The causes of chronic pelvic pain

Inflamed bladder lining of interstitial cystitis/ J. Gunter

Chronic pelvic pain affects 15% of women. It is one of the most common reasons women seek gynecologic care. To be classified as CPP the pain must be in the lower abdomen (below the belly button) and/or pelvis and be present at least two weeks out of every month.

Many different medical conditions can contribute to CPP, including:

• Muscle pain. The pelvic floor muscles become tight and painful. This can also cause pain with sex and the needing to constantly empty the bladder even when there is very little urine. Muscle pain is the most common cause of chronic pain anywhere in the body.
  

• Endometriosis. This a condition where the lining of the uterus grows outside of the uterus in the belly and on the pelvic organs. Endometriosis typically causes pain 1-2 weeks before and during the menstrual period, but improves once the bleeding stops. Pain that does not get worse with menstrual periods is less likely to be endometriosis.
  

• Irritable bowel syndrome (IBS). IBS is a communication problem between the muscles and nerves in the bowel. This can also produce diarrhea, constipation, or both. Excessive gas and bloating can also be a problem.
  

• Interstitial cystitis. This is a inflammatory condition of the bladder characterized by pain that gets worse as the bladder fills; many women also have the constant urge to urinate.
  

• Neuropathic pain. Nerve pain is the result of inflammation and abnormal communication within the nervous system.
  

• Celiac disease. A gluten allergy that causes inflammation in the bowel. Celiac disease is usually associated with diarrhea.
  

• Inflammatory bowel disease. A chronic inflammation that produces open sores in the bowel. .

Other factors, such as hormones, stress, depression, and inactivity can make pain worse, just like pouring gasoline on a fire. They are not the cause of the problem, but they can make recovery more challenging.

Women should track their pain to see if it is related to their menstrual cycle, bowel movements bladder habits, exercise, sex, or stress. This information can help doctors differentiate between the different causes of CPP.

CPP is complex and there may be several factors contributing to the problem so it is important that a woman with CPP see a doctor who understands the problem. Experts in chronic pelvic pain can be located via the International Pelvic Pain Society.

For more info: on chronic pelvic pain

Remember, this column does not constitute individual medical advice.