Chronic pelvic pain describes ongoing or recurring discomfort in the pelvic area, which can be either constant or intermittent. It can significantly affect physical, emotional, and social well-being.

Common Causes of Chronic Pelvic Pain: 

– Endometriosis

– Pelvic Inflammatory Disease

– Uterine Adenomyosis

– Uterine Fibroids: Benign uterine growths that may cause pressure or pain

– Pelvic Floor Dysfunction: Tension or weakness of the pelvic floor muscles

– Myofascial Pain Syndrome: Trigger points in the pelvic or abdominal muscles

– Hernias or Nerve Entrapment: Such as pudendal neuralgia

– Nerve Damage or Neuropathy: Following surgery or trauma

– Male-Specific causes include Prostatitis, Orchitis, or Epididymitis

Assessment and Diagnosis: 

To understand and treat chronic pelvic pain effectively, a thorough evaluation is necessary to determine the underlying cause.

– Comprehensive history and assessment

– Investigations: Blood tests, ultrasound, X-ray, MRI, CT scan

– Follow-up for a personalised multimodal management plan

– Referrals to specialists (e.g. Gastroenterologist, Gynaecologist, Urologist)

Multimodal Treatment: 

Treatment varies depending on the underlying cause and may include:

– Oral analgesics, including anti-neuropathic medications

– Pain interventions: nerve blocks to the pudendal nerve, pulsed radiofrequency of the nerves, sympathetic ganglion of impar block, and trigger point injections

– Physical therapy: pelvic floor exercises

– Lifestyle and dietary modifications

– Psychological support: stress management and cognitive behavioural therapy (CBT)

– Laparoscopy for suspected endometriosis or adhesions

– Surgery for conditions such as severe endometriosis, fibroids, or pelvic organ prolapse