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Causes
By Mayo Clinic staffSeveral conditions may be the source of chronic pelvic pain. Sometimes, chronic pelvic pain may develop for no apparent reason and without any definitive source or cause. In addition, psychological factors may contribute to your pain. The emotional distress that may result from dealing with pain that has no good explanation over a long period of time often in itself makes the pain feel worse.
Some causes of chronic pelvic pain include:
- Endometriosis. This is a condition in which tissue from the lining of your womb (uterus) 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. Instead, they remain in your abdomen, where they may lead to painful cysts and fibrous bands of scar tissue (adhesions).
- Tension in your pelvic floor muscles. Spasms or tension of the pelvic floor muscles can lead to recurring pelvic pain.
- Chronic pelvic inflammatory disease. This can occur if a long-term infection, often sexually transmitted, causes scarring that involves your pelvic organs.
- Ovarian remnant. During a complete hysterectomy — surgical removal of the uterus, ovaries and fallopian tubes — a small piece of ovary may accidentally be left inside and later develop painful cysts.
- Fibroids. These noncancerous uterine growths may cause pressure or a feeling of heaviness in your lower abdomen. They rarely cause sharp pain unless they become deprived of a blood supply and begin to die (degenerate).
- Irritable bowel syndrome. Symptoms associated with irritable bowel syndrome — bloating, constipation or diarrhea — can be a source of uncomfortable pelvic pain and pressure.
- Painful bladder syndrome (interstitial cystitis). This condition is associated with chronic inflammation of your bladder and a frequent need to urinate. You may experience pelvic pain as your bladder fills, which may improve temporarily after you empty your bladder.
- Psychological factors. Depression, chronic stress or a history of sexual or physical abuse may increase your risk of chronic pelvic pain. Emotional distress makes pain worse, and living with chronic pain contributes to emotional distress. These two factors often get locked into a vicious cycle.
- Pelvic congestion syndrome. Some doctors believe enlarged, varicose-type veins around your uterus and ovaries may result in pelvic pain. However, other doctors are much less certain that pelvic congestion syndrome is a cause of pelvic pain because most women with enlarged veins in the pelvis have no associated pain.
References
- Howard F. Causes of chronic pelvic pain in women. http://www.uptodate.com/home. Accessed April 7, 2013.
- Howard F. Treatment of chronic pelvic pain in women. http://www.uptodate.com/home. Accessed April 7, 2013.
- Gallenberg MM (expert opinion). Mayo Clinic, Rochester, Minn. April 19, 2012.
- Rakel RE. Textbook of Family Medicine. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2011. http://www.mdconsult.com/das/book/body/191205553-4/0/1481/0.html#. Accessed April 7, 2013.
- Chronic pelvic pain. The American Congress of Obstetricians and Gynecologists. http://www.acog.org/~/media/For%20Patients/faq099.pdf?dmc=1&ts=20130418T1809515975. Accessed April 18, 2013.
- Howard F. Evaluation of chronic pelvic pain in women. http://www.uptodate.com/home. Accessed April 7, 2013.
- Interstitial cystitis/painful bladder syndrome. National Kidney and Urologic Diseases Information Clearinghouse. http://kidney.niddk.nih.gov/kudiseases/pubs/interstitialcystitis/index.htm. Accessed April 7, 2013.
- Carinci AJ. Complementary and alternative treatments for chronic pelvic pain. Current Pain and Headache Reports. 2013;17:316.
- Stones W, et al. Interventions for treating chronic pelvic pain in women. Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000387/abstract. Accessed April 7, 2013.
- Relaxation techniques for health: An introduction. National Center for Complementary and Alternative Medicine. http://nccam.nih.gov/sites/nccam.nih.gov/files/relaxation_introduction.pdf.Accessed April 14, 2013.
- Noncyclic chronic pelvic pain therapies for women: Comparative Effectiveness Review No. 41. AHRQ Publication No. 11(12)-EHC088-EF. https://www.ncbi.nlm.nih.gov/books/NBK84586. Accessed April 28, 2013.
- Martinez B. Management of patients with chronic pelvic pain associated with endometriosis refractory to conventional treatment. Pain Practice. 2013;13:53.
- George SE, et al. Physical therapy management of female chronic pelvic pain: anatomic considerations. Clinical Anatomy. 2013;26:77.
- 14. Kotarinos RK. Pelvic floor physical therapy for management of myofascial pelvic pain syndrome in women. http://www.uptodate.com/home. Accessed April 8, 2013.
- Hunter C, et al. Neuromodulation of pelvic visceral pain: Review of the literature and case series of potential novel targets for treatment. Pain Practice. 2013;13:3.
- Acupuncture for pain. National Center for Complementary and Alternative Medicine. http://nccam.nih.gov/health/acupuncture/acupuncture-for-pain.htm. Accessed April 14, 2013.
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