Basics of Top Pelvic Pain Treatment

Pelvic Pain

Pelvic pain is a common issue for many women. Often, the cause of pelvic pain is unknown, with no evident disease in some cases. Pelvic pain can be of a chronic nature, meaning it is constant or frequently comes and goes for longer than six months.

What causes pelvic pain?

Pelvic pain may originate in the reproductive organs or lower abdomen structures, and is pain in and around the pelvic region. Causes of pelvic pain include:

• Inflammation and/or irritation of the nerves that supply the pelvis by fibrosis, injury, intraperitoneal inflammation, or pressure.
• Cramps and/or contractions of both skeletal and smooth muscles.
• Ectopic pregnancy (occurs outside the uterus).
• Recurrent menstrual cramps and pain.
• Endometriosis (uterine tissue growing outside the uterus).
• Uterine fibroids (growths in or on the uterus wall).
• Scar tissue in or between the pelvic cavity internal organs.
• Reproductive tract cancers.

How common is chronic pelvic pain?

In a recent 3-month prevalence study, 15% American women aged 18 to 50 years had chronic pelvic pain. In the U.K., the rate was as high as 38 per 1,000 person years.

What symptoms are often associated with pelvic pain?

Pelvic pain can be different for everyone. The pain can be cramping, throbbing, aching, sharp, or dull. In addition, it may be associated with heavy menstrual bleeding or defecation. The pain may be worse with movement or during an examination.

How is pelvic pain diagnosed?

To diagnose the cause of pelvic pain, the doctor will ask many questions about your symptoms, inquire about your medical history, and conduct a pelvic and physical examination. Tests used to diagnose pelvic pain include:

• Blood tests – Various laboratory tests to check for infection, inflammation, and chronic conditions.
• Urinalysis – Urine sample evaluation to check for infection, blood, and other abnormalities.
• Pregnancy test – Used to assess for tubal or normal pregnancy.
• Culture of cells from the cervix – Obtained during pelvic exam.
• Ultrasound – Simple diagnostic test that uses sound waves to create images of internal organs
• Computed tomography (CT) scan – A test that uses x-ray technology to develop horizontal images of the body structures.
• Magnetic resonance imaging (MRI) scan – A noninvasive procedure that produces a two-dimensional view of internal structures.
• Laparoscopy – Minor surgery using a thin tube with a light to assess the pelvic area.
• Colonoscopy – Involves insertion of a long, flexible scope into the rectum and colon to assess for growths, inflamed tissue, bleeding, and ulcerations.

How is pelvic pain treated?                            

Chronic pelvic pain treatment is focused on curing the underlying problem. With chronic conditions, treatment focuses on alleviating symptoms. The options of treatments are:

Superior hypogastric plexus block – The superior hypogastric plexus is a bundle of nerves that supplies the pelvic region. With this procedure, the doctor inserts a small needle near the nerves using x-ray technology for correct placement. A long-acting anesthetic and/or neurolytic agent (phenol or alcohol) is injected onto the nerves to block pain signals. According to medical reports, this procedure has a 72% efficacy rate when neurolysis was added, and a 70% success rate without it.

Celiac plexus block – For severe lower abdominal pain associated with the celiac plexus nerves, the doctor injects an anesthetic and/or neurolytic agent onto these nerves. This procedure has an 85-90% success rate, according to clinical studies.

Intrathecal pump implant – The doctor can surgically place a small pump in the lower abdomen or buttock region. A catheter runs from the pump to the spinal cord region. The pump delivers narcotic pain medication to bypass the gastrointestinal tract. In a recent clinical study, the pump had an 86% efficacy rate.

Transcutaneous electrical nerve stimulation (TENS) – This device delivers mild electrical currents via wires that attach to electrodes, which are placed on the skin near the spine. These electrical sensations interfere with transmission of pain signals.

Medications – Chronic pain is often treated with a combination of medications. Common agents used include tricyclic antidepressants (nortriptyline and amitriptyline), anticonvulsants (Tegretol and Neurontin), anti-inflammatory agents (ketoprofen and naproxen), and muscle relaxants (Baclofen and Flexeril). In addition, narcotic analgesics are used short-term for severe pain.

Premier Pain & Spine in Chicago offers top treatment for all types of pelvic pain with both medication management and interventional procedures. Pain clinics are open in Chicago, Downers Grove, Park Ridge, Wilmette, Glenview, Schaumburg and Berwyn. Call us today!

Resources

Corrado P, Alperson B, & Wright (2006). Perceived success and failure of intrathecal infusion pump implantation in chronic pain patients. Neuromodulation, 11(2), 98-102.

Mishra S, Bhatnagar S, Gupta D, & Thulkar S (2008). Anterior ultrasound-guided superior hypogastric plexus neurolysis in pelvic cancer pain. Anaesth Intensive Care, 36:732-5.

Schmidt AP, Schmidt SR, & Ribeiro SM (2005). Is superior hypogastric plexus block effective for treatment of chronic pelvic pain? Rev Bras Anestesiol, 55(6):669-679.

Zondervan K & Barlow DH (2000). Epidemiology of chronic pelvic pain. Best Pract & Res Clin Obst & Gyn, 14(3), 403-414.