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Pelvic Pain Assessment
Pelvic pain is one of the most common reasons why women are seen in hospital during reproductive life (from 15-45 years). It can occur at any time (sporadic) or it can be more usually linked to a particular phase of the menstrual cycle (cyclical). Irrespective of when or why it occurs it can lead to severe disruption of personal and family life and warrants investigation and treatment.
What causes it?
Pelvic pain can be caused by a variety of causes and sometimes the cause is not obvious even after full investigation. Listed below are some common or more severe causes of pelvic pain.
• Pelvic infection: this can cause pelvic pain at any time and the onset is normally very quick. Women can become very ill quickly with accompanying fever, vomiting and a vaginal discharge.
• Endometriosis: this is a condition whereby the internal lining of the womb that is shed every month as a period becomes attached to some pelvic organs. It usually causes cyclical pain during menstrual periods but could also cause pain during sex.
• Uterine fibroids: these are benign (non-cancer) swellings of the womb that can give rise to pain and heavy periods.
• Ovarian cysts: these are cystic swellings of the ovaries that normally do not cause pain but that can sometimes undergo accidents which give rise to sudden pain (like torsion or bleeding).
• Cancer: cancer of the ovaries, womb and cervix can give rise to pelvic pain of varying degrees during their course.
• Non-gynaecological causes: sometimes the cause of pelvic pain is not gynaecological including bladder infection or stones, appendicitis and inflammatory large bowel disease.
What problems can it lead to?
Pelvic pain can be debilitating and can lead to disruption of personal and family life. It can contribute to several days of lost productivity from work absences. The impact on the sufferers’ quality of life can be profound. If not investigated and treated properly, the underlying cause can progress to more severe stages when treatment might be difficult or impossible.
How is it investigated?
The key to understanding the nature of pelvic pain is a good history; it is very helpful if affected women can give a detailed history of their symptoms. The doctor will then undertake a full physical examination that includes examination of the abdomen and pelvis. Vaginal and cervical swabs will be taken during the examination to check for infections. A pelvic ultrasound scan is a very useful investigation that can detect the presence of swellings and cysts of the pelvic organs. Sometimes, all of these might not reveal the cause of the pain and it might be necessary to undertake a minor (day-case) surgical procedure called laparoscopy to inspect the inside of the abdomen and pelvis.
How is it treated?
The treatment of pelvic pain is essentially the treatment of the underlying condition although other general measures are sometimes used in attempts to control the pain.
•General measures: these generally aim to control pain, thereby reducing suffering and improving quality of life. Many painkillers help but the anti-inflammatory variety have been found to be particularly useful. Women with cyclical pain that is associated with menstrual periods often benefit from having fewer periods and this can be achieved with hormone preparations (like the pill). It might be useful to stop periods completely for some time and this is achieved with regular monthly injections. Women often enquire about complimentary therapies such as acupuncture; we advise that these can be used alongside the traditional measures detailed above so long as they do not entail taking additional medicines that could interact with the pain killers.
•Specific treatment: this is essentially treatment of the underlying cause and these will be covered in those specific sections. Pelvic inflammatory disease is usually treated successfully with antibiotics but surgery might be necessary very occasionally to deal with more severe cases. Endometriosis can be treated by medical means (hormonal tablets, painkillers, stopping periods) but surgery offers the only real chance of eradicating the condition. Fibroids can be treated by surgical removal (myomectomy) or hysterectomy (for older women) or by blockage of the blood supply to the fibroid (uterine artery embolisation).
Long-term outlook for women with pelvic pain
Most forms of pelvic pain are treated successfully by the measures outlined above. However, a small number of sufferers with chronic pelvic pain might unfortunately not be helped by these (even after pelvic clearance). These situations are very difficult to manage and sufferers are ultimately referred to the care of chronic pain specialists.