What is Chronic Pelvic Pain?

It is a pain in the area below the belly button and between the hips that lasts six months or longer.

What are the symptoms of Chronic Pelvic Pain?

• Severe and steady pain
• Pain that comes and goes
• Dull aching
• Sharp pains or cramping
• Heaviness deep within your pelvis
• Pain during sex
• Pain while having a bowel movement or urinating
• Pain when you sit for long periods

What are the causes of Chronic Pelvic Pain?

Chronic pelvic pain is a complex condition that can have a single cause or multiple causes. Some causes of chronic pelvic pain include:

• Endometriosis
• Musculoskeletal problems
• Chronic pelvic inflammatory disease
• Ovarian remnant
• Fibroids
• Irritable bowel syndrome
• Painful bladder syndrome
• Pelvic congestion syndrome
• Psychological factors

What is the diagnosis of Chronic Pelvic Pain?

The doctor will suggest the following test or exam:

Pelvic exam: It is done to check for any infection, abnormal growths or tense pelvic floor muscles.

Lab tests: They are done to check for infections such as Chlamydia or Gonorrhoea.

Ultrasound: It is done to detect masses or cysts in the ovaries, uterus or fallopian tubes.

Other imaging tests: The doctor may recommend abdominal X-rays, CT-scans, or MRI to detect abnormal structures or growths.

Laparoscopy: It is a surgical procedure in which a small incision is made in the abdomen and examined with a laparoscope.

How is Chronic Pelvic Pain Treated?M

The treatment is aimed to reduce symptoms and improve quality of life. Depending on the cause, the doctor may recommend several medications to treat the condition such as pain killers, hormone treatment, antibiotics, and antidepressants.

The doctor may also recommend specific procedures for the treatment of chronic pelvic pain. These may include:

Physical therapy: Exercises, massage, and other relaxation techniques may improve chronic pelvic pain.

Neuro-stimulation: It involves implanting a device that blocks nerve pathways so that the pain signal cannot reach the brain.

Trigger point injections: In this method, analgesic medicine is injected into the painful areas to block pain and ease discomfort.

Surgical Procedure: To correct the underlying problem that causes chronic pelvic pain, the doctor may recommend a surgical procedure such as Laparoscopic Surgery and Hysterectomy.

Fibroids

Fibroids are abnormal, non-cancerous growths that develop in or on the uterus. The cause behind these growths or tumours is unknown and sometimes fibroids don’t cause any symptoms, so in most cases, women don’t even know that they have them.

Causes and risk factors M

Although the cause behind fibroids is unclear, certain factors influence their development.

• Family history of the condition increases the chances of their development.
• Hormones oestrogen and progesterone may stimulate their growth. So, they can occur during a menstrual cycle or during pregnancy.
• Women who are on the heavier body weight side and those who are above the age of 30 are at higher risk.

Types of fibroids

Fibroids are classified based on where they develop on the uterus:

• The most common type is intramural fibroids that develop in the muscle layer of the uterus.
• Subserosal fibroids develop on the outside of the uterus and can make the womb look larger on one side.
• When the subserosal fibroids develop a base and stem like structure to support the growth, they are called pedunculated fibroids.
• Fibroids that develop in the middle mucosa of the uterus are called submucosal fibroids.

What are the symptoms of fibroids?

The symptoms of fibroids depend upon the location and size of the growth. If the fibroid is small, you may not experience any symptoms while submucosal fibroids could cause heavy bleeding and trouble in conceiving. Possible symptoms include:

• Heavy bleeding during periods and otherwise
• Pelvic pain
• Menstrual cramping
• Abdominal bloating or swelling
• Pain while having intercourse
• Longer menstrual cycles

Diagnosis and treatment of fibroids

During a regular pelvic exam, your gynaecologist will check your uterus to look for any abnormalities. You may also be required to get an ultrasound or MRI scan done so that the doctor can get a clear picture of the location and size of the fibroid.

The treatment plan is developed by your doctor, keeping in mind various factors like your age, health, size and location of the fibroid. Some dietary and lifestyle changes may be recommended, medications to help shrink fibroids and other options to help manage the pain and bleeding. In cases where there are multiple growths or the fibroids are very large, surgical procedures like a laparoscopic surgery may be required to remove the fibr

Ovarian Cysts

A cyst is a fluid-filled sac that causes no pain or symptoms and sometimes develop on one of the ovaries. The ovaries are a part of the female reproductive system and are responsible for the production of eggs and hormones.

