Chronic pelvic pain may have multiple causes, and there may be many contributing factors to pelvic pain in a single patient.
The endometrial growths that occur in endometriosis are a direct cause of chronic pelvic pain (CPP). Due to complex nervous system interactions, CPP can still continue even when the endometriosis has resolved. Up to 54 percent of women treated for endometriosis continue to experience CPP, and five to 26 percent have reported continued CPP more than one year after hysterectomy. The symptoms include generalized pelvic pain and pain associated with sexual intercourse, and they sometimes are worse in the days before a menstrual period.
Pelvic inflammatory disease is an acute infection that can affect the uterus, fallopian tubes and/or ovaries. It is usually caused by chlamydia and gonorrhea, which are sexually transmitted diseases. Up to 35 percent of women with PID go on to develop CPP with or without clear evidence of organ damage, regardless of treatment. PID can cause severe pelvic pain and other symptoms; however, some women do not experience any pain at all and may never know of their infection unless long-term consequences such as CPP develop.
In pelvic congestion syndrome, the veins in the pelvis are unusually dilated and engorged, causing pelvic pressure and pain. This has been shown to be related to high levels of estrogen, as estrogen causes veins to dilate. There are often other signs of hormone imbalance, such as heavy and painful periods. Women of reproductive age are usually affected; the condition is very rare after menopause. The pain is usually dull and aching, although episodes of sharp stabbing pain can occur. It is typically worsened by prolonged standing, and painful intercourse is common. There is post-coital aching that can last hours or even one to two days, and lower back ache.
The pudendal nerve is one of the nerves of the pelvic floor muscles. Pain can originate from spasm of the pelvic floor muscles with compression of the nerve or from causes of neuropathies (such as infections, metabolic disorders and autoimmune disorders) that can affect the nerve itself. Pudendal neuralgia is characterized by perineal pain that is aggravated by sitting and reduced by standing. It is often relieved by sitting on a toilet. It may be associated with bladder problems (overactive bladder, urgency, urinary retention), bowel problems (cramps, frequent bowel movements, constipation) and sexual problems (decreased libido, pain during intercourse). The diagnosis is confirmed by physical examination.
Vulvodynia is defined as chronic vulvar discomfort or pain, especially characterized by complaints of perineal burning, stinging, irritation or rawness. There is redness and inflammation of the area around the vaginal opening, and severe tenderness to touch. A common symptom is pain during intercourse. Some women report perineal hypersensitivity to clothing or touch, and sexual activities are restricted. Bladder symptoms such as urgency, frequency and dysuria can also occur. Daily activities such as walking and sitting can be affected. Patients may even develop other distant symptoms like burning of the tongue or facial pain.
It is estimated that every 15 seconds, a man in the U.S. is diagnosed with CPP. Studies have suggested that the condition may be genetic and passed down from one generation to the next. Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is characterized by pelvic or perineal pain without evidence of urinary tract infection that lasts longer than three months. Pelvic pain may radiate to the back and rectum, and sitting may be uncomfortable. Urinary habits can be affected, causing frequent urination and often a burning sensation during urination. Other symptoms include joint pain, muscle aches, unexplained fatigue and abdominal pain. Sexual activity can affected, and some patients develop low libido, sexual dysfunction and erectile difficulties. A constant burning pain in the penis can occur. A hallmark of the condition is post-ejaculatory pain.
IBS is defined as abdominal pain that lasts at least three months during the last year. It is estimated that up to 60 percent of women who visit a gynecologist for pelvic pain have IBS. Altered bowel habits occur, and the pain can be relieved by a bowel movement. Up to 80 percent of patients with CPP will have symptoms consistent with IBS, including abdominal pain, bloating, belching, diarrhea, constipation, painful defecation, dyspareunia, pelvic pain, cramping and left lower quadrant pain.
Interstitial cystitis (IC), also known as painful bladder syndrome. IC is a chronic condition in which the walls of the bladder are irritated and inflamed. It is often diagnosed as a bladder infection, although it is not directly caused by an infection. Ninety percent of those diagnosed with IC are women, but it can affect men as well. The main symptom is pain that increases as the bladder fills and may be relieved by urination. There also can be constant pain in the bladder, abdomen, lower back, vagina or thighs. People with IC may need to urinate more urgently, more frequently or both.
A wide range of issues can occur when the muscles of the pelvic floor are underactive or overactive, or if the skeletal system is impaired. Nerves in the pelvic area can be pinched by tight muscles, or by scars or fascia tissues. Chronic pain can be created by spasm of the pelvic muscles lining the pelvis. There are many different causes for this spasm, including fibromyalgia, anterior abdominal cutaneous or pudendal nerve entrapment, iliopsoas muscle spasm, Tarlov cysts, and lumbar spine and muscle injuries.
Post-surgical pelvic pain can occur as result of tissue or nerve injuries from surgery, or from healing and adhesion formation. Nerve entrapment can result from a surgery or an accident. A nerve that is cut or damaged during surgery may be trapped or compressed in the muscle layer of the abdomen, which can cause pain. Adhesions may form after surgery or as a result of infections; these are bands of scar tissue that can occur between internal organs. Normal body movements can pull on these adhesions and cause pain.