Pelvic Pain and Disease- 01

1- Chronic Pelvic Pain

2- Diagnosing Chronic Pelvic Pain
3- How to Ease Your Chronic Pelvic Pain

4- Chronic Pelvic Pain: Questions to Ask
5- Questions to Ask Your Doctor About Pelvic Pain
6- Pelvic Inflammatory Disease (PID)

7- Symptoms of Pelvic Inflammatory Disease
8- How Do I Know If I Have PID?
9- What's the Treatment for Pelvic Inflammatory Disease?

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1- Chronic Pelvic Pain

Causes and Symptoms of Chronic Pelvic Pain

Many different conditions can cause chronic pelvic pain. You may have one or more of them. All can have similar symptoms, and that often makes it hard to figure out the source of the pain. The main symptom is pain that lasts for more than six months, but there are usually other symptoms, as well. Understanding your symptoms can help you and your doctor begin to pinpoint the cause or causes of your chronic pelvic pain. Here are some of the causes and the related symptoms:

Endometriosis

In endometriosis, cells that normally line the inside of the uterus (the endometrium) grow inappropriately outside on organs such as the ovaries, bladder, or rectum.

Symptoms you may have:

• Pelvic pain or cramps before or during your period
• Pain during or after sex
• Pain when you ovulate
• Painful bowel movements
• Rectal bleeding during your period
• Pain when you urinate
• Lower back pain
• Infertility
• Spotting between periods
• Bloating in your abdomen

Adenomyosis

This condition is similar to endometriosis. Cells that normally line your uterus (the endometrium) invade the muscle tissue of the uterus wall (the myometrium). Many women with adenomyosis don't have any symptoms.

Symptoms you may have:

• Pain during your period
• Feeling of pressure on your bladder or rectum
• Heavy periods
• Periods that last longer than usual
• Spotting between periods

Interstitial Cystitis

Women with interstitial cystitis have an inflamed bladder. The inflammation is not caused by an infection. This condition tends to affect women in their 30s and 40s.

Symptoms you may have:

• You need to urinate very often
• Often feeling an urgent need to urinate
• Discomfort when you urinate
• Pain during sex

Urinary Tract Infection

Bacteria are usually the cause of urinary tract infections. Infections can involve any part of the urinary tract, including the kidneys, bladder, and urethra. Urinary tract infections are much more common in women than in men.

Symptoms you may have:

• Feeling pressure in your lower pelvis
• Pain or a burning sensation when you urinate
• Needing to urinate often
• Often feeling an urgent need to urinate
• Needing to get up at night to urinate
• Cloudy urine
• Blood in urine
• Urine has strong or bad smell
• Only a trickle of urine comes out
• Lower back pain

Pelvic Inflammatory Disease

This is an infection of the uterus, fallopian tubes, or ovaries that causes them to become inflamed and infected. Most often, it is a sexually transmitted bacterial infection, like gonorrhea or chlamydia. These bacteria enter the uterus through the vagina and leave the fallopian tubes to infect surrounding organs like the ovaries. Scars left by the infection may cause chronic pelvic pain; however, more commonly the pain is acute.

Symptoms you may have:

• Vaginal discharge having an unusual color, texture, or odor
• Abdominal or pelvic pain in a specific area or more widespread
• Pain during sex
• Irregular or missed periods
• Menstrual cramps that are worse than usual
• Frequent need to urinate
• Pain when you urinate
• Pain when you ovulate
• It hurts when you press on certain areas of your pelvis
• Lower back pain
• Fatigue
• Fever
• Nausea

Pelvic Congestion Syndrome

Pelvic congestion is just like the varicose veins that some women have in their legs, but it affects the veins of the pelvis. Blood backs up in the veins, making them become enlarged and engorged. Pelvic congestion causes chronic pelvic pain in some women.

Symptoms you may have:

• Pain starts 7-10 days before your period
• Pelvic pain is worse when you sit or stand
• Lying down relieves pelvic pain
• Lower back pain
• Aches in your legs
• Pain during sex

Irritable Bowel Syndrome

Chronic pelvic pain sometimes isn't only due to problems with reproductive organs or the urinary tract; other organs in the pelvic area, if "diseased," can present as pelvic pain. Irritable bowel syndrome, an intestinal condition that often causes pain, may be the cause.

