Refractory pelvic pain

Introduction:

Refractory pelvic pain refers to any pain in your pelvic region � the area below your bellybutton and between your hips � that lasts six months or longer. If you were asked to locate your pain, you'd be more likely to sweep your hand over that entire area rather than point to one spot. Chronic pelvic pain can be a symptom of another disease, or it can be designated as a condition in its own right.
Determining what's causing your discomfort may be one of medicine's more puzzling and frustrating endeavors. Indeed, no physical cause may ever be discovered. Many women who experience chronic pelvic pain never receive a more specific diagnosis.
If your doctor can determine the source of your chronic pelvic pain, then treatment can focus on eliminating that cause. If no cause can be found, then treatment for chronic pelvic pain focuses on managing the pain.

Causes:

Several gynecologic problems may be the source of chronic pelvic pain. However, other diseases can cause pelvic pain, such as irritable bowel syndrome and interstitial cystitis. In addition, psychological factors may contribute to your pain.
Some of the more common causes of chronic pelvic pain include:
  • Psychological factors: If you are depressed, experience chronic stress or have been sexually or physically abused, you may be more likely to experience chronic pelvic pain. Emotional distress makes pain worse, and likewise living with chronic pain makes emotional distress worse. So chronic pain and emotional distress frequently get locked into a vicious cycle.
  • Interstitial cystitis: Chronic inflammation of the bladder and a frequent need to urinate characterize interstitial cystitis. You may experience pelvic pain as your bladder fills, which may improve temporarily after emptying your bladder.
  • Irritable bowel syndrome: Symptoms associated with irritable bowel syndrome � bloating, constipation or diarrhea � can be a source of uncomfortable pelvic pain and pressure.
  • Fibroids: These noncancerous uterine growths may cause pressure or a feeling of heaviness in your lower abdomen. They rarely cause sharp (acute) pain unless they become deprived of nutrients and begin to die (degenerate).
  • Ovarian remnant: During a complete hysterectomy � surgical removal of the uterus and ovaries � a small piece of ovary may be left inside, which can later develop tiny, painful cysts.
  • Pelvic congestion syndrome: This is a condition that may be caused by enlarged, varicose-type veins around the uterus and ovaries.
  • Chronic pelvic inflammatory disease: This can occur if a long-term infection, often sexually transmitted, causes scarring involving the pelvic organs.
  • Tension in your pelvic floor muscles: Spasms or tension of the pelvic floor muscles can lead to recurring pelvic pain.
  • Endometriosis: This is a condition in which tissue from your uterine lining (endometrium) grows outside your uterus. These deposits of tissue respond to your menstrual cycle, just as your uterine lining does � thickening, breaking down and bleeding each month as your hormone levels rise and fall. Because it's happening outside your uterus, the blood and tissue can't exit your body through your vagina and become trapped in your abdomen. This can lead to painful cysts and adhesions (fibrous bands of scar tissue).

Treatment:

Treatment for chronic pelvic pain is based upon an individualized plan and may need to be performed over a period of time. Some treatment options include:
  • Pain medications that provide relief temporary relief of pain while other therapies are tried. These may be used in combination with other medications like anti-depressants or anti-inflammatory drugs.
  • Physical therapy may be used to strengthen and stretch certain muscles. Muscle or nerve stimulators may be used to help with muscle retraining or to block pain sensations. Biofeedback, relaxation and breathing exercises may also be useful.
  • Psychological evaluation and therapy may be part of a comprehensive treatment plan.
  • Family education to help them understand the nature of the patients problem, the treatment plan and possible outcomes may also contribute to the patient's recovery.
  • Surgery may be necessary in some cases to evaluate pain, to remove pelvic adhesions or endometriosis.
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