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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 no cause for your pelvic pain can be found, your treatment goals will focus on managing your pain.
Possible treatments for chronic pelvic pain include:
- 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 prescribed, but rarely will a medication be the sole solution for chronic pain.
- Hormone treatments. Some causes of pelvic pain have a cyclical pattern, meaning that they're tied to your menstrual cycles and the hormones your body produces. You may tend to feel the pain at certain times of the month rather than on a daily basis. Using 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 (Aventyl, 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.
- Physical therapy. Applications of heat and cold to your abdomen, stretching exercises, massage and other relaxation techniques, or transcutaneous electrical nerve stimulation (TENS) therapy 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.
- Counseling. Your pain could be intertwined with a serious psychological or social problem stemming from such factors as depression, sexual abuse, a personality disorder, a troubled marriage, difficulty in maintaining relationships or a family crisis, for example. 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.
- Nerve separation (ablation). Sometimes the source of chronic pelvic pain is linked to complex pathways in your neurological system. Procedures to control the pain impulses sent to or from your pelvic region might reduce or stop the pain. Such procedures include removing (excising) targeted nerves, injecting a medicine into the nerve to block its sensitivity, or using heat or a laser to destroy nerve tissue.
- Surgery. Your doctor might recommend surgery to correct certain underlying problems. For instance, pelvic adhesions or endometriosis deposits can be removed by laparoscopic surgery. In laparoscopic surgery, your surgeon performs the operation through several small incisions in your abdominal wall, using instruments with an attached camera. As a last resort, your doctor might recommend a hysterectomy. Hysterectomy may be an option for certain causes of pelvic pain.
You will often need to try a combination of treatment approaches before you find what works best for you.
References
- Chronic pelvic pain. American Academy of Family Physicians. http://familydoctor.org/online/famdocen/home/women/reproductive/gynecologic/033.html. Accessed Jan. 8, 2009.
- Chronic pelvic pain. International Pain Society. http://www.pelvicpain.org/pdf/Patients/CPP_Pt_Ed_Booklet.pdf. Accessed Jan. 8, 2009.
- Pelvic pain. American College of Obstetricians and Gynecologists. http://www.acog.org/publications/patient_education/bp099.cfm. Accessed Jan. 8, 2009.
- Howard F. Evaluation of chronic pelvic pain in women. http://www.uptodate.com/home/index.html. Accessed Jan. 8, 2009.
- Chronic pelvic pain. Rockville, Md.: Agency for Healthcare Research and Quality. http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=10940&nbr=5720&string=. Accessed Jan. 8, 2009.
- Howard F. Treatment of chronic pelvic pain in women. http://www.uptodate.com/home/index.html. Accessed Jan. 8, 2009.
- Gallenberg MM (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 16, 2009.
