Facts About Pelvic Pain

EVER had pains down below? You’re not alone. Most women have. But it’s knowing the difference between mild pelvic pain due to periods, ovulation or sexual intercourse and, in its severest form, chronic persistent pain that should spark major cause for concern.

Women can’t do anything to prevent cysts, endometriosis or fibroids but better knowledge would prevent any of these things from becoming even more of a problem.

There is also of course a range of pain experiences somewhere between the acute and chronic. Every woman’s experience of pelvic pain is different and should be dealt with on an individual basis. If left, it can have a huge impact on the quality of life from relationships to work attendance. At least 15 per cent of women will experience some form of pelvic pain at some point in their lives according to Dr Luciano Nardo - consultant in gynaecology, reproductive medicine and surgery and director of North West Fertility and GyneHealth. He believes it’s important to get medical advice immediately if you’re not sure why you’re experiencing pelvic pain.

When should I visit my GP?

 Dr Nardo: It's important to visit your GP if pelvic pain is occurring at specific times such as during periods or if the pain is persistent. Pelvic pain could be down to a number of things so it's very important that when describing your symptoms to your GP you are very specific. It's vital that all symptoms are described, even if they don't seem relevant. 

What are the differences in pelvic pain in younger women and older women?

Dr Nardo: Gynaecological problems with younger women (under 30s) are often associated with painful periods, pelvic inflammatory (sometimes as a result of STIs), vulval pain or endometriosis. With older women (over 30s) the problems are slightly different. Pelvic inflammatory issues for example, could be down to previous surgery, or fibroids. Ovarian cancer is also more common with older women and it can be a cause of pelvic pain. It is however very uncommon with younger women.

What will my GP do?

Dr Nardo: Your GP will go through your symptoms. Most then refer to a gynaecologist. Clinical examinations are very important if a gynaecological problems are suspected. Most will also require a pelvic scan (to look inside the pelvis).

The initial investigation is to first scan the pelvis and then based on the symptoms there may be further tests to examine the bladder, and if necessary a test to examine the bowels.

Patients are often referred to a gastroenterologist (to look at the stomach and intestines) and then a urologist (to look at the kidneys, adrenal glands, ureters, urinary bladder and urethra) if the gynaecologists investigations come back negative.

However, if none of the tests explain the problem, it will be categorised as 'unexplained', and the patient will be given medication to ease the pain. One in three patients who go to their GP will be left undiagnosed.

Before performing any type of surgery, the patient’s medical history is examined and the treatments often depend on age and fertility. For example, older women having problems with their ovaries often have them removed, but younger women may want to go on to have children.

What are the possible causes of pelvic pain?

Dr Nardo:

-Bladder problems

-Bowel problems

-Gynaecological problems

-Muscular/skeletal problems

-Nerve problems

-Psychological problems (can be down to any traumatic experiences someone has suffered from previously). 

Chronic causes:

Endometriosis

Endometriosis is when cells that normally line the womb are found in other places in the body, such as in the fallopian tubes. This can cause painful periods and is a reoccurring pain. It isn’t treatable because the cells will regenerate once destroyed. However, depending on age and medical history, there are medical and surgical options. But this will only remove it temporarily. It is in many cases, a genetic symptom.

Adhesions:

Caused by endometriosis, infections or previous surgery, this condition mainly affects young women causing bladder problems, bowel obstruction and possible infertility. It is possible to suffer from both endometriosis and adhesions at the same time. The treatment for adhesions is surgery, but the success of this process is completely dependent on the surgeon’s techniques and skills. Adhesions are very hard to prevent from returning. There is a lot of research taking place at the moment to develop diagnosis for adhesions.

Ovarian Cysts:

Treatment for ovarian cysts depend almost entirely on age. For younger women cysts are normally removed, but this will only be a temporary action and means that ovarian cysts can develop again in younger women. For older women the ovary is often removed to stop it from developing more.

Fibroids:

Fibroids mainly affect older women. The non-surgical options are hormonal, aimed at stopping the hormones from feeding the fibroids. Another option is radiological, which stops the blood supply to the fibroid, meaning the fibroid will die off. For younger women, surgery is the most common choice so as not to affect fertility. For older women treatment is mainly non-surgical and x-ray based.

Vulval:

Vulval is a superficial pain (less common), experienced on the outside of the vagina rather than a deep, internal pain. This type of pain has no relationship with the menstrual cycle, but in some cases can relate to sexual intercourse. Vulval pain can be caused by infection, dryness and skin conditions, however it can be treated. Vulvodynia is a condition which means pain in the vulva and is also associated with nerve damage. Vulvodynia pain often arises after trauma, ie. child birth and is more common in older women. Sometimes skin and cancer conditions can cause the pelvic pain.

Ovarian Cancer:

Known as silent cancer, it has no symptoms until the cyst is quite large. The symptoms are difficult to diagnose and can often overlap with irritable bowel syndrome and premenstural syndrome. However, the four main symptoms are:

- Persistent pelvic pain

- Difficulty in eating and feeling full quickly

- Nauseous feelings

- Bloating

Can pelvic pain be prevented?

Dr Nardo: No, but what women should try to do is avoid infections and that’s achieved through good sex education. We know that adhesions resulting from infection, can come from repeat unprotected sexual intercourse with different partners, and this could lead to pelvic pain and infertility. Chlamydia is an infection that is a common cause of pelvic pain because it causes adhesions.

Women can’t however do anything to prevent cysts, endometriosis or fibroids, but better knowledge would prevent any of these things from becoming even more of a problem.

For example, a female patient had a 6cm ovarian cyst that hadn’t been seen before. She had painful periods, painful intercourse and constant pain. We removed the cyst but discovered she also had severe endometriosis. She didn’t tell us she was experiencing other symptoms such as bowel problems, until I told her she had endometriosis. She said she didn’t think it was relevant to tell me. No one is asking a patient to make a diagnosis but it’s important that women explain their symptoms thoroughly. The last thing you want is to leave women with no answers or management.

Dr Luciano G Nardo is a Consultant in Gynaecology and Reproductive Medicine. He is a Director of North West Fertility and GyneHealth - a comprehensive multidisciplinary independent sector service for women's health. He sees private patients regularly at his clinics in central Manchester, Cheshire and London, and is supported by a team of consultant colleagues, specialist nurses, counsellors, acupuncturists, reflexologists, dieticians, physiotherapists and administrative staff.