Chronic pelvic pain & Central sensitization

Chronic pelvic pain refers to pain in the lower abdomen and pelvis that has been present for longer than 6 months, either off and on, or present all the time. Pelvic pain can be constant dull pain, aching or cramping, or sharp shooting pain. There may be pain associated with urination, bowel movements, or intercourse. Exercise or eating certain foods may trigger worse pain. Pain may even spread to the lower legs and back. The type and quality of symptoms depends on the contributing sources to the pain.

Pelvic pain can be caused by or contributed to by multiple organ systems in the body:

· The reproductive system (uterus, ovaries)

· Gastrointestinal system (small and large bowel, appendix, rectum). 

· Urinary system (bladder, ureters)

· Musculoskeletal (pelvic floor muscles, abdominal wall)

· Nervous system (including the nerves of the pelvis and perineum)

Chronic pelvic pain can be contributed to or exacerbated by multiple conditions and disease at the same time, such as:

· Adenomyosis

· Endometriosis

· Pelvic congestion syndrome

· Mittelschmerz

· Ovarian cysts

· Pelvic inflammatory disease

· Fibroids

· Vulvodynia

· Postural orthostatic tachycardia syndrome

· Inflammatory bowel disease (Crohn’s disease or Ulcerative colitis)

· Irritable bowel syndrome

· Hernia

· Fibromyalgia

· Interstitial cystitis

· Kidney stones

· Pelvic floor tension myalgia

· Myofascial pain

· Sciatica

· Pudendal neuralgia 

· Hip dysplasia

When someone suffers from chronic pelvic pain for a long time, a phenomenon called central sensitization can occur. This describes how a body experiencing pain can ramp up ALL of its responses to stimuli, so that even regular sensations can cause pain.

Pain is the way the body communicates to us and keeps us safe. Remember when you were little and you touched a hot stove? You learned right away never to do that again. In the same way, when you are experiencing pelvic pain, the body is trying to communicate that something is wrong. But unlike a cut on your finger or a broken bone, pelvic pain doesn’t have a quick fix. When the pain stimulus persists (or the problem doesn’t disappear), the body thinks you haven’t gotten the message - and tries to send you even more pain signals (also called hyperalgesia). Eventually, even normal sensations can trigger pain (also called allodynia).

The first step is to figure out what might be contributing to your unique symptoms. This may require consultation with a team of doctors and care providers to come up with a comprehensive treatment plan. Not everything works for everyone, but we may suggest a variety of strategies, including:

· Excision of endometriosis

· Pelvic floor physical therapy

· Transcutaneous electrical nerve stimulation 

· Trigger point injections

· Centrally-acting medications

· Gonadal vessel embolization

· Acupuncture

· Vaginal suppositories

· Pelvic floor yoga

· Cognitive behavioral therapy

· Diet modification

· Mindfulness training

· Bladder Botox

If the pain generating problem is addressed quickly, central sensitization can be reversed. For example, early surgical excision of endometriosis may completely eradicate pain. However, if someone has suffered from chronic pelvic pain and central sensitization for a long time, some elements of pain may continue after treatment. Always, our goal is to find ways to increase your quality of life and improve functional living.