Pelvic Pain

Chronic Pelvic Pain is Indicator of Endometriosis, Pelvic Adhesions and Infertility

Although at Texas Fertility Center, we do not typically treat patients for chronic pain, many patients with infertility have other conditions that can cause pain. Many conditions, such those discussed below, can cause both infertility and pelvic pain.

Common Causes of Pelvic Pain

Pelvic pain can be caused by a variety of disorders associated with the gynecologic, gastrointestinal, urinary, or musculoskeletal systems.  In addition, some types of pain have no demonstrable physical cause and they are therefore believed to have a significant psychological component. Data from large studies suggest that gynecologic problems are responsible for only 20% of chronic pelvic pain.

Some gynecologic causes of pelvic pain include:

Endometriosis: This is a condition where the uterine lining cells are found outside the uterus.  Some women with endometriosis may have no symptoms, while others experience significant pain and problems with infertility.

Pelvic inflammatory disease:  Some types of pelvic infection can lead to chronic pelvic pain.  Infection can involve the uterus, fallopian tubes, and ovaries and produce symptoms like pain, abnormal uterine bleeding, fever, and chills.  The infection may also cause adhesion (scar tissue) to form around the pelvic organs, which can also lead to chronic pelvic pain.

Adhesions:  Scar tissue may occur after infection, surgery, or as a result of endometriosis.  There is a growing body of evidence that adhesions, especially dense scar tissue, may cause pain.

Adenomyosis:  Adenomyosis is similar to endometriosis in that the disease is characterized by the presence of uterine lining cells in a location outside the uterine cavity.  Whereas with endometriosis affected locations include organs in the pelvic cavity (ovaries, tubes, bowel, lining of the pelvic cavity, etc.), with adenomyosis, the uterine lining actually grows into the muscular wall of the uterus.  This abnormal tissue can form tumors that are often confused with uterine fibroids.  The major symptoms of adenomyosis include abnormal bleeding and painful periods.  Whereas endometriosis is always treatable and occasionally curable, the same cannot be said of adenomyosis.  In fact, the recommended treatment for adenomyosis is hysterectomy, as it is rarely possible to completely resect masses of adenomyosis.  At TFC, we are very conscious of the fact that our patients desire pregnancy and we will therefore attempt to resect adenomyosis without removing the uterus if at all possible.  Patients must understand, however, that even following a very aggressive attempt to remove adenomyosis, pregnancy rates will still be substantially diminished when compared to women who do not have adenomyosis.

Fibroids: These benign tumors of the muscular uterine wall are the most common tumors of the pelvis in women.  By age 35, 25% of Caucasian women, 40% of Hispanic women, and 50% of African American women will have symptomatic uterine fibroids.  Fibroids most commonly cause painful periods (dysmenorrhea), however, they can also cause abnormal vaginal bleeding, pain with intercourse, and/or abnormalities in bowel or bladder function.

Abnormalities of the gastrointestinal system are also a common cause of chronic pelvic pain.

Inflammatory bowel disease (such as Crohn’s Disease or Ulcerative Colitis): The hallmarks of these bowel disorders include fatigue, diarrhea, crampy abdominal pain, weight loss, and fever.

Irritable bowel syndrome: This condition is characterized by chronic abdominal pain and altered bowel habits that are not explained by any other obvious cause.

Diverticulitis: A diverticulum is a sac-like pouch that may form in the intestinal wall.  Diverticulitis occurs when a diverticulum becomes infected.  This can cause symptoms including abdominal pain, nausea/vomiting, constipation, or diarrhea.

Celiac disease:  This is a disorder caused by an allergic reaction to gluten, which is found in such foods as barley rye, oats, and wheat.  It leads to impaired absorption of nutrients, causing diarrhea, weight loss, and abdominal or pelvic pain.

Other sources of pelvic pain include abnormalities of the urinary, musculoskeletal, or other systems.

Interstitial cystitis: This condition may cause pain in the bladder and surrounding tissues, similar to that caused by a urinary tract infection, however, there is no infection.  Typical symptoms include frequent urination and/or an urgent sensation to urinate.  Some women also experience pelvic pain with these other symptoms.

Pelvic floor dysfunction:  This is a poorly defined condition whereby the muscles of the pelvic floor can become shortened, tightened, and tender.  It is not clear how this problem develops.  A physical therapist may be able to help with treatment of this condition.

Depression:  Chronic pelvic pain can be a manifestation of depression, and chronic pain can also exacerbate depression and other mood disorders.  Although many physicians are quick to diagnose depression or other psychological disorders in patients with chronic pelvic pain it is important to first perform a thorough evaluation in order to diagnose any conditions that may be easily treatable.

In addition to the conditions described above, there are many other, less common causes of pelvic pain.  A thorough medical history, physical examination, and other testing (as indicated) can help your physician to identify possible causes of pelvic pain.  Often, a multi-disciplinary approach is needed to identify the organ system which is leading to pelvic pain.  Even if the exact cause of pain is not found, there are treatments that can be helpful in managing pain as well as improving overall physical and emotional function.