Chronic pelvic pain — disabling and persistent pain for at least three to six months, affects 25% of reproductive-aged patients, but some studies have found higher rates (up to 39%). Its causes can vary significantly and range from issues with organs inside the body such as the bladder, the intestines or the uterus, to issues with the complex musculature of the pelvic floor.

The pelvis refers to the area between your hips, whether in the front or the back.

In reproductive-age women, the most common cause of chronic pelvic pain is endometriosis, accounting for about 70% of cases.

Your health care provider can help rule out other sources of pain, such as gastrointestinal issues, before considering gynecologic causes.

Because there’s a wide variety of potential causes, diagnosing this complex condition can be challenging. The board-certified and fellowship-trained OB/GYNs with Norton Women’s Care have the experience and expertise to provide a precise diagnosis and a treatment plan customized for you.

Any chronic pain syndrome, including chronic pelvic pain, can be difficult to pinpoint as far as the cause and can be frustrating for you. You may feel that other health care providers haven’t taken you seriously or dismissed your symptoms. At Norton Women’s Care, you’ll be heard and seen. We will work with you to uncover the cause of your pain and help you along the journey of addressing it.

Your health care provider will start the diagnostic process by collecting a detailed medical history from you and performing a physical exam. A pelvic exam often can pinpoint the source of your pain if it is related to the pelvic floor muscles or ligaments.

Imaging tests such as ultrasound, CT scan or MRI may be needed to examine the pelvic area.

Laparoscopy or cystoscopy — inserting tiny cameras into the area of your body near the pain — can help provide a direct visualization of your pelvic organs.

The treatments for chronic pelvic pain vary as widely as the causes and include medications, physical therapy and pelvic floor exercises, nerve blocks, pain management techniques and support, as the constant pain can take a toll on your mental health. Ultimately, treating the root cause is paramount.

Minimally invasive procedures can address the source of your pain and promote healing. If surgery is required, choose a Center of Excellence in Minimally Invasive Gynecology.

This certification, which has been given to Norton Women’s & Children’s Hospital, recognizes minimally invasive gynecologic surgery programs that are focused on improving the safety and quality of gynecologic patient care and are designed to expand access to minimally invasive gynecologic procedures performed by surgeons.

At Norton Women’s Care, we are committed to achieving high standards in safe, quality care for those who need minimally invasive gynecologic surgery. Our fellowship-trained and board-certified minimally invasive gynecologic surgeons are at the forefront of new discoveries and perform many procedures with only a few small incisions — procedures that traditionally required a large abdominal incision.

Causes of Chronic Pelvic Pain

• Endometriosis. This painful condition is the result of tissue that lines the uterus growing outside the uterus onto other organs or structures. It is most often found on the ovaries, fallopian tubes, outer surface of the uterus and lining of the pelvic cavity and is characterized by severe painful periods, painful sex, and in some cases trouble getting pregnant.
• Ovarian cysts. Symptoms can vary depending on the size, weight, and location of the cyst. The pain can be similar to menstrual pain or can manifest as an intermittent “tugging” sensation when shifting positions. Furthermore, a ruptured ovarian cyst can cause sudden, sharp pain on one side of the lower abdomen. Other cysts may cause a dull pain or a feeling of pressure.
• Interstitial cystitis or painful bladder syndrome. This chronic bladder condition is characterized by painful urination, urinary frequency, and worsening pain if urination is delayed. Menstruation and vaginal intercourse also can be painful if you have this condition.
• A urinary tract infection can cause pain, especially when urinating, pressure in the lower pelvis and a backache. Urinary tract infection pain however, typically wouldn’t last long enough or be persistent enough to qualify as chronic pelvic pain.
• Scar tissue. Surgeries, infections, including pelvic inflammatory disease, or injuries can leave behind scar tissue and adhesions binding internal organs. The result is restricted movement and persistent pain. Physical therapy often can improve mobility and reduce pelvic floor muscle tension. Surgery to restore normal anatomy can be effective in some cases.
• Irritable bowel syndrome. Also known as IBS, this usually presents as lower abdominal cramping that usually is relieved after a bowel movement. Patients also report intermittent diarrhea and constipation.
• Pelvic floor dysfunction. Also known as pelvic floor myalgia, this condition is a muscular pain. The pelvic floor muscles hold up the uterus, bladder and rectum. Like any muscle, they can become strained and irritated. Physical therapy, the use of neuromodulators and nerve blocks can be effective treatments.
• Pelvic inflammatory disease or chronic pelvic inflammatory disease. This is a bacterial infection of the upper reproductive organs. Pain usually is accompanied by purulent vaginal discharge, fevers and abnormal labs. Testing for infections can help evaluate for this.
• Uterine fibroids. A uterine fibroid is a noncancerous tumor that grows in the wall of the uterus. Uterine fibroids can be single masses or clusters and can grow to the size of a cantaloupe and larger.

In men, chronic prostatitis or chronic pelvic pain syndrome is pelvic pain or discomfort, often accompanied by frequent or urgent need to urinate, and sexual dysfunction such as painful or premature ejaculation. Despite the “prostatitis” name, there is no consistent prostate involvement in the condition.

Chronic Pelvic Pain Treatment

The treatment for your pain will depend on the cause. Determining the source of your chronic pain starts with taking your symptoms seriously and providing a correct diagnosis. Sometimes, just knowing the cause of your pain can be a relief, as your condition can create mental stress in addition to debilitating pain.

Every patient’s situation is taken into account in order to formulate a treatment plan that is customized to the individual. In other words, we tailor every available treatment option to your unique set of needs.

Reviewed by Steven J. Radtke, M.D., FACOG, FMIGS, gynecologic surgeon with Norton Women’s Care.