Diagnosing Chronic Pelvic Pain

Your pelvic pain may not have an obvious cause. It may take some time and effort to figure it out. According to the International Pelvic Pain Society, 61% of women suffering from chronic pelvic pain don't know what is causing it. But with the right diagnosis, you can get relief. There are specialists you can turn to and tests that can be done to determine why you have the pain and what can be done about it.

First, make a detailed list of your symptoms, both physical and emotional, to share with the doctor. Also make a note of:

  • When you started having each symptom
  • Anything you've tried has helped with the pain
  • Whether the pain is better or worse at certain times
  • If the pain is related to your menstrual cycle or sexual activity
  • Any injury, illness, or surgery you have had

Because chronic pelvic pain often has more than one cause, you may need to see more than one specialist. Your gynecologist would be a good person to see first. For some women, pelvic pain is related to a problem with the reproductive system. Other possible causes include the problems with the muscles of the abdominal wall, bladder, or bowels.

Tests for Chronic Pelvic Pain

First you will have a pelvic exam. Then the doctor will:

  • Look at the way you sit and stand
  • Press on various points all over your abdomen and pelvic area, asking you to say if anything hurts
  • Have you tense and relax your pelvic muscles
  • Feel for anything unusual inside your vagina, uterus, and rectum

Tests that may be performed include blood count, pregnancy test and testing for infection such as chlamydia and gonorrhea. In addition, a urine test can help identify if a urinary tract infection might be the cause of your pelvic pain.

A pelvic exam may be enough to diagnose your problem, or at least part of it. But the doctor may want to do an imaging test like a transvaginal ultrasound, a CT scan, or an MRI scan of the abdomen and pelvis for a more complete picture.

Radiological tests may be useful to diagnose:

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Procedures Used to Diagnose Chronic Pelvic Pain

If imaging tests don't reveal the cause of your pelvic pain, a procedure called laparoscopy may be recommended. It involves inserting a camera or scope through a small incision to look at the pelvic organs or take tissue samples. Also, a hysteroscopy, a small camera placed through the vagina into the uterus, may be useful to diagnose abnormalities that may cause pain originating inside the uterus.

"Pain mapping" is a technique some doctors use. While you're sedated but awake, a doctor uses a laparoscope and a probe to stimulate points inside your pelvis. You rate any pain you feel and say whether it is like the pain you typically experience. This creates a "map" of sensitive areas.

The Role of a Urologist

A urologist is another specialist whom you might see if pain is related to your urinary tract. For example, if your symptoms and pelvic exam suggests interstitial cystitis (IC), there are tests that a urologist can do. IC is painful bladder inflammation that isn't caused by an infection.

A cystoscopy is one way to diagnose interstitial cystitis. Using a special scope, the doctor looks inside your bladder for bleeding or ulcers. The potassium sensitivity test is another way to diagnose it. For this, the doctor fills your bladder with a potassium solution and then with water. People with IC feel more pain and a more urgent need to urinate with potassium than with water. But doctors may diagnose interstitial cystitis without these tests if you have symptoms of IC and no other pelvic problems.

The Role of a Gastroenterologist

Some women with pelvic pain may need to see a gastroenterologist, a doctor who specializes in digestive diseases. That's because irritable bowel syndrome (IBS) is a common cause of pelvic pain. It may be the only cause or it may exist with other causes.

Usually doctors diagnose IBS based on symptoms you describe. Tests can rule out other diseases if the doctor thinks that something else may be wrong.

The Role of a Pain Specialist

Pain specialists are usually anesthesiologists who have specialized training in pain management. Some women with chronic pelvic pain can seek out these physicians to complement treatment provided by their primary care or gynecologist. Pain specialists may be necessary for appropriate trials of nerve blocks, the use of transcutaneous electrical nerve stimulation (TENS) units, or management of medications used for chronic pain.

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The Role of a Physical Therapist

Physical therapists can help develop an exercise program and relaxation techniques to help strengthen the pelvic floor muscles, reduce pain, and manage stress and anxiety in women who suffer from chronic pelvic pain.

The Role of a Therapist

Psychiatrists and psychologists can help, too -- even if there is a physical source of pelvic pain. The mind plays a powerful role in how pain is perceived. And, depression, stress, and anxiety can make any pain seem worse.

No matter what specialists you see, it's important to choose a health care provider who knows a lot about chronic pelvic pain. Many different kinds of doctors can have a special interest in helping people with pain. If your regular doctor is not familiar with causes of pelvic pain, ask for an outside referral.

WebMD Medical Reference Reviewed by Trina Pagano, MD on September 28, 2014

Sources

SOURCES: 

MedlinePlus Medical Encyclopedia, National Library of Medicine web site: "Adhesion;" "Uterine fibroids;" "Pelvic inflammatory disease (PID);" and "Interstitial cystitis (IC)." 

The Merck Manual of Diagnosis and Therapy, 17th Edition, Merck & Co., 1999. 

American College of Obstetricians and Gynecologist, "Practice Bulletin Number 51, March 2004." 

The International Pelvic Pain Society web site: "Chronic Pelvic Pain: A Patient Education Booklet." 

Venbrux, A., Journal of Vascular and Interventional Radiology, February 2002; vol 13: pp 171-178. 

Howard, F., Obstetrics and Gynecology, December 2000; vol 96: pp 934-939. 

American Urological Association web site: "Interstitial Cystitis."

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