Seeking help and learning pain-relief strategies benefit women with chronic pelvic pain

April 30, 2015
Minor pelvic discomfort or pain is part of the menstrual cycle for many women. For most of us, it's short-lived and manageable - we might take an over-the-counter painkiller, but we carry on with our regular work and family responsibilities.
But for some women, pelvic pain goes far beyond monthly discomfort, reaching the point where it has a profound impact on their lives. Severe pelvic pain has the potential to affect spousal relationships and productivity at work.

Pelvic pain also has a significant impact on the health care system. Women with pelvic pain account for about 10 per cent of referrals to gynecologists. About 40 per cent of diagnostic laparoscopy procedures are related to pelvic pain, as well as 12 per cent of hysterectomies.

If you are experiencing chronic pelvic pain, it's important to seek medical advice, explains Dr. Catherine Allaire, Medical Director for the BC Women's Centre for Pelvic Pain and Endometriosis, as there are treatments and pain-relief strategies that can help. 

Chronic Pelvic Pain

For medical purposes, chronic pelvic pain means pain that goes on for longer than three months. The frequency and cause varies from woman to woman. While ovulation and menstruation may trigger the pain for some, for others it may be activated by sexual activity, passing urine, having a bowel movement or even just moving around.

In general, pelvic pain comes in different formats: pain in the front of the abdomen; back or pubic pain; and pelvic floor pain or tension. About  50 per cent of chronic pelvic pain is related to gynecological problems. Other causes may  include: interstitial cystitis in bladder; irritable bowel syndrome; abdominal wall hernias; pain in the muscles and tendons; or nerve pain.

The first step is to unravel the source or "trigger" of the pain, explains Allaire.

Pain rooted in the reproductive system is often caused by endometriosis, a chronic inflammatory disease resulting from endometrial cells (cells from the lining of the uterus) that become implanted in other parts of the pelvis or abdomen, or adenomyosis, where endometrial cells migrate from the lining into the wall of the uterus. The pain itself may arise from adhesions of the tissue and organs inside the pelvis, a potential complication of endometriosis, surgery or pelvic infection.

If you are referred to a gynecologist, he or she will talk to you in detail about your medical history and perform a physical examination. For some women, a laparoscopy (a minimally invasive procedure where the gynecologist uses a telescope and specialized instruments inside the abdomen) may be needed for further investigation or treatment.

Treatment and pain relief

For women with gynecological pain, treating the cause, such as a procedure to remove endometriosis in the uterus or pelvis, can help. Suppressing hormones and menstruation with medications may also bring relief.

However, Allaire stresses that even after the physical cause is found and treated, the pain may continue for some women. This happens because the body's response to pain - the pain alarm system - has been affected by the onslaught of pain over time.  

"There are many possible triggers of pain in the pelvis, and a thorough history and physical exam are very important," she says. "But once all the triggers have been treated, if the pain is still there, we have to consider the pain alarm system as part of the problem, and we have to address that aspect of the pain."

The good news is that it's possible to "calm down" the pain alarm system  by learning how to manage the body's approach to pain and resetting the way the pain is perceived in the brain and nervous system. This involves helping women with a combination of strategies that can address the pain and improve their quality of life. These include physiotherapy, counselling, nutrition, meditation techniques, improved sleep habits and peer support.

Allaire notes that these strategies go beyond helping women cope with chronic pain, as this approach can actually reduce the pain. "There is hope. Pain, and especially pain sensitization, can be addressed with the tools that we have. Improvement of both pain and quality of life can be achieved."

Specialized centres like the one at BC Women's can provide this interdisciplinary approach. For some women, one of the province's chronic pain programs may also be helpful to help learn strategies to manage and relieve chronic pelvic pain.  For example, the University of Victoria Chronic Pain Self-Management Program is available province-wide.

What can you do if you have chronic pelvic pain?
  • Learn how your body works and find out what is hurting
  • Work together with your doctor and support network of family and friends to manage your pain
  • Invest in a good diet and healthy lifestyle
  • Reach out and share with other women

Your family physician

If you are experiencing chronic pelvic pain, which may include menstrual symptoms that affects your ability to function at home work or home, it's important to discuss this with your family physician.  He or she can suggest some strategies to manage your pain. These may include anti-inflammatory medications or medications that can temporarily stop menstruation. If you need to see a gynecologist or need help from a specialized program like the BC Women's Centre for Pelvic Pain and Endometriosis, you will also need a referral from your family physician.


BC Women's Centre for Pelvic Pain and Endometriosis

The BC Women's Centre for Pelvic Pain and Endometriosis  is the provincial referral centre for specialized treatment of severe endometriosis, as well as the diagnosis and treatment of complex pelvic pain.

The centre is one of very few centres for excellence for the treatment of pelvic pain in Canada, and a centre for training in advanced laparoscopic surgery.

The team includes specialized gynecologists, nurses, a physiotherapist and a counsellor. The focus is on pain education and self-management, as well as finding and treating the cause when possible. Patients are of reproductive age and usually participate in the program for approximately six months.

You can find out more on the Resources for Patients page, which includes information on whether the clinic might be appropriate for you. 

As well as providing care, the centre has an active research program to improve the understanding, diagnosis, and treatment of endometriosis and pelvic pain.


Understanding Pain

The YouTube video Understanding Pain: What to do about it in less than five minutes? can help you understand the role that your brain and nervous system plays in chronic pain that persists beyond the initial injury or tissue damage.


This article was written by Anne McLaughlin with information provided by the BC Women's team of registered dietitians and reviewed by Dr. Catherine Allaire.


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