Treatment of Chronic Pelvic Pain and Menstrual Pain

What Is Chronic Pelvic Pain?

Chronic Pelvic Pain (CPP) is defined as persistent pain located in the lower abdomen or below the umbilicus that lasts for more than 6 months. The pain may be continuous or intermittent and can significantly affect quality of life.
This condition can occur in both women and men and often requires a multidisciplinary approach for accurate diagnosis and effective treatment.

 

Causes of Chronic Pelvic Pain

Chronic pelvic pain has multiple possible causes. While it is commonly related to the female or male reproductive systems, it may also involve the gastrointestinal, urinary, or nervous systems.

1. Gynecologic and Reproductive System Disorders

• Endometriosis / Chocolate Cyst (Ovarian Endometrioma)
  A condition in which endometrial tissue grows outside the uterus, causing severe menstrual pain, chronic pelvic pain, and sometimes infertility.

• Pelvic Adhesions
  Scar tissue resulting from prior infections or surgeries, leading to chronic pain due to abnormal tissue attachment.

• Uterine Fibroids
  Benign tumors of the uterus that may cause pelvic pain, heavy menstrual bleeding, and a sensation of pelvic pressure.

• Chronic Pelvic Inflammatory Disease (PID)
  Inadequately treated pelvic infections that can lead to persistent pain and adhesions.

• Pelvic Congestion Syndrome (PCS)
  Abnormally dilated pelvic veins causing chronic, dull pelvic pain.

 

2. Other Conditions Associated with Chronic Pelvic Pain

• Chronic Prostatitis / Chronic Pelvic Pain Syndrome (CP/CPPS)
  Seen in men, causing persistent pelvic pain, painful urination, or pain radiating to the genital or groin area.

• Urinary Tract Disorders
  Including interstitial cystitis, kidney stones, or chronic urinary tract infections.

• Gastrointestinal Disorders
  Such as Irritable Bowel Syndrome (IBS) or Inflammatory Bowel Disease (IBD).

• Nerve Entrapment Syndromes

  • Ilioinguinal, Iliohypogastric, and Genitofemoral Neuropathy
    Often caused by prior abdominal surgery, pregnancy, or inflammation, leading to pelvic and groin pain.

  • Pudendal Nerve Entrapment (PNE)
    Compression of the pudendal nerve causing pelvic pain that may radiate to the genital area and affect bowel or sexual function.

 

Diagnostic Evaluation

Accurate diagnosis requires a comprehensive assessment, which may include:

• Pelvic examination or prostate examination to evaluate reproductive organs

• Pelvic ultrasound (transabdominal and transvaginal) to detect endometriosis, fibroids, or ovarian cysts

• Hysteroscopy or laparoscopy to identify conditions not visible on imaging

• MRI or CT scan in complex cases

• Diagnostic nerve block tests to determine whether pain originates from nerve entrapment

 

Treatment Approaches for Chronic Pelvic Pain

1. Pharmacological Treatment

• Analgesics: NSAIDs (Ibuprofen, Naproxen) or Acetaminophen

• Hormonal therapy: Oral contraceptives, progesterone, or GnRH agonists for endometriosis

• Neuropathic pain medications: Pregabalin, Mirogabalin

• Antidepressants: Tricyclic antidepressants (TCAs) or Duloxetine to modulate chronic nerve pain

 

2. Non-Pharmacological Treatment

• Pelvic floor physical therapy to relax and rehabilitate pelvic muscles

• Acupuncture and yoga to reduce stress and pain perception

• Lifestyle modification: Regular exercise, dietary management, and stress reduction

 

3. Interventional Pain Management

• Trigger Point Injections for pelvic muscle–related pain

• Nerve Block Injections targeting specific nerves, such as:

  • Ilioinguinal nerve

  • Iliohypogastric nerve

  • Genitofemoral nerve

  • Pudendal nerve

• Radiofrequency Ablation (RFA) to deactivate pain-transmitting nerves and provide longer-lasting relief

 

Treat the Cause for the Best Outcome

Chronic pelvic pain is a complex condition that requires precise diagnosis and treatment directed at the underlying cause, not just symptom relief.
If pain interferes with daily life or does not respond to initial treatment, consultation with a specialist physician is essential.

At Sapiens Hospital, we provide advanced diagnostic tools, minimally invasive endoscopic procedures, and a wide range of low-risk, evidence-based treatment options tailored to each patient.

 

Our Services

We provide comprehensive care for chronic pelvic pain and menstrual pain, including:

• Targeted pain medication for menstrual and pelvic pain

• Nerve block injections for menstrual pain relief

• Laparoscopic surgery for uterine fibroids

• Laparoscopic surgery for ovarian cysts and chocolate cysts

• Laparoscopic adhesiolysis for pelvic adhesions

Our mission is to restore comfort, function, and quality of life through accurate diagnosis, minimally invasive treatment, and compassionate, patient-centered care.

Sapiens Hospital provides comprehensive care for chronic pelvic pain, offering targeted pain medication, nerve block injections, and minimally invasive laparoscopic surgeries for conditions like uterine fibroids, ovarian cysts, and pelvic adhesions, all aimed at restoring comfort and quality of life.