doctors often use hormonal therapies, like oral contraceptives or other medications that influence hormone cycles, for pain related to menstruation.
These treatments work by reducing or stopping cycles that may worsen pelvic pain.

Antibiotics

When doctors link the pain to a bacterial infection, they prescribe antibiotics to clear up the infection, which can help relieve symptoms.

Antidepressant and Nerve Medicines

Doctors sometimes prescribe antidepressants even if the patient is not depressed.
These medicines can change the way the brain senses pain and help reduce discomfort over time.
Doctors may also prescribe muscle relaxers if tight muscles are making pain worse.

Table: Examples of Medicines Used

Medicine Type	Main Use
Pain relievers	General pain relief
Hormonal therapies	Pain from menstrual cycles
Antibiotics	Infection-related pelvic pain
Antidepressants	Nerve pain, mood support
Muscle relaxants	Pain from muscle tension

Supportive and Non-Medication Treatments

Several therapies apart from medicines can help reduce chronic pelvic pain and improve quality of life.

Physical Therapy

Physical therapists address tight or sensitive muscles in the pelvic region.
Therapists use techniques like myofascial release, where they stretch and press on muscle spots to ease tightness.
They may use tools such as transcutaneous electrical nerve stimulation (TENS) to deliver mild electric currents to nerves, blocking some pain signals.
Biofeedback helps patients become more aware of muscle tension in the pelvis so they can learn how to relax these areas.
Dry needling places tiny needles into muscle trigger points to try and lower pain.

Nerve Block and Stimulation Therapies

Providers use trigger point injections with numbing medicine to relax painful spots in muscles.
Surgeons may implant a spinal cord stimulation device inside the body to send signals that block pain messages before they reach the brain.
Providers might also use peripheral nerve stimulation and sacral nerve stimulation in certain cases.

Counseling and Behavior-Based Therapy

Counselors or psychologists help patients manage emotional or psychological factors linked to pain.
Cognitive behavioral therapy teaches new ways to handle pain and stress for improved daily function.
Sex therapists help people whose pain is connected to sexual activity and provide strategies for comfortable intimacy.

Surgical Treatment Choices

Doctors may recommend surgery when a clear physical problem has not responded to other treatments or when there are specific conditions such as endometriosis or pelvic adhesions.

Laparoscopic Surgery

Surgeons use minimally invasive laparoscopic procedures with a small camera inserted near the belly button.
They remove or treat tissues causing pain, such as endometriosis growths or pelvic adhesions.
Surgeons use adhesiolysis in laparoscopy to free or remove pelvic adhesions.

Removal of Organs

In select cases, doctors may recommend a hysterectomy (removal of the uterus), sometimes combined with removal of the ovaries (oophorectomy), if other treatments fail.
These surgeries are major and come with possible long-term effects.
Patients should carefully discuss the risks and benefits with a healthcare provider.

Nerve-Targeted Surgeries

Surgeons may perform presacral neurectomy to target nerves linked to pelvic pain, aiming to decrease severe pain that does not respond to other treatments.

Multi-Treatment Pain Management Programs

Some people require a mix of medical and non-medical treatments before they see improvement.

Pain Rehabilitation Approaches

Pain rehabilitation programs provide coordinated care, often led by a team of healthcare professionals.
Programs include physical therapy, medical management, counseling, and help with daily activities.
The aim is to reduce pain and improve the ability to function at home, work, and in social life.

Table: Treatments Often Included in Pain Programs

Treatment Approach	Description
Physical therapy	Stretching, strengthening, and relaxation
Counseling	Emotional and cognitive support
Medicine management	Adjustments and monitoring of medications
Education	Learning about pain and how to manage symptoms
Support groups	Sharing experiences and coping strategies

Many people find the most benefit from using several approaches together, tailored to their unique situation.

Lifestyle and home remedies

Managing long-term pelvic pain often starts with healthy habits at home. Relaxation methods such as meditation and deep breathing help lower stress and make it easier to sleep. Good posture eases pressure on pelvic muscles and joints.

Helpful lifestyle tips:

Keep a Healthy Weight: This reduces strain on the pelvis.
Exercise Regularly: Find an activity you like and move at your own pace.
Practice Relaxation: Try meditation or slow breathing to lessen pain and anxiety.

Tip	Benefit
Good posture	Eases muscle tension
Regular exercise	Improves strength and mood
Healthy weight	Lowers risk of muscle strain

Ask a doctor before starting a new activity if pain is severe.

Other Care Options

Some people use acupuncture to help manage pelvic pain. Practitioners place very fine needles into the skin at certain points.

This method may relieve pain through the release of endorphins, which are natural chemicals the body makes to lower pain. Acupuncture is safe for most people.

Tip: Always talk with a healthcare provider before starting any new alternative or complementary treatment.

Getting Ready for Your Visit

Steps You Can Take Before the Appointment

Taking a few simple steps before the appointment can help make the visit smoother and more helpful.

Writing down symptoms, even those that may not seem connected, gives the provider a clearer picture. Listing any major stresses or changes in daily life that have happened recently is also helpful.

Make a table of all current medicines, including over-the-counter products, vitamins, and supplements. Include the exact amount taken for each item.

Name of Medicine/Supplement	Dose (Amount)	How Often Taken

Bringing a trusted friend or family member can help, as they may remember points or details missed during the visit. They can also provide emotional support if tricky topics come up.

Preparing questions in advance can make the most of the short time in the appointment. Some example questions might be:

What could be causing my pain?
What tests might be needed?
What treatment options are available if a cause is found, and what if no cause is found?
Should I change anything in my daily habits?
Would seeing a specialist be helpful?
Are there cost-friendly medicine options?
Can you recommend written materials or certain websites for further reading?

Bringing up other questions or concerns during the appointment is important too. It is always okay to ask for clarification if something is unclear or confusing.

What Your Healthcare Provider Will Likely Do

The provider will ask many questions to understand the pain better. Some common questions include:

When did the pain begin, and has it changed over time?
Does the pain come and go, or do you feel it all the time?
How much does the pain hurt, and how long does it last when it is present?
Exactly where does the pain occur?
What words best describe the pain (sharp, dull, throbbing, etc.)?

The provider may also ask questions to learn what impacts the pain most. For example:

Do activities like peeing or having a bowel movement cause or change your pain?
Is there a link between the pain and your menstrual cycle (if relevant)?
Does anything you do seem to help or make the pain worse?
How has pain affected your daily life or ability to do things you enjoy?

The provider will review your health history. They may want to know if you have had pelvic surgery, been pregnant, or had certain infections in the past. They will likely ask about current treatments or medicines, along with their results so far.

The provider also considers your emotional well-being and safety. They may ask about changes in mood or feelings of sadness. They may gently ask if anyone has ever touched you against your will, as this can impact health.

Your provider gathers as much information as possible to find the best way forward, whether that means more testing, changes to your current care, or referring you to another specialist.

They might suggest seeing a specialist like a gastroenterologist, physical therapist, or other experts, depending on your symptoms.

Chronic Pelvic Pain – Diagnosis and Treatment