Symptoms you may have:

• Diarrhea
• Constipation
• Incontinence
• Flatulence
• Bloating
• Pain relieved by a bowel movement

Uterine Fibroids

Fibroids are noncancerous tumors that grow in, and on, the wall of the uterus. Not all women who have them notice symptoms, but for some, fibroids can be painful.

Symptoms you may have:

• Heavy periods
• Feeling pressure or fullness in your abdomen
• Need to urinate frequently
• Pain or cramps during your period
• Constipation
• Hemorrhoids

Levator Syndrome

Sometimes, spasms of a pelvic muscle called the "levator ani" cause pelvic pain.

Symptoms you may have:

• Pain is related to sitting
• Pain doesn't seem to be related to bowel movements
• You wake up at night in pain
• Pain usually lasts less than 20 minutes at a time

Pelvic Support Problems

Sometimes women have pelvic pain when the muscles and ligaments that hold organs in place weaken. This causes organs like the uterus, the bladder, or the rectum to move from their normal places and herniate into the vagina. The vagina may also change shape. Pregnancyand giving birth may cause these kinds of problems.

Symptoms you may have:

• Leaking urine
• Feeling like something is falling out of your vagina
• Difficulty with bowel movements
• Lower back pain
• Pain during sex
• Pelvic organs bulge into the vagina, or even stick out the vaginal opening, in severe cases

Vulvodynia

Vulvodynia is pain that affects the vulva for no apparent reason. The pain of vulvodynia may be constant or it may come and go.

Symptoms you may have:

• Burning or stinging sensations in the vulva
• Pain when something presses on the vulva, like during sex or when you straddle a seat
• Pain in your inner thighs

Psychological Causes

For some women, the root of pelvic pain is psychological. That's not to say that the pain isn't real. There just isn't an identifiable physical cause. Some people have emotional problems that only show up as physical symptoms. Women who have suffered sexual abuse or assault often have chronic pelvic pain afterward.

Symptoms you may have:

• Depression
• Anxiety
• Substance abuse
• Stress

2- Diagnosing Chronic Pelvic Pain

Diagnosing Chronic Pelvic Pain

Your pelvic pain may not have an obvious cause. It may take some time and effort to figure it out. According to the International Pelvic Pain Society, 61% of women suffering from chronic pelvic pain don't know what is causing it. But with the right diagnosis, you can get relief. There are specialists you can turn to and tests that can be done to determine why you have the pain and what can be done about it.

First, make a detailed list of your symptoms, both physical and emotional, to share with the doctor. Also make a note of:

• When you started having each symptom
• Anything you've tried has helped with the pain
• Whether the pain is better or worse at certain times
• If the pain is related to your menstrual cycle or sexual activity
• Any injury, illness, or surgery you have had

Because chronic pelvic pain often has more than one cause, you may need to see more than one specialist. Your gynecologist would be a good person to see first. For some women, pelvic pain is related to a problem with the reproductive system. Other possible causes include the problems with the muscles of the abdominal wall, bladder, or bowels.

Tests for Chronic Pelvic Pain

First you will have a pelvic exam. Then the doctor will:

• Look at the way you sit and stand
• Press on various points all over your abdomen and pelvic area, asking you to say if anything hurts
• Have you tense and relax your pelvic muscles
• Feel for anything unusual inside your vagina, uterus, and rectum

Tests that may be performed include blood count, pregnancy test and testing for infection such as chlamydiaand gonorrhea. In addition, a urine test can help identify if a urinary tract infection might be the cause of your pelvic pain.

A pelvic exam may be enough to diagnose your problem, or at least part of it. But the doctor may want to do an imaging test like a transvaginal ultrasound, a CT scan, or an MRI scan of the abdomen and pelvis for a more complete picture.

Radiological tests may be useful to diagnose:

• Endometriosis
• Pelvic congestion
• Adhesions
• Fibroids
• Pelvic inflammatory disease

Procedures Used to Diagnose Chronic Pelvic Pain

If imaging tests don't reveal the cause of your pelvic pain, a procedure called laparoscopy may be recommended. It involves inserting a camera or scope through a small incision to look at the pelvic organs or take tissue samples. Also, a hysteroscopy, a small camera placed through the vagina into the uterus, may be useful to diagnose abnormalities that may cause pain originating inside the uterus.

"Pain mapping" is a technique some doctors use. While you're sedated but awake, a doctor uses a laparoscope and a probe to stimulate points inside your pelvis. You rate any pain you feel and say whether it is like the pain you typically experience. This creates a "map" of sensitive areas.

