Pelvic Pain; Diagnosis

NWHRC Health Center - Pelvic Pain, June 9, 2005

As with many pain conditions, chronic pelvic pain (CPP) can be difficult to diagnose. For one thing there is no screening test. For another, because symptoms may be variable, it can be difficult for a woman to define and localize her pain. Finally, there are all those possible causes and associated conditions to investigate.

Conditions that can cause pelvic pain may be divided into six categories:

The most common cause of chronic pain is fibromyalgia. For more information on this condition, visit the "Fibromyalgia" topic at this Web site.

Gynecologic conditions

* Endometriosis is a condition in which tissue that makes up the lining of the uterus (endometrium), exits the uterus and attaches to the ovaries, fallopian tubes, bowels or other organs in the abdomen. Because endometrial tissue responds to hormone changes during a woman's menstrual cycle, the abnormally located tissue swells and bleeds, sometimes causing pain. Endometriosis pain is not always restricted to the menstrual cycle. Many women with endometriosis have pain at other times of the month. Endometriosis can also scar and bind organs together, cause tubal (ectopic) pregnancies and lead to infertility, although these outcomes are unusual. In fact, some women with endometriosis have neither pain nor fertility problems.

* Fibroids are benign (non-cancerous) tumors or clumps of abnormal tissue that can grow inside, in the wall of or outside the uterus. Many women don't know they have fibroids since often they have no symptoms. However, depending on their location, fibroids may cause pelvic pain, backaches, heavy menstrual bleeding, pain during intercourse and such urinary problems as incontinence, frequent urination and repeated urinary tract infections (UTIs). They rarely interfere with fertility or pregnancy. Pain with fibroids is very unusual; most women with pain and fibroids have the fibroids coincidentally with another cause of the pain.

* Adenomyosis, like endometriosis, involves the abnormal growth of cells from the uterine lining. In this case the cells grow into the wall of the uterus where clumps of them press against the muscle fibers there. The result is painful cramps and heavy menstrual bleeding.

* Adhesions are fibrous bands of scar tissue that form after surgery or a condition that causes inflammation. When these bands tie organs and tissues together inappropriately, even normal movements and sex may stretch the scar tissue and cause pain. When adhesions block the fallopian tubes or ovaries, infertility can result. If they wrap around the bowel, they can result in bowel obstruction.

* Pelvic inflammatory disease (PID) includes any infection or inflammation of the fallopian tubes, uterine lining and ovaries. It often begins as a sexually transmitted infection. Many women with PID have no symptoms or only mild symptoms (abnormal vaginal bleeding or discharge, or pain with intercourse) and may not seek treatment. However, left untreated, PID may cause scar tissue to form that can lead to chronic pelvic pain, abscesses, tubal pregnancies and infertility.

Urinary Tract Disorders

* Interstitial cystitis (IC) is an inflammatory condition in which the bladder wall becomes irritated, scarred and stiff for reasons that are unclear. The lining of the bladder that protects the wall from irritation seems to break down. The resulting discomfort can range from tenderness to intense pain in the bladder and surrounding area. Symptoms include more urgent and frequent need to urinate. Of those with IC, 90 percent are women, whose symptoms may get worse during menstruation. Pain may also intensify during intercourse.

* Chronic urethritis is an inflammation and irritation of the urethra (the tube through which urine is eliminated from the bladder) caused by either an infection or a narrowing of the tube.

Intestinal disorders

* Irritable bowel syndrome (IBS) is characterized by abdominal discomfort or painful cramping, bloating and gas and constipation or diarrhea (or bouts of both). Stress and depression can increase the symptoms, as can particular foods and beverages. Women are three times more likely to have IBS than men and their symptoms are often worse during their periods. For more information on IBS, visit the "IBS" topic at this Web site.

* Diverticulosis occurs when small pockets develop in the wall of the large intestine. When these pockets get plugged with undigested food, an infection can develop in the bowel wall causing diverticulitis. Usual symptoms are pain in the lower left abdomen, fever and constipation.

Skeletal disorders

* Scoliosis (lateral curvature of the spine), herniated disks in the lumbar (lower) region of the back and other disorders of the bones in the pelvic region can result in chronic pelvic pain.

Psychological disorders

* Depression is a common and treatable illness; chronic pain can be one symptom of depression.

Other conditions

* Hernias, which occur when the intestine pushes through the abdominal wall can cause pelvic pain.

* After abdominal surgery, nerves may get entrapped by re-grown tissue, causing pain. Pelvic pain can also develop from a nerve disorder similar to phantom limb pain. In this case, the discomfort remains even after the pelvic organ has been removed.