Chronic pelvic pain has many possible causes, and the symptoms may vary with what’s causing the pain. Pain can be caused by a gynecologic condition, or be the result of an intestinal, urinary or muscular problem. Pelvic pain can even be a manifestation of stress or depression.

Common reasons for pelvic pain include:

• Pelvic Adhesions – Adhesions are bands of scar tissue that bind organs together. They are created by previous infections such as appendicitis or pelvic inflammatory disease, by pelvic or abdominal surgery or by endometriosis. Symptoms from adhesions include generalized pelvic discomfort or localized pain. Adhesions can be difficult to diagnose, however in some cases, the uterus and ovaries feel bound together on pelvic examination. A definitive diagnosis of adhesions is usually made during surgical exploration, frequently via laparoscopy. Surgery to cut bands of scar tissue can relieve pain. However, sometimes the adhesions re-form.
• Uterine Fibroids – Fibroids are non-cancerous (benign) growths that develop within the uterus. Most women with fibroids have no symptoms and don’t need treatment. When symptoms occur, women should seek medical attention.
• Ovarian Cysts – Cysts are closed sacs that contain fluid, semifluid or solic material.
• Irritable Bowel Syndrome – This is a very common cause of pelvic pain. It may be associated with diarrhea, constipation or a combination of both. Symptoms of bloating and discomfort may be relieved by a bowel movement. Stress and diet can aggravate the condition. The gynecology provider may make a referral to a gastrointestinal specialist for diagnosis and treatment.
• Bladder Problems – Pelvic pain may be triggered by a bladder condition. Pain associated with the need to urinate frequently or urgently may need to be evaluated by a urologist.
• Myofacial Trigger Points – Chronic pain can be created by spasm of the muscles that line the pelvis. On pelvic examination, there may be tenderness and tightness in particular muscles.
• Depression – Recurring or chronic pain can cause some women to feel depressed. These feelings are normal. In some cases, pelvic pain can be a symptom of depression or anxiety.
• Endometriosis – This is a condition in which the lining of the uterus (endometrium) grows outside the uterus. The lining can attach to the ovaries, fallopian tubes, intestines or other structures in the pelvis. It may cause pelvic pain, especially during menstruation. Hormones of the menstrual cycle cause the endometriosis to bleed each month. This can be painful and result in the formation of pelvic adhesions, also known as scar tissue. Blood trapped in the ovary can build up into a cyst. This is called an endometrioma.
• Vulvodynia – Vulvodynia is pain at the opening to the vagina or the surrounding lips (vulva). The cause is unknown. It’s thought that the nerves, muscles and tissues in the area are inflamed, so treatment is focused on addressing these factors. Women with this condition may find it painful to insert a tampon, have sexual intercourse or even wear tight pants. Symptoms include burning, stinging, stabbing, irritation and rawness. The pain may be constant or intermittent, localized or diffuse.
• Musculoskeletal Causes – The muscles, joints and nerves in the pelvis can be injured just like any other part of your body. For instance, tissues can be overstretched, torn or cut in childbirth or surgery; muscles can weaken or tighten from disuse and injury; and habitual postures and movements can slowly stretch or compress structures in the pelvis, leading to pain and dysfunction. The pelvic muscles, joints and nerves may be the sole cause of pain or just a piece of the problem. A thorough examination of the abdomen and pelvis can uncover these sources of pain, which can be treated with physical therapy and biofeedback.

Treatment for chronic pelvic pain is tailored to each patient, depending on the underlying causes of the pain. Some treatment options include:

• Hormones for conditions such as endometriosis or heavy menstrual bleeding.
• Pain medications such as narcotics, nonsteroidal anti-inflammatories or medicines for nerve pain.
• Surgery for some women with adhesions, adenomyosis or endometriosis.
• Physical therapy and biofeedback for women with myofascial (connective tissue) or muscle pain.
• Mind/body techniques such as meditation, breathwork, guided imagery and yoga.
• Nutrition and supplements — for instance, a diet rich in fruits, vegetables and grains is important. Avoiding foods that can increase inflammation and increasing foods that decrease inflammation can be useful.
• Alternative healing systems such as traditional Chinese medicine, which have been found to help relieve pain.
• Psychological therapy, medication, or both to help you cope with chronic pain. A therapist can offer support and tools to handle living with chronic pain, and can also help you and your partner cope with the relationship and sexual issues that can arise as a result of chronic pain.