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Relief From Chronic Pelvic Pain

Many women -- and their doctors -- never realize the mysterious pain they feel has a diagnosis.
WebMD Feature
Reviewed by Louise Chang, MD

Any woman who makes the rounds of doctors without getting relief or even a diagnosis for chronic pelvic pain might begin to question if her pain is real. Experts know that it's real, and they're coming to a new understanding of this baffling syndrome that affects 15% of American women aged 18 to 50, the majority of whom go undiagnosed.

Chronic pelvic pain includes a cluster of conditions, some of which seem improbable because they don't involve the pelvic region. Endometriosis and interstitial cystitis (IC) are among the most common conditions that place women at risk for chronic pelvic pain. Related conditions include vulvodynia, pelvic inflammatory disease, irritable bowel syndrome, scarring after abdominal surgery, fibromyalgia and chronic fatigue syndrome. Many studies have even suggested that women who have suffered physical or sexual abuse are also at risk for chronic pelvic pain. Women with chronic pelvic pain may also have a normal physical exam.

Many women who have these conditions are treated successfully and do not go on to experience chronic pelvic pain. According to the International Pelvic Pain Society, pelvic pain is considered chronic when:

  • It has been present for at least six months.
  • Conventional treatments yield little relief.
  • The degree of pain perceived seems out of proportion to the degree of tissue damage detected by conventional means.
  • Physical appearance of depression is present, such as sleep problems, poor appetite, constipation, and slowed body movements.
  • Physical activity is extremely limited.
  • Emotional roles in the family are altered, and the patient is displaced from her accustomed role, such as wife, mother, or employee. WebMD talked to experts in chronic pelvic pain and pain management about the latest developments in understanding and treating chronic pelvic pain.

New Understanding of Chronic Pelvic Pain

What women already know is now validated by medical experts. A woman can experience severe pain even after physical exams and tests show that her risk factor for chronic pelvic pain, such as endometriosis, has lessened or disappeared. Moreover, that pain can become more severe over time.

"We know that people who have little pathology can hurt a lot," says C. Paul Perry, MD, founder and board chairman of the International Pelvic Pain Society in Birmingham, Ala. "Issues in the last four or five years have helped us understand there are neurophysiolgical processes that aren't discussed in the ob-gyn literature."

He says chronic pain causes what's called CNS upregulation, or an increasing sensitivity of cells that transmit pain sensation.

Perry explains that the spinal cord not only transmits pain signals up to the brain but also back down to other organs. "That's how the bladder can get involved, and there's such a huge association between endometriosis and IC -- the evil twins."

He tells WebMD that if chronic pelvic pain isn't stopped, it will lead to multiple disorders and ultimately become a total end-stage disease. "We want to educate health care providers so patients get proper treatment and avoid going into chronic pelvic pain syndrome."

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