Pelvic Pain Clinic

Diagnosis & Treatment

Diagnosis of Chronic Pelvic Pain

To understand what may be causing chronic pelvic pain, your doctor will discuss your symptoms and ask about your medical history, including any previous conditions, surgeries or treatments. They may also ask about your family history and how your symptoms affect your daily life.

Depending on your symptoms, you may also need tests such as:

• Pelvic examination: Your doctor may examine the pelvic area to look for abnormalities, including changes in the pelvic floor muscles.
• Laboratory tests: Blood and urine tests may be used to check for signs of infection or other conditions that may contribute to your symptoms.
• Ultrasound: This imaging test allows doctors to examine the uterus, ovaries and fallopian tubes and look for abnormalities such as cysts or growths. Other imaging tests, including computed tomography (CT) scans or magnetic resonance imaging (MRI), may also be recommended depending on your symptoms.
• Laparoscopy: In some cases, a thin tube with a camera is inserted through a small incision in the abdomen to allow doctors to examine the pelvic organs.

Treatment for Chronic Pelvic Pain

Treatment of chronic pelvic pain aims to ease your symptoms and improve your quality of life. The treatment recommend will depend on the underlying cause of your pain, if identified, as well as your symptoms and individual needs.

Medications:

Mediation may be used to help manage chronic pelvic pain, depending on the cause.

• Pain relief
• Hormone replacement: Birth control or other hormonal medications may help manage pain associated with certain gynecologic conditions or menstrual cycles.
• Antibiotics: If the pain is caused by a bacterial infection.
• Antidepressants: Certain medications in this group can help manage some types of chronic pain through their effects on pain signaling.
• Muscle relaxants: Certain types can help to relax the muscles linked to pelvic pain.Physical therapy: Pelvic floor physical therapy (PFPT) focuses on the muscles and tissues that may contribute to pelvic pain. Approaches include:
• Internal myofascial release: Identifying areas of muscle or tissue tension and applying targeted pressure to help improve mobility and reduce tension.
• Biofeedback: This technique helps you become more aware of pelvic floor muscle activity so you can learn to control and relax these muscles.
• Down-training: This approach focuses on helping an overactive pelvic floor muscle group relax, reduce muscle tone resting and decrease protective muscle guarding.Interventional pain management: Targeted procedures may be recommended to help manage chronic pelvic pain, including:
• Pudendal nerve blocks
• Superior hypogastric plexus blocks
• Ganglion impar blocks
• Pelvic floor Botox injections for severe spasms (vaginismus),
• Trigger point injections (TPI)

Behavioural and psychological support:

Chronic pelvic pain can affect emotional wellbeing and daily activities. Behavioral and psychological therapies, including pain neuroscience education (PNE) and cognitive behavioral therapy (CBT), may help patients develop strategies to manage chronic pain and its impact on their lives.

Advanced Neuromodulation:

For some patients with persistent or refractory pelvic, bladder or bowel-related neuropathic pain, neuromodulation treatments such as sacral nerve stimulation (SNS) or spinal cord stimulation may be considered. These treatments aim to modify pain signals and may be recommended when other treatments have not provided sufficient relief.