Diagnosing Chronic Pelvic Pain
Mikio A. Nihira, MD
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
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:
- Pelvic congestion
- Pelvic inflammatory disease
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.