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Treatments and drugs
By Mayo Clinic staffIf your doctor can pinpoint a specific underlying cause, your treatment will focus on eliminating that particular cause. However, if you're unable to find the cause of your pelvic pain can be found, treatment will focus on managing your pain.
Medications
Depending on the underlying cause, your doctor may recommend a number of medications to treat your condition, including:
- Pain relievers. Over-the-counter pain remedies, such as aspirin, ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others), may provide partial relief from your pelvic pain. Sometimes a prescription pain reliever may be necessary. Pain medication alone, however, rarely solves the problem of chronic pain.
- Hormone treatments. The days when you have pelvic pain may coincide with a particular phase of your menstrual cycle and the hormonal changes that control ovulation and menstruation. Birth control pills or other hormonal medications may help relieve cyclic pelvic pain.
- Antibiotics. If an infection is the source of your pain, your doctor may prescribe antibiotics.
- Antidepressants. Antidepressants can be helpful for a variety of chronic pain syndromes. Tricyclic antidepressants, such as amitriptyline, nortriptyline (Pamelor) and others, seem to have pain-relieving as well as antidepressant effects. They may help improve chronic pelvic pain even in women who don't have depression.
Therapies
Your doctor may recommend specific therapies or procedures as a part of your treatment for chronic pelvic pain. These treatments may include:
- Physical therapy. Applications of heat and cold to your abdomen, stretching exercises, massage and other relaxation techniques may improve your chronic pelvic pain. Your doctor might also recommend exercises to strengthen your pelvic floor muscles. A physical therapist can assist you with these therapies and can help you develop coping strategies for the pain.
- Transcutaneous electrical nerve stimulation (TENS). This approach may help improve localized or regional pain. During TENS therapy, electrodes deliver electrical impulses to nearby nerve pathways — which can help control or relieve some types of pain.
- Counseling. Your pain could be intertwined with depression, sexual abuse, a personality disorder, a troubled marriage or a family crisis. Getting help for psychological, social, spiritual and emotional challenges may be an essential part of your treatment plan.
- Trigger point injections. If your doctor finds a specific point where you feel pain, a possible treatment option is the direct injection of a numbing medicine into a painful spot (trigger point). The medicine, usually a long-acting local anesthetic, can block pain and ease discomfort.
Surgery
To correct an underlying problem, your doctor may recommend a surgical procedure:
- Laparoscopic surgery. In some instances, pelvic adhesions or endometrial tissue can be removed by laparoscopic surgery. During laparoscopic surgery, your surgeon performs an operation through several small incisions in your abdomen, using instruments with an attached camera.
- Hysterectomy. As a last resort, your doctor might recommend a hysterectomy — surgery to remove your uterus. Hysterectomy may be an option for certain causes of pelvic pain but usually isn't recommended unless you're also experiencing severe menstrual pain that hasn't gone away after more-conservative treatment approaches.
You will often need to try a combination of treatment approaches before you find what works best for you.
References
- Hoffman BL. Pelvic pain. In: Schorge JO, et al. Williams Gynecology. New York, N.Y.: McGraw-Hill Medical; 2008. http://www.accessmedicine.com/content.aspx?aID=3154265. Accessed Jan. 18, 2011.
- Lentz GM. Differential diagnosis of major gynecologic problems by age group: Vaginal bleeding, pelvic pain, pelvic mass. In: Katz VL, et al. Comprehensive Gynecology. 5th ed. Philadelphia, Pa.: Mosby Elsevier; 2007. http://www.mdconsult.com/das/book/body/208746819-4/0/1524/0.html. Accessed Jan. 10, 2011.
- Chronic pelvic pain. American Congress of Obstetricians and Gynecologists. http://www.acog.org/publications/patient_education/bp099.cfm. Accessed Jan. 18, 2011.
- Howard F. Evaluation of chronic pelvic pain in women. http://www.uptodate.com/home/index.html. Accessed Jan. 18, 2011.
- ACOG Committee on Practice Bulletins - Gynecology. Chronic pelvic pain. Obstetrics & Gynecology. 2004;103:589.
- Howard F. Treatment of chronic pelvic pain in women. http://www.uptodate.com/home/index.html. Accessed Jan. 18, 2011.
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