Chronic Pelvic Pain: 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.
