Chronic Female Pelvic Pain

Cause

If you have pelvic pain, your health professional will consider a broad range of possible causes. Female pelvic pain is typically caused by a medical condition involving the reproductive organs, muscles of the abdominal wall, urinary tract, or lower gastrointestinal tract. Some causes are always short-term (acute), and others can become long-lasting (chronic) unless successfully treated.

Female pelvic pain can be a difficult-to-solve medical mystery. Experts have yet to understand all possible causes of pelvic pain, particularly when it has become chronic. For this reason, some women have chronic female pelvic pain with no known cause, even after a lot of testing. This does not mean, however, that there isn't a cause behind the pain nor that there is no possible treatment.¹

Chronic pain with no diagnosable cause can occur in any part of the body. Long after a disease or injury has healed, nerves can continue firing pain signals (neuropathic pain). This is thought to be caused by an overloading of the nervous system by extreme or long-lasting pain. It also helps explain why it's fairly common for chronic pelvic pain to have no obvious cause.

Conditions that can cause acute pelvic pain include:

• Normal ovulation, which can cause brief ovary pain, or "mittelschmerz." This pain is cyclic, meaning that it happens once during each normal menstrual cycle.
• Ectopic pregnancy, which requires emergency treatment. For more information, see the topic Ectopic Pregnancy.
• Kidney stones, which can become chronic. For more information, see the topic Kidney Stones.
• Appendicitis, which requires immediate medical care. For more information, see the topic Appendicitis.
• Functional ovarian cysts, which can become chronic. For more information, see the topic Functional Ovarian Cysts.
• Urinary tract infection. For more information, see the topic Urinary Tract Infections in Teens and Adults.
• Pelvic inflammatory disease (PID) or tubo-ovarian abscess, which requires medical treatment. For more information, see the topic Pelvic Inflammatory Disease.
• Sexually transmitted infections, which occasionally become chronic. For more information, see the topic Exposure to Sexually Transmitted Infections.

Conditions that can cause chronic pelvic pain include:

• Endometriosis, the growth of uterine lining (endometrial) tissue outside of the uterus, which often causes cyclic pain and bleeding. For more information, see the topic Endometriosis.
• Adenomyosis, the growth of endometrial tissue into the uterine muscle, which can cause cyclic pain and bleeding.
• Non-cancerous (benign) tumours of the uterus, such as:
  • Uterine fibroids. For more information, see the topic Uterine Fibroids.
  • Endometrial polyps.
• Scar tissue (adhesions) in the abdomen and pelvis, typically caused by pelvic inflammatory disease, radiation treatment of the pelvis, or pelvic or abdominal surgery. For more information, see the topic Pelvic Inflammatory Disease.
• Bowel problems, such as irritable bowel syndrome. For more information, see the topics Abdominal Pain, Age 12 and Older and Irritable Bowel Syndrome.
• Physical or sexual abuse in the recent or distant past. (Though poorly understood, combined emotional and physical trauma are thought to cause chronic pain or make it worse.¹) For more information, see the topics Domestic Violence and Child Abuse and Neglect.
• Urinary tract problems, such as bladder inflammation (chronic interstitial cystitis).
• Pelvic organ cancers. For more information, see the topics Endometrial (Uterine) Cancer, Ovarian Cancer, and Cervical Cancer.
• Structural problems with the uterus.
• Muscle spasm or pain in the lower abdominal wall muscles ("trigger points"). This is sometimes linked to past surgery in that area.

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Author:	Kathe Gallagher, MSW Carrie Henley	Last Updated: March 30, 2007
Medical Review:	Renée M. Crichlow, MD - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology Donald Sproule, MD, CM, CCFP, FCFP - Family Medicine
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