The Role of a Urologist

A urologist is another specialist whom you might see if pain is related to your urinary tract. For example, if your symptoms and pelvic exam suggests interstitial cystitis(IC), there are tests that a urologist can do. IC is painful bladder inflammation that isn't caused by an infection.

A cystoscopy is one way to diagnose interstitial cystitis. Using a special scope, the doctor looks inside your bladder for bleeding or ulcers. The potassium sensitivity test is another way to diagnose it. For this, the doctor fills your bladder with a potassium solution and then with water. People with IC feel more pain and a more urgent need to urinate with potassium than with water. But doctors may diagnose interstitial cystitis without these tests if you have symptoms of IC and no other pelvic problems.

The Role of a Gastroenterologist

Some women with pelvic pain may need to see a gastroenterologist, a doctor who specializes in digestive diseases. That's because irritable bowel syndrome (IBS) is a common cause of pelvic pain. It may be the only cause or it may exist with other causes.

Usually doctors diagnose IBS based on symptoms you describe. Tests can rule out other diseases if the doctor thinks that something else may be wrong.

The Role of a Pain Specialist

Pain specialists are usually anesthesiologists who have specialized training in pain management. Some women with chronic pelvic pain can seek out these physicians to complement treatment provided by their primary care or gynecologist. Pain specialists may be necessary for appropriate trials of nerve blocks, the use of transcutaneous electrical nerve stimulation (TENS) units, or management of medications used for chronic pain.

The Role of a Physical Therapist

Physical therapists can help develop an exercise programand relaxation techniques to help strengthen the pelvic floor muscles, reduce pain, and manage stress and anxiety in women who suffer from chronic pelvic pain.

The Role of a Therapist

Psychiatrists and psychologists can help, too -- even if there is a physical source of pelvic pain. The mind plays a powerful role in how pain is perceived. And, depression, stress, and anxiety can make any pain seem worse.

No matter what specialists you see, it's important to choose a health care provider who knows a lot about chronic pelvic pain. Many different kinds of doctors can have a special interest in helping people with pain. If your regular doctor is not familiar with causes of pelvic pain, ask for an outside referral.

3- How to Ease Your Chronic Pelvic Pain

6 Ways to Ease Your Chronic Pelvic Pain

Chronic pelvic pain (CPP) is discomfort that occurs in the area below your belly button and between your hips that lasts for 6 months or longer. It could be caused by a number of conditions (reproductive, urinary, digestive), or it might have no cause at all. If you have pelvic painthat doesn’t go away, see your doctor. She’ll work to find out what’s behind it. In the meantime, there are a number of things you can do at home to feel better. This article outlines six of them.

1. Over-the-counter pain relievers. Taking ibuprofen(Advil, Motrin) or acetaminophen (Tylenol) is a good first step for CPP relief. Take them as directed to reduce the swelling that can lead to chronic pelvic pain.
2. Get moving. It might be hard to think about exercisewhen you feel you can’t get off the couch—but you must. Exercise increases blood flow. What’s more, when you work out, your body releases feel-good chemicals (doctors call these “endorphins.”) These are you body’s natural painkillers. Just 30 to 45 minutes of moderate exercise -- like speed walking -- 5 or 6 days a week can help to relieve your pain.
3. Take the heat. It helps increase blood flow, which may help reduce your pain. Sit in a tub full of warm water to provide relief during flare-ups. If you don’t have a tub, then a heating pad or warm compress on your belly can work just as well.
4. Make a change. Just tweaking some of your habits can have an effect on your pain. If you smoke, stop. Nicotine -- the active ingredient in tobaccoproducts -- inflames nerves and triggers pain. If you’re overweight, shedding the extra pounds may help ease pressure on nerves and, in turn, relieve pain.
5. Try supplements. In some cases, chronic pelvic pain is linked to lower-than-normal amounts of key vitamins and minerals in the blood. Vitamin D, vitamin E, and magnesium supplements may help to soothe chronic pelvic pain. Talk to you doctor before you decide to take any over-the-counter nutritional supplements. Herbs might also provide relief from chronic pain. Dong quai, licorice, evening primrose oil, and willow all help to ease inflammation naturally. Again, check with your doctor before taking any herbs.
6. Relax. Meditation, yoga, and even deep breathing exercises can help to reduce the stress and tension that can make chronic pain even worse. Another bonus: They might help you sleep better.