Symptoms of ovarian cysts

Cysts usually show no symptoms and are painless but sometimes as they grow in size, below symptoms may begin to appear:

• Pain while having intercourse
• Tender breasts
• Bloating of the abdomen
• Painful bowel movements
• Pelvic pain

Types of Ovarian Cysts

There are various types of ovarian cysts of which functional cysts are the most common ones. These can be of two types, follicle and corpus luteum cysts.

• Follicle Cyst: Every month, the egg is released from a sac called a follicle. The egg grows in this sac and the follicle breaks open to release it. But if the sac doesn’t open then the fluid inside it can develop into a cyst on the ovary.
• Corpus Luteum: These cysts develop in cases where the follicle sacs do not dissolve after releasing the egg. Additional fluid develops in the sac causing a cyst to form on the ovary.

Other types of cysts include dermoid cysts that are growths containing hair or fat, endometriomas cysts that form due to growth of inner uterus tissues on the outside and cystadenomas cysts that develop on the outer surface of the ovaries.

Diagnosis and Treatment of Cysts

Ovarian cysts can be detected during a routine pelvic examination and your doctor may require you to get an ultrasound test done to locate the cyst and determine its size and shape. Since cysts usually disappear on their own after a few weeks, usually no immediate treatment is recommended. Instead, your doctor will ask you to come back in a few weeks for another ultrasound scan to check on the cyst.

In cases where the cyst does not disappear or starts to grow, treatment options like birth control pills to stop ovulation, laparoscopy or a laparotomy may be recommended by your doctor to remove the cyst.

Uterine & vaginal disorders

What is Uterine Prolapse?

Uterine prolapse is defined as a condition which occurs when pelvic floor muscles and ligaments stretch and weaken and are not able to provide enough support for the uterus. It can happen in women of any age, but it often affects postmenopausal women who have had one or more vaginal deliveries.

What causes Uterine Prolapse?

It occurs due to the weak pelvic muscles and supportive tissues. Weak pelvic muscles and tissues can be caused due to:

• Pregnancy
• Overweight
• Chronic cough
• Repeated heavy lifting
• Difficult delivery and labor
• Chronic constipation

What are the symptoms and risk factors of Uterine Prolapse?

Mild uterine prolapse doesn’t show any signs or symptoms, but moderate to severe uterine prolapse have symptoms such as:

• The sensation of heaviness in the pelvis
• Mass protruding from the vagina
• Urinary problems
• Trouble having a bowel movement
• The sensation of looseness in the tone of the vaginal tissue

The risk factors of uterine prolapse include:

• Obesity
• Prior pelvic surgery
• Chronic constipation
• Delivering a large baby
• One or more pregnancies and vaginal births
• Increasing age

How is Uterine Prolapse diagnosed?

Uterine prolapse is usually diagnosed during a pelvic exam. During the exam, the doctor will ask you to bear down as if having a bowel movement. This will help the doctor to assess how far the uterus has slipped into the vagina.

What is the treatment for Uterine Prolapse?

The treatment of uterine prolapse depends on the severity of the condition and symptoms. If there are no or very few symptoms, then the doctor will ask you to do Kegel exercises to strengthen the pelvic muscles, losing weight and treating constipation.

A vaginal pessary which is a plastic or rubber ring is inserted into the vagina to support the bulging tissues.

If the uterine prolapse is severe, then the doctor may recommend minimally invasive or vaginal surgery. Surgery can involve repair of weekend pelvic floor tissues or the removal of the uterus. Doctor recommends a hysterectomy if the condition is severe, but it possess long-term health risks such as increased risk of heart and blood vessel diseases.

Vaginal Yeast Infection

Yeast is a fungus that is commonly found living in the vagina in small numbers. The Lactobacillus acidophilus bacteria are responsible for keeping the yeast count under check. When something disrupts this balance, the yeast cells grow excessively, causing an infection. Vaginal yeast infection is a result of excessive growth of the yeast cells in the vagina which may be triggered by various factors like certain antibiotics which cause an imbalance, high levels of oestrogen which may be due to pregnancy or hormone therapy or sometimes health conditions like HIV or diabetes.

What are the symptoms of a yeast infection?

Vaginal yeast infections can cause a lot of worry but are mostly never serious. These infections are quite common, easy to treat and symptoms include:

• Vaginal itching and soreness of the vagina
• Pain or burning sensation during urination
• Thick white vaginal discharge

Vaginal Yeast Infection Treatment

These infections are common and easy to diagnose on your own, but if you are having doubts it is best to consult your gynaecologist. The symptoms are more common just before your periods and the infection is common around pregnancy too. During pregnancy or even otherwise, it is best to see if the infection clears up on its own over a period. In case it doesn’t clear, your doctor will prescribe some simple antifungal creams or tablets to help.