Disclaimer :: This great insight into chronic pelvic pain is sponsored and written by Dr. Catherine Bevan, a local Tarrant County OB/GYN.
Dealing with chronic pelvic pain is an awful, frustrating experience. It is estimated that 15 percent of reproductive-aged women are forced to tackle this common problem. Despite countless physician visits, laboratory tests, imaging studies, and hours of pain, many women are left without significant answers or relief of their symptoms. Chronic pelvic pain (also known as CPP and is defined as non-cyclic pelvic pain for at least six months) is a symptom that may be caused by more than 50 different etiologies. This complicates diagnosis and treatment and often results in a “trial and error” approach to pain management. Gynecologic, mental health, urinary tract, gastrointestinal, musculoskeletal, and neurologic disorders have all been shown to cause chronic pelvic pain. Further complicating things is the fact that CPP can also be the end result of several different medical conditions. For this reason, a physician’s approach to management of CPP focuses on relief of symptoms and determining the underlying cause.
Here, I will cover a few of the most common causes of CPP with the caveat that this barely scratches the surface of potential diagnoses.
- Endometriosis: Endometrium (the lining on the interior of the uterus) can sometimes implant elsewhere outside the uterus (usually within the pelvis). This phenomenon is termed endometriosis. These implants of endometrial tissue are benign and quite common. Depending on the extent of implantation, they may be asymptomatic or they may cause pain, infertility, bowel, or bladder symptoms. Diagnosis is usually made by exploratory surgery (laparoscopy) though often physicians will start empiric treatment before proceeding with surgery. The implants can be treated with medications (pain and hormone therapy) as well as surgical removal.
- Leiomyomas (fibroids): These are benign tumors of the smooth muscle cells within the uterus. They are exceedingly common (up to 70-80 percent) and most often do not cause any symptoms. However, large fibroids may cause pressure and chronic pain within the pelvis. They can also lead to abnormal uterine bleeding and reproductive dysfunction. If fibroids cause symptoms, they can be surgically removed.
- Interstitial cystitis (bladder pain syndrome): Usually considered a diagnosis of exclusion, interstitial cystitis is caused by chronic inflammation of the bladder wall, leading to chronic pain as well as several other urinary symptoms such as urinary frequency, hesitancy, and pain with urination. Treatment is complicated and ranges from conservative therapy (diet and stress management) to medical management and even occasionally to invasive intervention such as cystectomy (removal of the bladder).
- Irritable bowel syndrome (IBS): A gastrointestinal pain syndrome characterized by chronic or intermittent abdominal pain associated with bowel function. IBS is a common disorder (about 10 percent of people have symptoms consistent with IBS) that is also a diagnosis of exclusion. Treatment is highly dependent on a patient’s specific symptoms.
There are few things more frustrating for patients than chronic pelvic pain. As with all of medicine, communication is paramount in order to achieve good outcomes. The best treatment plan is very individualized for each patient and should consider patient preferences and values regarding testing, medical versus surgical treatment, and future childbearing plans. Many times, there will be a combination of therapies recommended, and a multidisciplinary approach is often necessary to achieve relief of symptoms.
Dr. Catherine Bevan is a board certified obstretician and gynecologist, who practices in Tarrant County, with offices in Fort Worth and Willow Park. She is a Fort Worth native and received her Bachelor of Arts degree from Washington University in St. Louis where she graduated cum laude, Phi Beta Kappa. She then returned to Texas to complete her medical degree at UT Southwestern as well as her residency training at Parkland Memorial Hospital. She also spent an additional year as an assistant professor at UT Southwestern, specializing in gynecologic surgery and emergency women’s care. Providing excellent service to her patients is a passion for her as she guides them to the best possible healthcare outcomes.
You can read more from Dr. Bevan on the Fort Worth Moms Blog archives.
You can contact Dr. Bevan at:
- 1250 8th Avenue, Ste 320 // Fort Worth, TX 76104 // (P) 817-924-2111 // (F) 817-564-3980
- 134 El Chico Trail, Suite 103 // Willow Park, TX 76087 // (P) 817-441-1644 // (F) 817-441-1626