Question: I’ve been battling aching pain between my hips for over a year now, but it just won’t go away. I have visited several clinics, but none of the tests I’ve done has found an underlying cause. I am 26 years old and single, but pretty much miserable and curled up in bed for several hours on most days… just to make the pain bearable. Should I start all over again with a new specialist doctor?
Answer: Your symptoms may be due to a condition called Chronic Pelvic Pain. This is the medical term for pain of varied character in the region between the hips and up to the belly button that has gone on for six months or longer, sometimes without any identifiable cause. It is most common in women of child-bearing age, but is different from menstrual pain, and is not related to pregnancy. When no specific cause is identified after medical assessment, the condition can still be successfully managed if the woman and her health care providers shift the main goal of treatment to attainment of a meaningful active life.
Chronic pelvic pain may be caused by disorders of the reproductive parts, the urinary or digestive organs, the brain and system of nerves, or the bones and associated muscles. It could also be caused by mental and emotional disorders stemming from previous experience of sexual abuse, physical violence, traumatic genital procedure, or difficult childbirth.
In about one-third of women having chronic pelvic pain, no obvious cause will be evident even after extensive blood tests and body scans. This can be a frustrating experience for distressed women who may then despair of ever becoming well again. Such women are often left wondering “What have I done to deserve this pain?”, and “Isn’t there an underlying condition that can be treated to make this pain go away permanently?”. As successive test results are reported normal and there are no clear-cut answers, affected women may become disappointed, resentful, and even depressed.
Emotional distress worsens perception of pain. The consequence is that affected women may complain bitterly of escalating pelvic pain despite the best efforts of their medical team and carers to provide treatment and support. Over time, people may misunderstand sufferers as being unduly dramatic, difficult, or unpleasant to deal with, leading to gradual erosion of friendships and social support networks.
There is a better way; and it starts well ahead of the doctor’s first request for any laboratory or imaging test. It is advisable for women with chronic pelvic pain to review their past experiences ahead of the initial clinic visit, and to make a point of discussing any disturbing recollections with their healthcare providers. This is because previous violation of bodily integrity can be a risk factor for unexplainable chronic pelvic pain. While going from one doctor to another is usually not a good idea, it is advisable to get care from providers who have experience treating chronic pelvic pain.
Comprehensive check for an underlying cause of chronic pelvic pain is standard care. When an underlying cause is detected, cause-specific treatment is the norm, and this can be expected to improve or in some cases eliminate the pain. When no underlying cause is identified, treatment is most successful when different approaches that are known to be potentially helpful are used in combination, depending on the response of the woman. Such multi-disciplinary care requires a good patient-doctor relationship built over time through mutual cooperation and an open line of communication. The goal of treatment is to reduce symptoms and improve quality of life.
The treatment approaches that can be used in combination to relieve chronic pelvic pain include the following:
- Exercise: An exercise routine consisting of aerobics, pelvic floor training and postural adjustments is recommended for easing chronic pelvic pain. Exercise-stimulated release of certain body hormones also works to keep depression away, and improve sleep quality. It is a myth that immobility and bed rest are best for alleviating chronic pain.
- Physical therapy: A good example is heat applications (warm compress, heating pad) to the lower belly, which work well to relieve chronic pain by improving blood flow to the pelvis. The benefits can be increased, when this is combined with mind-body techniques such as meditation and relaxation therapy.
- Prescription medications: These usually include pills prescribed for altering pain sensation and/or enhancing muscle relaxation. Some women may require antidepressants.
- Counselling: Health education about the complex nature of pain, and the possible outcomes of diagnostic tests for chronic pelvic pain may help affected women to be open-minded about the focus of care and to guard against avoidable emotional reactions to diagnostic test results.
It is helpful to remember that knowledge is power, and you are never powerless against chronic pelvic pain.