Treatments for Pelvic Pain

To go over this I am going to re-list the causes of pelvic pain and simply list the treatment approaches.

Non reproductive organ disease - Irritable Bowel syndrome (IBS) and Interstitial Cystitis (IC) are important non reproductive causes of pelvic pain. IBS is treated with medicine and diet. IC is treated with medicine and some physical treatments on the bladder, such as bladder distention.

Normal processes may cause pain; i.e., pregnancy, ovulation. Sometimes just learning the cause of pain helps people to deal with the discomfort. It helps to have the reassurance that something sinister is not present. If ovulation is quite uncomfortable, it can always be suppressed with the pill.

Abnormal pregnancy like miscarriage or ectopic pregnancy can cause pain. These require resolution medically or surgically.

Infections of pelvic organs with or without abscess cause pain. The lower pelvis is naturally full of many types of bacteria. In disease conditions, these can pass to the upper pelvis where they do not belong. These infections are treated with antibiotics, and if an abscess is present, it sometimes requires surgical drainage.

Hernias in various places may cause pain. These can be mechanically supported or surgically repaired.

Cysts of the ovaries or fallopian tubes may cause pain by causing pressure, twisting or rupturing. Many ovary cysts will spontaneously resolve over time. If cysts recur repeatedly, ovarian activity can be suppressed with the pill.

Fibroids (aka myomas) in the uterus may cause pain. These can be treated medically, either with hormones or with medicines that suppress hormones. They can also be selectively removed in a procedure called myomectomy, or the uterus containing them can be removed.

Endometriosis may cause pain. Endometriosis is hormone responsive. Pain may improve either with hormone treatment or with medicines that suppress hormones, for as long as the treatment is taken. Pain may also be alleviated with surgery, but it is prone to recurrence.

Adhesions, aka scar tissue, may cause pain. Pain may be alleviated with surgery, but it is prone to recurrence.

Pelvic floor muscle problems may cause pelvic pain. These may respond to targeted pelvic floor physical therapy by specially trained physical therapists. Surgical intervention can address for pelvic organ prolapse.

Nerve irritability or damage from any of the above. - This is most nebulous, challenging, and in some ways, the most important category of pelvic pain. Understanding this requires a sophisticated appreciation for the integrated nature of the human body and the the mind, through what we know as the nervous system. The nervous system is composed of the combination of the brain, spinal cord, and all our peripheral nerves all over our body. These together create a web of sensation and impression which varies moment to moment in its focus and sensitivity. It is there to allow us to sense and interact, but it can come to function abnormally. According to C. Paul Perry, MD, founder of the International Pelvic Pain Society, "...chronic pain causes what's called CNS up regulation, or an increasingly sensitivity of cells that transmit pain sensation. " (1)

The task of treating pain caused from CNS up regulation is therefore to produce CNS down regulation, and reduced pain sensitivity.