Abdominal pain, pelvic pain, or urogenital pain will affect 1 in 5 women and 1 in 12 men at some stage in their life. It is a condition that is rarely discussed and one that can have a significant impact on quality of life. Many people suffer for years before finding help. Abdominal or pelvic pain can be a warning of acute or chronic tissue injury to the internal organs or it can be a chronic condition without a readily identifiable cause. Often the cause cannot be diagnosed on a scan or a blood test.

Generally, by the time a sufferer of chronic abdominal or pelvic pain is referred to a specialist pain service they may have had opinions from many experts and may have undergone numerous procedures or surgeries.

Chronic abdominal, pelvic or urogenital pain may be a complex interplay between visceral pain, neuropathic pain, post-surgical pain, and both peripheral and central sensitization.

 

Causes

There are numerous causes for abdominal and pelvic pain, including:

  • Abdominal / Pelvic solid organs: Pancreas / Liver / Spleen / Ovaries / Uterus
  • Abdominal / Pelvic hollow organs: Stomach / Bowel / Bladder
  • Vascular causes for chronic pelvic pain include abdominal angina (mesenteric ischaemia)
  • Referred from other areas (including the spine)
  • Post-surgical causes for abdominal pain include: Adhesions, Neuropathic pain (including post hernia repair)
  • Irritable bowel syndrome
  • Gynaecological: levator ani spasm, pelvic floor dysfunction, endometriosis
  • Pelvic Pain Syndrome: Is where there is persistent or recurrent episodic pelvic pain associated with symptoms suggestive of lower urinary tract, sexual, bowel or gynaecological dysfunction.

The pain could be constant, intermittent or a combination of both. Sometimes an exact cause is not found but this does not mean that you should give up on achieving a life with less suffering. There are many treatment options available, as well as pain management plans.

 

Clinical Presentation

Abdominal and Pelvic pain can be associated with significant functional impairment and can impact a person’s lifestyle a great deal. Suffering from chronic abdominal or pelvic pain can affect your life in many ways:

  • Poor sleep
  • Trouble concentrating
  • Weight loss (or gain)
  • Difficulty with activities of daily living
  • Social withdrawal and isolation
  • Relationship issues
  • Dyspareunia (Painful sex)
  • Period Pain
  • Employment issues

Some abdominal and pelvic pains are visceral pain which is often severe, poorly localised, associated with an emotional component and producing physiological changes like tachycardia (racing heart beat), diaphoresis (perspiration), or hypertension (high blood pressure). It can be associated with and cause pain in other internal organs (viscero-visceral hyperalgesia) or it can refer and cause pain in muscles and skin at a distant site (viscero-somatic hyperalgesia).

 

Management

When abdominal or pelvic becomes chronic or is too severe to live with, you may need some help from the specialists at QPain.

QPain’s specialists can work to diagnose the cause of your pain, and create a tailor made treatment program personally for you.

This may involve:

  • Non-procedural treatments:
    • Pharmacotherapy (medications)
      • Antineuropathic agents
      • Analgesics
      • Anti-emetics
      • Anti-spasmodics
    • Physiotherapy/Physical Activity
      • Those suffering from chronic abdominal and pelvic pain will benefit from including physical activity in their treatment plan.
      • Some forms of pelvic pain may require specialist women’s health physiotherapy to address pelvic floor instability or spasm.
    • Psychology
      • Chronic pain almost always includes an emotional component. Those suffering can benefit from visits to specialist pain psychologists, who will help you become more resilient and learn to cope with a life with pain.
    • Procedural treatments:
      • Including non-surgical treatment and minimally invasive surgery.
      • In some cases of chronic abdominal (coeliac plexus) and pelvic pain (ganglion impar), nerve blocks or plexus blocks with certain medications are appropriate and have the potential to offer short or long lasting relief or reduction of pain.
      • In some cases of chronic abdominal or pelvic pain, radiofrequency neuromodulation in the form of pulsed radiofrequency or radiofrequency ablation is appropriate and can offer longer lasting relief or reduction of pain.
      • Some cases of chronic abdominal or pelvic pain can respond very well to spinal cord stimulation or sacral / peripheral nerve field stimulation.
      • Some cases of abdominal or pelvic pain may be due to other illness or dysfunctions that require referral to and coordination with other specialties including Gastroenterology, Gynaecology, Oncology, and Surgery.
      • Even if no cause is found for the chronic abdominal or pelvic pain, procedural treatments may be able to help.

The best treatment of abdominal and pelvic pain is often a combination of treatments, which can be multimodal or multidisciplinary. You may find a pain management program beneficial. QPain specialists are able to arrange a program to suit your needs.