Any discomfort felt in the structures related to the pelvis, below the belly button, is considered as pelvic pain. It may be felt in the lower abdomen, perineum, anus, buttocks, or tailbone. In women it can also be felt in the vulva and vagina, and in men it can be felt in the penis and testes.
Pelvic pain can be categorised into:
- Acute pelvic pain - A pain that is sudden and unexpected, but there is often an obvious cause such as appendicitis, inflammation or infection.
- Chronic pelvic pain - A non-malignant pain related to the structures of the pelvis, that is persistent or recurrent over 6 months and is not associated with menstruation, pregnancy or sexual intercourse. Effected muscles, nerves and tissues may continue to send pain signals through the nerves of your spinal cord, to your brain, even after the original cause has been resolved. The pain itself is now the disease.
- Chronic pelvic pain syndrome - If you suffer from chronic pelvic pain for a long time, your emotions and behaviour can suffer as you try and cope with it. Whether consciously or unconsciously, you will now be suffering from chronic pelvic pain syndrome.
The pain can be further classified by the organs affected and where the pain is worst i.e dyspareunia is pain that is worst during penetrative sex and urethral pain syndrome is pain localised to the urethra.
Symptoms of Pelvic Pain
Chronic pelvic pain may vary in location throughout the day, moving from left to right or up and down. Sometimes it may be more of a general ache or a throbbing sensation over a wide area. Other times it may be a sharp, stabbing sensation in a specific location. It can vary in depth, sometimes feeling like a soreness of the skin, and other times feeling like an injury deep in the pelvis.
Visceral pain is stimulated from injury to the pelvic organs and is often quite widespread. Somatic pain is stimulated from injury to the skin, muscles and tissue. Visceral pain is often significantly more painful when stimulated by pressure and movement, and results in many more symptoms that affect the body.
If you suffer from chronic pelvic pain, being active may intensify it. Even coughing or sneezing may cause it to spike. If you fall pregnant, you can expect your pain to be more consistently heightened. As is the case during menstruation (dysmenorrhea).
Chronic pelvic pain can be so relentless and severe that it becomes physically and mentally exhausting, causing you to:
- cut down on your daily activities - most sufferers rest at least one day each month.
- not be able to get out of bed - 25% of female sufferers spend at least 2 days in bed each month.
- take sick days off work - 15% of sick days taken by women are as a result of pelvic pain.
- feel helpless and depressed - leading to frustration and changes in your mood.
- be considered functionally disabled - you may consciously reduce your mobility in an attempt to prevent further pain.
- unconsciously, or consciously change your behaviour - in an attempt to reduce the pain.
- look for temporary relief - by changing your surroundings and emotions.
- have suicidal thoughts - 26% of women consider suicide due to the pain, that's in comparison to 6% of healthy peers.
The symptoms of chronic pelvic pain can be split into physical symptoms, emotional symptoms and changes in behaviour. The experience of pelvic pain is different for every sufferer and can change for each individual over time, in terms of location, intensity and how they are able to reduce it. Possible symptoms, other than the pain itself, include:
- Physical symptoms:
- no obvious cause - for the pain, or the pain is much more severe than expected from the known cause.
- muscle tension - causing lower back and leg pain, issues with normal bladder and bowel function, and a tight pelvic floor.
- loss of appetite
- slower reflexes and reactions
- constipation or diarrhoea
- abdominal bloating
- urge incontinence
- painful sex
- minimal relief - 'over the counter' pain relief medications, and conventional treatments, provide minimal pain relief, if any.
- Emotional / psychological symptoms:
- feeling of sadness and tearfulness
- feeling of helplessness
- Changes in behaviour:
- exhaustion - sleeping too much or exhaustion from insomnia.
- less active
- missing work
- change in relationships
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