ObGyn

Midsouth Wellness Guide

Pelvic Pain in Women

By Riad Homsi, MD, F.A.C.O.G
Just For Women, PLC Many women have pain in their pelvic region at some point in their lives. Each woman responds to pain in her own way. The type and duration of the pain will help identifying the problem but often, there is more than one reason for the pain and its exact source can be hard to identify. leaks uid or bleeds a little. This happens usually around the middle of the menstrual cycle but goes away within a day or two. However, some cysts may last a long time, and they are felt as a dull ache or heaviness and sometimes they can cause pain during sex. Most of the small cysts will go away by themselves. Others may need surgery iii. Ectopic pregnancy. It is a pregnancy outside the uterus, most often in one of the tubes. This usually happens in women who had damage to their tubes or they had previous history of PID. The pain starts on one side of the abdomen after a missed period. Vaginal bleeding or spotting may occur with the pain and this problem needs immediate attention and requires sometimes surgery. iii. Chronic pain. By denition, chronic pelvic pain is a non-cyclic pain of six or more months duration that localizes to the pelvis, anterior abdominal wall at or below the umbilicus (navel), the lower back or the buttocks and is of sufcient severity to cause social disability and lead to medical care. Examples of chronic pain include the following: i. Dysmenorrhea, which means pain with menstrual periods. It is usually caused by prostaglandin, which is a hormone made by the lining of the uterus (endometrium), which causes spasm or cramping of the uterus Endometriosis and adenomyosis. Sometimes, menstrual cramps can get worse over the years and may be due to conditions like endometriosis iv. or adenomyosis. Endometriosis occurs when the endometrium (internal womb lining) is found in other areas outside the uterus as over the ovaries, bowel, bladder or peritoneum (inside lining of the pelvis). This often makes menstrual cramps worse or can cause pain at different times during the menstrual cycle. Sometimes, intercourse is painful. However, the severity of the pain does not depend on the amount of endometriosis present. On the other hand, adenomyosis occur when the endometrium buries itself in the muscle wall of the uterus, which can cause menstrual cramp. It may also cause pressure and bloating feeling in the lower abdomen before period and heavier bleeding during the period. Fibroids are benign growth that arises from the muscle tissue of the uterus. They can grow on the inside of the uterus, on its outer surface or within the uterine wall. Fibroid often cause no symptoms; however, when symptoms do occur, they may include heavier or more frequent menstrual periods and pain or pressure in the abdomen or lower back. Adhesion or scar tissue can form as a result of the healing process. Scar tissue causes the surface of organ structures inside the abdomen to bind to each other. Conditions like endometriosis, surgery or severe infection like PID can cause adhesion or scar tissue. Those adhesions can cause constant vague pain.

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Causes of pelvic pain aredivided in two categories:

Acute and chronic

Acute pain. It is a pain that startsover a short period of time fromfew minutes to few days Usually,it has one cause and most oftenan exam and some tests can nd the reason. Some of the causesof acute pain include the following: i. Infection. Pelvic pain can be caused by an infection or inammation, which may involve the reproductive organs, or other organs like the bladder, the bowel, or even the appendix. Pelvic inammatory disease (PID) is a term that has been used to describe infection of the uterus, the fallopian tubes, and the ovaries. Most cases of PID are thought to come from sexually transmitted diseases. Infection of the bladder or the kidneys may also cause pain usually felt during urination with a strong and frequent urge to urinate when there is little urine in the bladder.

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Ovarian cyst. A cyst is a uid lled sac that may develop in an ovary. Those cysts sometimes will form as a ii. result of normal process of ovulation, i.e., release of an egg from the ovary. Sharp pain can occur if a cyst

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v. Pelvic congestion is the presence of varicose veins lateral to the wall of the uterus. This may cause vague pain in the pelvis. Musculoskeletal pain that starts with the pregnancy or immediately following the delivery may suggest peripartum pelvic pain syndrome, which is caused by strain of the ligament in the pelvis and lower spine from a combination of factors including hormonal change, damage to pelvic ligament, muscle weakness, and the weight of the fetus and the uterus. In addition, faulty posture may account for about 75% of the cases of chronic pelvic pain. Other musculoskeletal disorders may cause or contribute to pelvic pain and this includes trigger point, bromyalgia, and pelvic oor (supporting tissue of pelvic organs) myalgia. GI disorders. This includes conditions like irritable bowel syndrome, hernia, lactose intolerance, and inammatory bowel disease Urologic disorders. This include interstitial cystitis which is a condition in which the women feel the need to urinate urgently and frequently and cause them to have pelvic pain or pressure that interferes with their lives in the absence of bladder infection. Physical and sexual abuse. Studies have found that 40% to 50% of women with chronic pelvic pain have a history of abuse, whether physical or sexual. The mechanism is unclear. Laparoscopy is the best testto accurately assess endometriosisand some other causes of pelvic pain. This is a type of surgerywhere a slender camera is inserted through the navel while you areasleep under anesthesia. Usually, B. all the female internal organs canbe seen through it. Sometimes,treatment can be done at the sametime. have been used in some patients with pelvic pain and depression to break the connection. Surgery. Certain problems may be treated with surgery but the type of surgery depends on the specic problem. Your doctor will discuss those options with you. Other treatments. Heat therapy, muscle relaxants, nerve block, and relaxation exercises may help to treat other problems. There are other specic treatments for pain arising from the bladder, bowel or other organs.

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Treatment. Acute pain often involves treatment of one specic condition. However, treatment of chronic pain is different and may involve several medications at once, non-drug treatment, and surgery as well. A. Medication. Antibiotic can be used to treat the pelvic infection or urinary tract infection or any other STDs. Drugs like ibuprofen can be used to reduce the inammation and lessen the cause of the pain or menstrual cramps. For other problems, treatment with hormones may work. Birth control pills can relieve pain from menstrual cramps and ovarian cysts. Other hormones can shrink some types of growth such as endometriosis or broids. Drugs like antidepressants

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About the author

Riad Homsi, M.D. is a board certied obstetrician/gynecologist and a certied menopause practitioner. He is the director of the practice Just For Women, located at 6025 Walnut grove suite 400,Memphis, TN 38120. For more information, please call (901) 50STORK or visit www.justforwomendoc.com

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Diagnosis. Because there are so many possible causes of pelvic pain, nding its cause is a process of elimination and can take a long time. Your doctor will use several different kinds of tests to diagnose the problem. He may ask you to keep a diary to describe the exact nature of the pain, the timing of the day, the relation to eating, urination, bowel movements, intercourse, physical activity, or sleep, and you have to bring that to the ofce to analyze it. You may also have consultation with other specialists. The evaluation also includes an exam looking for tender areas like muscles,ligaments, bladder and pelvicorgans. Cultures, blood tests, and pregnancy tests sometimes can be done to look for the reasons. Other studies are sometimes useful to determine the cause of the pain. They include ultrasound or special X-Ray called CAT scan