What is the cause of pelvic pain?

From the Guidelines

Pelvic pain should be initially evaluated using transabdominal and transvaginal ultrasound when the differential diagnosis is primarily of gynecologic origin, as recommended by the American College of Radiology Appropriateness Criteria 1. When considering the management of pelvic pain, it is crucial to determine the underlying cause, as treatment depends on the specific condition. For immediate relief, over-the-counter pain medications like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) can help manage discomfort. Applying a heating pad to the lower abdomen for 15-20 minutes several times daily may also provide relief. Some key points to consider in the evaluation and management of pelvic pain include:

• Common causes of pelvic pain include urinary tract infections (requiring antibiotics), menstrual cramps (responsive to NSAIDs and hormonal treatments), endometriosis, ovarian cysts, pelvic inflammatory disease, or musculoskeletal issues 1.
• If the pain is severe, persistent, or accompanied by fever, vomiting, bleeding, or difficulty urinating, seek immediate medical attention.
• Lifestyle modifications like regular exercise, stress reduction techniques, and avoiding trigger foods may help manage chronic pelvic pain.
• Pelvic floor physical therapy can be beneficial for pain related to muscle tension or spasm.
• In postmenopausal women, the most common causes of pelvic pain from gynecologic origin are ovarian cysts, uterine fibroids, pelvic inflammatory disease, and ovarian neoplasm, and imaging modalities such as CT with intravenous contrast or MRI may be useful for further characterization 1. Given the complexity and variability of pelvic pain, a thorough evaluation by a healthcare provider is essential to determine the underlying cause and develop an effective treatment plan, with consideration of the most recent guidelines and evidence-based recommendations 1.

From the Research

Pelvic Pain Management

• Pelvic pain is a common and burdensome condition that affects a significant portion of the female population, with chronic pelvic pain (CPP) accounting for 40% of laparoscopies and 12% of hysterectomies in the US annually 2.
• The management of chronic pelvic pain poses a significant challenge to both physicians and patients, requiring a comprehensive evaluation of both gynecologic and nongynecologic conditions 3.

Diagnostic Evaluation

• Interventional procedures, such as superior and inferior hypogastric plexus blocks, ganglion impar blocks, and transversus abdominis plane blocks, can be applied for diagnostic evaluation and treatment of pelvic pain 4.
• A thorough history, physical examination, and imaging studies are essential for diagnosing the underlying cause of pelvic pain 5.

Treatment Options

• Treatment of chronic pelvic pain may involve medical and surgical options, including hormonal therapy, opioid therapy, and alternative therapies such as physical therapy and cognitive-behavioral therapy 6.
• Multidisciplinary chronic pain management, including a team of clinicians from various disciplines, is recommended for women with chronic pelvic pain 6.
• Musculoskeletal pain and dysfunction are common in patients with CPP, and treatment may involve trigger point injections, sacroiliac joint injections, and neuromodulation approaches 4, 2.

Patient-Centered Care

• Patient involvement, shared decision-making, and functional goal setting are essential components of the evaluation and management process for chronic pelvic pain 2.
• Clinicians should consider centrally mediated pain factors, as well as pelvic and nonpelvic visceral and somatic structures that can generate or contribute to pain, when managing chronic pelvic pain 2.
• Trauma-informed care and pelvic musculoskeletal examination are essential to reduce patient anxiety and avoid missing the origin of myofascial pain 2.