19th June 2017
By Dr Marc Russo & Danielle Santarelli, PhD
Pelvic pain is a broad term to describe any pain within the area of the lower abdomen/pelvis. There are numerous causes for pelvic pain - it may be muscular, nerve or organ related (particularly the reproductive organs, urinary tract or bowel), or due to a specific underlying medical condition. Some conditions of pelvic pain occur in women only and others occur only in men. This article provides a brief overview of some common types of pelvic pain and ends with a discussion on the issue of pain after pelvic mesh surgery.
Pelvic Muscle Spasm
Stabbing pains, aches or cramps may be caused by muscle spasms. In terms of pelvic pain, common culprits are the obturator internus, piriformis or the pelvic floor muscles. Exercises or stretches aimed at relaxing the pelvic muscles may help, preferably guided by a specialised physiotherapist. Steroid, local anaesthetic or Botox injections may be performed by a Pain Specialist to treat muscle spasms and related pain.
Pudendal neuralgia is caused by irritation, trauma or compression to the pudendal nerve – the nerve that carries signals between the genitals, anus and urethral sphincter. Specific causes include childbirth, surgery, cycling, and pelvic floor muscle spasm or tightness. Symptoms include pain or numbness, and sexual, urinary or bowel issues. Stretches or relaxation exercises aimed at relaxing and lengthening the pelvic muscles may help, preferably guided by a pelvic physiotherapist, along with minimising pressure on the nerve (i.e. using a U-shaped cushion). Steroid, local anaesthetic or Botox injections may be performed by a Pain Specialist.
Irritation and pain of the bladder may be caused by an infection of the urinary tract (bacterial cystitis) or by an unknown cause not associated with infection (interstitial cystitis / painful bladder syndrome). Painful bladder syndrome is a chronic condition causing urinary pain, frequency and/or urgency. These issues are more common in women. Drinking the right amount of water or making dietary changes may help. Medications such as Amitriptyline or Pentosan may be prescribed by your doctor to treat bladder-related pain.
Pelvic Pain in Men
Pelvic pain in men tends to occur later in life and is commonly related to stress or injury. Testicular, perineal and penile pain are frequent complaints by men seeking help with pelvic pain. Prostatitis (inflammation of the prostate) is a common cause of pelvic pain in men. Symptoms commonly reported by men with pelvic pain include pain when seated, burning pain of the scrotum, penis or crotch, bowel and bladder issues, pain during intercourse, and mood/behavioural/emotional changes.
Pelvic Pain in Women
Many women suffer in silence with chronic pelvic pain. Painful issues specific to women include dysmenorrhoea (painful menstruation), endometriosis (endometrial tissue growth outside of the uterine cavity), vulvodynia (chronic vulval/vaginal pain), pelvic organ prolapse (i.e. bladder drop), pelvic inflammatory disease (often due to a STD), painful intercourse, ectopic pregnancy (growth of an embryo outside of the uterus), ovarian cysts and uterine fibroids (noncancerous growths in the uterus).
Pain after Pelvic Mesh Surgery
Unfortunately, it has now become clear over time of a significant number of complications in patients who have received pelvic mesh implants (and, to a lesser extent, synthetic sling implants) for the symptoms of pelvic organ prolapse. These complications can include chronic groin, pelvic or suprapubic pain, pain during or after intercourse, and mesh erosion into either the vagina or other structures. The criteria to appropriately deploy mesh are being tightened, according to the recently published consensus statement by the European Urology Association and the European Urogynaecological Association (full text available here).
The issue of how to deal with the pain in those who suffer complications is slowly becoming clearer. Surgery in terms of mesh removal can have a role but is best considered in centres of excellence due to the complex nature of the surgery. Above all else, effective pain management in a multidisciplinary pain clinic is generally the first point of call to optimise pain control through medication, control over pelvic floor muscle spasm, interventional techniques to reduce/block pain signal transmission, and, in some cases, an advanced pain management technique called Sacral Nerve Stimulation - a small nerve implant to block incoming pain signals from the pelvis.
The key is not to suffer in silence, but to approach your General Practitioner and ensure you get a referral to a Pain Clinic that knows how to manage this complex situation.
References & Further Reading:
- About Endometriosis. Endometriosis Australia. (2016) Accessed online via: https://www.endometriosisaustralia.org/about-endometriosis
- Baribieri RL. Patient education: Chronic pelvic pain in women (Beyond the Basics). UpToDate. (Last updated 18/08/2016) Accessed online via: https://www.uptodate.com/contents/chronic-pelvic-pain-in-women-beyond-the-basics
- Blocker W. What’s Causing Your Pelvic Pain? OnHealth. (2016) Accessed online via: http://www.onhealth.com/content/1/pelvic_pain_causes
- Chapple CR, Cruz F, Deffieux X, et al. Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence. European Urology. (2017) [Epub ahead of print]. https://www.ncbi.nlm.nih.gov/pubmed/28413126
- Evans S & Bush D. Pelvic Pain E-booklet. Pelvic Pain Foundation of Australia. (2016) Accessed online via: http://www.pelvicpain.org.au/wp-content/uploads/Pelvic-Pain-Ebook-2016.pdf
- Interstitial Cystitis (Painful Bladder Syndrome). NIH: National Institute of Diabetes and Digestive and Kidney Diseases. (January 2017) Accessed online via: https://www.niddk.nih.gov/health-information/urologic-diseases/interstitial-cystitis-painful-bladder-syndrome
- Litwin M, Schaeffer A & O’Leary MP. Prostatitis: Inflammation of the Prostate. NIH: National Institute of Diabetes and Digestive and Kidney Diseases. (July 2014) Accessed online via: https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostatitis-inflammation-prostate
- Pelvic Pain. MedlinePlus (U.S. National Library of Medicine). (Last updated 11/05/2017) Accessed online via: https://medlineplus.gov/pelvicpain.html
- Pelvic Pains. Pelvic Pain Foundation of Australia. (2016) Accessed online via: http://www.pelvicpain.org.au/information/pelvic-pains/
- Pudendal Neuralgia. Genetic and Rare Diseases Information Center. (Last updated 1/17/2017) Accessed online via: https://rarediseases.info.nih.gov/diseases/10713/pudendal-neuralgia/
- Image courtesy of Somikiat Fakmee at FreeDigitalPhotos.net