| How is Chronic Pelvic Pain Diagnosed Frequently the diagnosis is made in error because of failure to diagnose the actual condition responsible for the pain. In these cases, the patient is denied an effective rational treatment aimed at the underlying disease. Commonly, undiagnosed adenomyosis or fibroids are the cause of the pelvic pain. A woman with chronic pelvic pain must undergo a systematic and thorough investigation in order to rule out a variety of conditions. These include gynecological, gastrointestinal, urological, neurological, and musculoskeletal diseases. Gynecological conditions which can cause pelvic pain include fibroids, adenomyosis, endometriosis, pelvic inflammatory disease, pelvic adhesions, ovarian diseases (such as a cyst), and fallopian tube diseases. If gynecologic causes have been excluded, gastrointestinal evaluation may be required to rule out such conditions as inflammatory bowel disease, diverticulitis and irritable bowel syndrome. Urological conditions which may cause pelvic pain include bladder infection, urolithiasis (stones in the urinary tract) and urethral inflammation. Occasionally chronic pelvic pain is found to be associated with congestion of the pelvic veins (pelvic varicose veins). The diagnosis of pelvic varicocities requires special imaging studies, such as pelvic venography or ultrasound. What is the Treatment for Chronic Pelvic Pain True chronic pelvic pain with no apparent organic cause is best treated by an interdisciplinary approach which includes a gynecologist, nutritionist, psychologist and other specialists as needed. Medical therapy may include birth control pills and non-steroidal anti-inflammatory agents (such as ibuprofen.) . Medical treatment in chronic pelvic pain due to pelvic varicosities may include progestins, non steroidal anti-inflamatory drugs, birth control pills, Danazol (a mild androgenic steroid), or GnRH agonists. These measures are effective in 70% of cases. In some cases psychotherapy proves to be an effective measure. What is the Role of Hysterectomy in Treating Chronic Pelvic Pain Hysterectomy is rarely justified. Limited studies suggest that on rare occasions pelvic venous congestion does not respond to conservative measures. In these cases limited surgery such as ligation or embolization of the pelvic veins has been effective to relieve this pain. Hysterectomy, with or without resection of the ovaries, is reserved for the relatively rare cases that do not respond to conservative or limited surgical approaches. Hysterectomy is by no means foolproof and fails to relieve chronic pelvic pain in about 25% of cases. |