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HealthWhy we need to start talking about chronic pelvic pain

Chronic pelvic pain is hard to diagnose, treat and recover from, and many patients spend years before they find out what is wrong.
Dr Francesco CappellanoJuly 7, 202111 min
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No one minds talking about their wonky knee or sore hip. In fact we all know people who like nothing more than detailing their various aches and pains.

But there are a lot of chronic pain conditions that no one wants to hear about and that includes issues that involve the pelvic region. These include the pelvis, genital area, lower abdominal wall and lower back or buttocks and they can be serious enough to cause disability. In addition to it being almost taboo to talk about them, these conditions are hard to diagnose accurately.

Here are four reasons why we need to start talking about chronic pelvic pain.

It affects 1 in 7 women

Chronic pelvic pain may not be as well-known as other chronic conditions women experience, but is becoming more prevalent around the world. It tends to manifest itself differently from person to person, often starting in one place before progressing to another. It is commonly associated with a range of uncomfortable symptoms such as constipation, urinary hesitation, frequency and urgency, painful bowel movements and sexual dysfunction related to loss of libido. 

One of the few known causes of chronic pelvic pain is endometriosis, which happens when tissue that normally lines the inside of the uterus – the endometrium – starts to grow outside the uterus. The prevalence of endometriosis among women in the UAE is approximately 1.5 percent and these women tend to experience even more severe chronic pelvic pain (18.2 percent), further driving the need for proper diagnosis and treatment.

Another cause is Interstitial Cystitis (IC), which happens when the bladder mucosa – the moist inner lining also known as mucus membrane – becomes inflamed by unknown causes. In endometriosis, an updated epidemiologic study conducted in 2006 suggests that up to 12 percent of women may have early symptoms of IC.

It is often underdiagnosed and misdiagnosed

What makes chronic pelvic pain difficult to diagnose is that it is a multisystem disorder, with sexual, bowel, urinary and gynecological symptoms, among others. With several factors in play, it can be tough to determine a clear cause of pain and various emotional factors can occur as a side effect.  

Chronic pelvic pain is most often assumed to be a side effect of a urinary tract infection or labeled as chronic prostatitis in men. As a result, many patients are treated with an antibiotic prescription for years and don’t learn their true condition until several referrals over on average three to five years. The longer it takes to diagnose, the more chronic the pain becomes and the harder it is to treat.

Pain or a prickling sensation can often start in one place before progressing as far as the groin, inner leg, buttocks and abdomen. The pain is reported to be worse upon sitting and usually increases gradually during the day and night. Many patients experience pain at bedtime and face difficulty in falling asleep.

Treatment involves a number of specialties 

When specialist care is involved in the management of chronic pelvic pain, it can often be spread among several disciplines, such as urology, gynecology, urogynecology, colorectal services, pain medicine and occasionally, even spinal services. This increases the risk of patients being passed around between different specialist teams and not receiving consistent or effective care. 

The most common patient profile involves someone who has seen multiple physicians, experienced multiple failed pharmacologic treatments, failed physiotherapy and more, all while still being severely disabled by pain with no evidence of any organ disease.

There is a long-term emotional toll

One aspect that most people don’t consider when it comes to chronic pelvic pain is the emotional toll it can take on the patient. Without an effective diagnosis and treatment, other complicating factors can set in, such as depression, anxiety, poor sleep and difficulty with work and relationships. 

If left unaddressed, years of chronic pelvic pain can leave a patient feeling more distressed, uncertain and helpless, leading to strong secondary symptoms requiring psychiatric care in up to four percent of cases. To all patients, I would say: pain is never normal. We need to normalize the conversation around chronic pelvic pain and urge those who suffer through the symptoms each day to seek the help they need.

Tips for managing chronic pelvic pain:

• Find the right clinician and commit: Knowing the complex ways in which chronic pelvic pain can manifest, it is important to have a tailored solution specific to each patient. This makes the doctor-patient relationship more crucial than ever, so make sure you find the right doctor for you and avoid getting multiple opinions. The ideal candidate should give equal attention to your physical and psychological symptoms when treating chronic pelvic pain.

• Use medication responsibly:  It is best to think of the short-term benefit and the long-term impact when it comes to pharmacological treatment. In the short term, pain can be addressed by over-the-counter analgesics such as paracetamol, ibuprofen or aspirin. If these do not work for you, please speak with your doctor who may recommend a prescription drug instead. However, I do not recommend relying on prescription drugs as a long-term solution.

• Physical therapy: This can include hot applications, positioning, stretching exercises, traction, massages or ultrasound therapy. Based on the severity of your physical symptoms, your doctor may also recommend pelvic floor training.

• Psychophysiological therapy: Remember not to undermine the psychological aspect of physical conditions like chronic pelvic pain. For this, I would recommend relaxation therapy, counseling, a stress management program and biofeedback techniques. Combined with physical therapy, both frequency and severity of chronic pain may be reduced.

Dr Francesco Cappellano is  a consultant urologist and head of the urology department at Fakeeh University Hospital in Dubai

Dr Francesco Cappellano

Dr Francesco Cappellano is a consultant urologist and head of urology at Fakeeh University Hospital.