Pelvic pain management: Everything you need to know

The British Pain Society reveals that 28 million adults in the UK live with chronic pain. Up to 14.3% of adults experience pain that is moderate or disabling. One form of debilitating pain is chronic pelvic pain, experienced by one in six women in the UK. We speak with Consultant Anaesthetist and Pain Management Specialist Dr Sarah Aturia to discuss chronic pain in more detail.

Acute pain in the pelvic area has several causes

There are many reasons why you might experience pelvic pain. Pain in the pelvic area can be chronic or long-term, or acute (sudden and unexpected).

The most common causes of acute pelvic pain are constipation, appendicitis (a painful swelling of the appendix) and urinary tract infections, which can lead to a burning sensation during urination.

"The highest proportion of patients I receive have whiplash, neck pain, back pain and sciatica. On the other end of the spectrum, I also have fibromyalgia and pelvic pain patients who come to see me," explains Dr Aturia.

Ovarian cysts and acute pelvic inflammatory disease are other common causes of pelvic pain in women. Ovarian cysts are fluid-filled sacs that can develop on the ovaries and lead to pelvic pain.

Acute pelvic inflammatory disease is a bacterial infection of the fallopian tubes and womb. It will need to be treated immediately with antibiotics.

Chronic pelvic pain can affect your quality of life

If you have been diagnosed with chronic pelvic pain, your pain has most likely lasted for six months or more. Many of these conditions will also create pain in the lower back, and it's common to have chronic back pain and chronic pelvic pain together. Chronic lower back and pelvic pain is persistent and can have a devastating affect on your quality of life.

A 2020 survey published by Springer Nature found chronic pelvic pain significantly interferes with important aspects of everyday life, such as education, work and romantic relationships.

The NHS states that endometriosis, chronic pelvic inflammatory disease and irritable bowel syndrome (IBS) are the most common causes of chronic lower back and pelvic pain. Endometriosis occurs when tissue similar to the lining of the womb grows outside of your womb. Pelvic pain from endometriosis can dramatically worsen during your period.

"Two in five patients in the UK suffer from pain that affects their quality of life. I help these patients through an assessment of their pain condition," says Dr Aturia.

Chronic pelvic inflammatory disease is another common cause of chronic pelvic pain in women. It is the result of a bacterial infection affecting your womb and fallopian tubes. It often occurs after a sexually transmitted infection, such as chlamydia or gonorrhoea. However, this is not always the case.

Alternatively, IBS is a digestive condition that can cause chronic pelvic pain in both men and women. If you suffer from IBS, you may also experience cramps, bloating, diarrhoea and constipation.

Pain management uses a patient-centred approach

A holistic or patient-centred approach is often carried out by specialists to manage chronic pain. Pain management treatment programmes often include injections or medications. If needed, a multidisciplinary approach through physiotherapy and psychological techniques might help you manage your pain.

Dr Aturia says: “Chronic pain patients have had a long journey. At the pain clinic, our role involves carefully listening to the patient's needs and understanding their condition. I often integrate and combine techniques to target a patient's needs.

Injections for pelvic pain management fall under three groups

There are three groups of injections used to treat pain. The first group of injections target the area where your pain is located. These are injected into your affected joint to ease the pain.

However, the second group of injections target the nerve. For example, if you’re suffering from back pain, an injection can be administered to the nerve that supplies the small joints in your back. These are known as facet joints and help stabilise your spine.

The third group of injections used to provide relief from pelvic pain is radiofrequency treatment. Radiofrequency treatment is a procedure used to temporarily prevent a nerve from sending pain signals. During this procedure, a needle is inserted into the site of injection with a thin wire threaded inside the needle. The other end of the wire is attached to a radio frequency machine.

Pain relief from radiofrequency varies across individuals. It can last from a few days to several months. However, some patients do not experience any pain relief at all from the radiofrequency treatment.

Chronic pelvic pain: can it be resolved?

Unfortunately, chronic pelvic pain is a long-term condition. But, flare-ups can be managed through medications, injections and physiotherapy. And while you can't 'cure' these conditions, Dr Aturia stresses that many people experience huge improvements to your quality of life after treatment.

"The word cure fits in with acute conditions," she explains. "We can resolve the condition and you do not see the patient again. For patients with chronic pain conditions, there are mostly good days after treatment. There may be bad days, but you will be in a better place to manage them together with self-management techniques".