Why pain becomes chronic
At first, the pain usually has a specific source: a focus of endometriosis, adhesions after surgery, inflammation, dilated pelvic veins. If it lasts for months, the nervous system is rebuilt: the spinal cord and brain begin to amplify pain signals, and the pelvic floor muscles reflexively tense, adding their own pain. A self-sustaining mechanism is formed in which the intensity of complaints no longer corresponds to the changes found. That is why it often happens that examinations do not find anything, but the pain is real and requires treatment.
- Initial source of pain in the pelvic organs
- Increased sensitivity of the nervous system
- Pelvic floor muscle tension and trigger points
- Sleep disturbance and increased pain perception
- Anxiety and depression as a reinforcing factor
- Pain may persist after the cause has been eliminated
Possible reasons
The range of reasons is wide and goes beyond gynecology. On the part of the genital organs, these are endometriosis and adenomyosis, adhesions, chronic inflammation of the appendages, varicose veins of the small pelvis, fibroids with malnutrition of the node, prolapse of organs. From the intestines - irritable bowel syndrome and inflammatory diseases. From the urinary tract - interstitial cystitis and recurrent infections. A separate group consists of musculoskeletal causes: dysfunction of the pelvic floor muscles, problems of the sacroiliac joint, pinched nerves.
- Endometriosis and adenomyosis
- Adhesions after surgery and inflammation
- Varicose veins of the pelvis
- Irritable bowel syndrome
- Interstitial cystitis
- Pelvic floor muscle dysfunction
- Neuropathies and spinal problems
How it manifests itself
The nature of the pain suggests its source. A nagging pain that intensifies in the evening, after standing for a long time and during sexual intercourse, is characteristic of venous stagnation. Pre-menstrual pain and painful periods are typical of endometriosis. The association with bowel movement and bloating indicates intestinal causes, and the association with bladder fullness indicates urinary causes. Muscle pain is often local, reproduced by pressure. Sleep, mood and performance almost always suffer, which is important to discuss with your doctor.
- Constant or wave-like pain in the lower abdomen
- Increased before menstruation or after exercise
- Pain during intercourse
- Association with urination or stool
- Pain in the lower back and perineum
- Sleep disturbance, irritability, depression
What examinations are needed
The examination is based on prompts from complaints. A basic examination by a gynecologist, smears, pelvic ultrasound and a general urine test are performed. If venous congestion is suspected, Dopplerography of the pelvic vessels is performed, and if endometriosis and adenomyosis are suspected, MRI is performed. It is useful to evaluate the pelvic floor muscles and trigger points, and for intestinal and urinary symptoms, involve a gastroenterologist and urologist. Diagnostic laparoscopy helps to identify foci of endometriosis and adhesions, but it is not prescribed immediately, but when non-invasive methods have been exhausted.
- Gynecologist examination and smears
- Ultrasound of the uterus and ovaries
- Dopplerography of pelvic vessels
- MRI of the pelvic organs
- Urinalysis and blood tests
- Pelvic floor muscle assessment
- Diagnostic laparoscopy according to indications
Treatment
If a specific cause is found, it is treated: hormonal therapy for endometriosis, intervention for varicose veins of the pelvis, nutritional correction and medications for irritable bowel syndrome. At the same time, they work with the pain itself: they use pain-relieving regimens selected by the doctor, physical therapy and exercises to relax the pelvic floor, and gentle manual techniques. Psychotherapy and sleep work have proven benefits because anxiety and insomnia increase pain. Taking painkillers on your own for a long time without a diagnosis is unacceptable: it masks the problem.
- Treatment of the identified disease
- Pain relief regimens selected by a doctor
- Rehabilitation of the pelvic floor muscles
- Therapeutic exercise and posture correction
- Psychotherapy and sleep normalization
- Correction of nutrition for intestinal symptoms
- Regular observation and assessment of dynamics
