Dr Sneha Battin
Your abdomen is home to a lot of vital organs: the stomach, the intestines, the colon, liver, spleen, gallbladder, pancreas, uterus, fallopian tubes, ovaries, kidneys, uterus, bladder, and many blood vessels. Clinicians are trained to examine your body with their hands to find the cause of your distress.
In women, pressing down on their belly (involving two methods- Palpation and Percussion) also gives information about the uterus and ovaries. Pain associated below a women’s belly button in her abdomen and genital area is called Pelvic pain. It can also be present in men and can be due to varied reasons. It often varies in intensity, is anything between a mild ache or a sharp pressure in the abdomen and could be acute or chronic in nature. Acute- meaning the pain is sudden and severe. And chronic- meaning the pain comes and goes or is constant and lasts for several months. Pain that is 6 months or longer with no signs of improvement with treatment is categorized as Chronic Pelvic Pain. Often at times, it is accompanied by pain around the lower back, buttocks, the genital area as well as abnormal vaginal bleeding or discharge. For men, often the pain is related to their pelvic bone or is present in their non-reproductive internal organs such as the bladder or colon. For some patients, the pain gets so severe that it becomes difficult to have a productive day at work, makes one lose out on an exciting evening with friends or, worse, even some much-needed sleep!
Diagnosing the right cause of Pelvic pain is often tricky. It could be due to multiple reasons such as inflammation or nerve irritation because of injury, fibrosis, cramps, or contractions of smooth and skeletal muscles. But some of the common causes for Acute Pelvic pain are Ectopic pregnancy (pregnancy outside the uterus), infection of the reproductive organs, ovarian cysts, urinary tract infections, miscarriage, or ruptured fallopian tubes. Some conditions that could lead to Chronic Pelvic pain are:
- Fibroids (abnormal growths around the uterine wall)
- Menstrual cramps
- Scar tissues between the organs in the pelvic cavity
- Diagnosing Pelvic Pain
As Pelvic Pain may be related to the digestive, urinary, nervous, or reproductive system, your clinician will ask for detailed information about your pain and health history. Questions about when you started experiencing symptoms, about whether the pain is better or worse at certain times, and if it is related to your menstrual cycle and or followed by an injury or illness will be one of the crucial parts of your examination. A physical exam to assess the tissues and organs in the pelvic and abdominal area will be performed to check for abnormalities or tenderness.
Procedures and tests that can help in the right diagnosis of Pelvic Pain may include:
- Blood, urine, and vaginal culture: including pregnancy tests, sexually transmitted diseases, and urinary tract infections.
- Colposcopy, Vulvoscopy: to examine cervix and vulva (the skin around the vagina and anus).
- Ultrasounds, MRI: to view the structures inside and around the pelvic region.
- Laparoscopy: by making a small incision under the belly button to view the pelvis or to take tissue samples.
If your care practitioner can pinpoint a specific cause based on the above tests, your treatment will focus on that cause. However, if a cause cannot be identified, then the treatment goal is to reduce symptoms and improve the quality of life. For most women, the ideal approach includes a blend of treatments.
Medications: Pelvic pain is treated with medications that include antibiotics (for any suspected infections), over-the-counter pain relievers such as aspirin, ibuprofen (Advil or Motrin IB), or acetaminophen and antidepressants which can provide partial pain relief. Antidepressants prove especially helpful for chronic pelvic pain (even if you do not have depression) and give both pain-relief and anti-depressant effects. This is especially beneficial for patients with Chronic Pelvic Pain as the debilitating condition often causes one’s spirit and everyday activities to dampen. However, the prescription of a pain medication alone is not sufficient as it gives symptomatic relief rather than treating the actual cause.
Hormone therapy: If your pelvic pain coincides with your menstrual cycle, then the probable cause for your pelvic pain is the hormonal changes that control menstruation. In such cases, hormonal therapy or birth control pills help in reducing pelvic pain.
Physical therapy and Psychotherapy can also be included in your treatment regimen. Performing stretching exercises along with massage and other relaxation maneuvers not only helps in improving relaxation and blood supply but also soothes the pain. As Physical Therapists are trained in identifying specific target points of pain, they use electrotherapy which has proven to be an extremely beneficial treatment protocol. By this electrical stimulation technique called the Transcutaneous Electrical Nerve Stimulation (TENS), a Physical Therapist, transmits electrical stimulation to nerve pathways which helps in pain relief. They often use a combination of electrotherapy with stretching and strengthening exercises along with psychological intervention such as and Cognitive Behavioural Therapy (CBT), biofeedback, which helps the patients identify their problem areas and eventually in pain relief.
Surgery: A surgical procedure may be recommended for long-term Chronic Pelvic pain patients. For patients with endometriosis, Laparoscopic surgery can be performed to remove the endometrial tissue through a small incision. In other cases when multiple treatments have been tried and failed, hysterectomy (uterus removal) can be recommended. As this comes with important health issues, the clinician will have a detailed discussion explaining the risks and complications of this surgery with the patient.
Selfcare: Controlling Pelvic Pain is mainly a matter of finding the exact cause of your pain and being able to control it. As no two lives are the same, so is the case for the pain journey. Following an exact protocol of something that worked for someone else, might lead you to be distressed and in more pain. Empowering yourself to be open to the idea of trying out options that you feel will benefit you, should be your ideal approach. As more and more doctors give importance to the holistic approach, having a good discussion with your Clinician about your probable options will give you clarity of what to expect and how to lead a normal life.