Chronic Pelvic Pain: A Tricky Diagnosis
by Jennifer Wider, MD
Many women with chronic
pelvic pain suffer in silence. Roughly 60 percent of patients never receive
a proper diagnosis, according to statistics gathered by the Mayo Clinic. Many
women bounce around to different health practitioners without ever being treated.
"Up to 20 percent of women
between the ages of 18 and 50 have chronic pelvic pain of over a year's duration,"
says John M. Gibbons, M.D., director and chair of the Department of Obstetrics
and Gynecology at St. Francis Hospital in Hartford, Conn. The difficulty of
obtaining a proper diagnosis and adequate treatment is due in part to the
fact that many doctors are not well informed about the causes of pelvic pain,
Diagnosing chronic pelvic
pain can be challenging. One of the reasons that making the diagnosis is tricky
relates to the fact that there is no single underlying cause of chronic pelvic
"There is no universally
accepted definition of chronic pelvic pain," Gibbons explained. "A working
definition is non-cyclic pain of at least six months duration localized to
the anatomic pelvis including the anterior abdominal wall, the lumbosacral
back, and the buttocks."
Chronic pelvic pain can
be caused by a of host gynecological conditions including endometriosis, fibroids,
vulvodynia (chronic vulvar discomfort), spasms in the pelvic floor muscles
and pelvic inflammatory disease. Chronic pelvic pain can also result from
irritable bowel syndrome, bladder infections and varicose-type veins around
the ovaries. Psychological factors including depression, sexual abuse and
excessive stress have also been cited as potential triggers.
Women who suffer from chronic
pelvic pain usually experience pain in the area below the belly button. To
be classified as chronic, the symptoms typically last for at least six months.
The pain ranges from mild to severe and can vary from person to person. Some
women complain of steady pain. For others, the pain comes and goes. The pain
can be sharp, dull, cramping or feel like pressure or heaviness.
Most women with chronic
pelvic pain realize that something is wrong. But even when the signs are there,
the diagnosis may still be a challenge.
"Even when pathology is
present, accurate diagnosis may be difficult because of the nature of visceral
pain; it may be difficult for patients to localize, may vary under hormonal
influences, and is variable from person to person," explains Linda Porter,
Ph.D., who is a neuroscience program director at the National Institutes of
Health in Bethesda, Md.
Women who experience pain
in the pelvic region for more than six months should see a doctor.
"There are myriad ways
to arrive at a particular diagnosis," Gibbons said. "The woman's history will
establish the broad diagnosis of chronic pelvic pain. Identification of the
cause entails further history, physical examination, laboratory tests, and
special procedures that may range from neurophysiologic studies, to GI [gastrointestinal]
endoscopy, to pelvic laparoscopy, to sophisticated imaging such as CT scans
[also known as CAT scans or Computed Axial Tomography imaging] or MRIs [magnetic
Because there are many
different causes of chronic pelvic pain, treatment will depend on the cause.
"Medication, physical therapy, surgery, and techniques of alternative or complementary
medicine such as acupuncture and massage are commonly used," Gibbons said.
The way in which patients
perceive and handle pain can vary from person to person. "Psychological
concerns often arise in patients with chronic pain and should be addressed
in the treatment strategies. Patients cope with, perceive, and respond to
pain differently, because of many factors, including genetic, ethnic, and
sex differences," Porter explained.
The Society for Women's
Health Research is the nation's only not-for-profit organization
whose sole mission is to improve the health of women through research. Founded
in 1990, the Society brought to national attention the need for the appropriate
inclusion of women in major medical research studies and the resulting need
for more information about conditions affecting women. The Society advocates
increased funding for research on women's health, encourages the study of sex
differences that may affect the prevention, diagnosis and treatment of disease,
and promotes the inclusion of women in medical research studies. Dr. Donnica
Moore has been a member of the Society since 1990 and is a past member of its
Board of Directors.
Created: 6/9/2005  - Jennifer Wider, M.D.
Reviewed: 6/14/2005  - Donnica Moore, M.D.