Nov. 17, 1999 (Atlanta) -- Despite a wealth of medical knowledge and considerable psychological speculation, a complete understanding of the causes of chronic pelvic pain continues to elude medical researchers.
Defined as pain in the lower abdomen lasting six months or more, chronic pelvic pain should always signal a trip to the doctor's office, say physicians interviewed by WebMD.
According to a statistical analysis published in the November issue of the British Journal of Obstetrics and Gynaecology, the number of women in the United Kingdom suffering from chronic pelvic pain is similar to the number of people experiencing back pain, migraine headaches, and asthma.
The researchers also write that many women are not seeking treatment for it: "The condition is still not well understood and therefore is often inadequately managed. Its epidemiological characteristics are particularly unclear."
"That's right, it's called chronic pelvic pain without obvious pathology," Jill Maura Rabin, MD, tells WebMD. "In those cases we do an entire workup to rule out infection, malignancies, or pregnancy. Usually there's a chronic infection related to the ovaries or occasionally in the bladder or bowels. But if we can't make a diagnosis we can manage it through pain management by mild tranquilizers, [injections], or acupuncture."
Rabin -- associate clinical professor of obstetrics and gynecology at Albert Einstein College of Medicine, in New York -- says psychological factors are also considered during evaluation. "There's a lot of psychological literature on this, but eventually we usually figure out what it is," says Rabin.
Still, Rabin says that in her practice, about 3-5% of patients fall into the category of chronic pelvic pain without obvious pathology.
The U.K. study analyzed data on physician contacts made by 284,162 women aged 12-70 over a five-year period. After excluding diagnoses of sexual-intercourse causes, pregnancy, menstruation, chronic bowel disease, or malignancy, they found 24,053 cases of chronic pelvic pain.
Overall, the researchers calculated an annual rate of just under 40 cases for every 1,000 women. The prevalence was highest in women over 60. These findings were similar to those of a smaller American study published in 1996. That study found that only 25% of women with chronic pelvic pain sought medical treatment.
The researchers in the current study speculate that many more women suffer from chronic pelvic pain in the general population than are found in medical records. They describe it "as a condition that many people cope with themselves without seeking health care."
"Absolutely, people should come in," says Rabin. "If medical and psychological causes are ruled out, patients can be referred to pain management centers."
Says William Andrews, MD, past president of the American College of Obstetricians and Gynecologists, "It's hard to pin down, either as functional bowel pain, nervousness, or bowel spasms, and it's much more common in women. The need is to talk to the patient about how this is something they are not imagining -- the corollary can be [that it's] like a headache. The big thing is trying to understand."