Disease Awareness Page for R3 Stem Cell – Pelvic Pain

What is pelvic pain?

Pain felt in the general pelvic area is known as pelvic pain, and depending on the duration, it can be classified into acute and chronic pelvic pain. Acute pelvic pain is pain that hasn’t lasted up to six months, and the pain is considered chronic when it exceeds a six-month duration. Pelvic pain occurs in men and women and is caused by several conditions, both physiological (normal) and pathophysiological (abnormal). Additionally, the causes in men differ from those in women, although they also share similar causes. 

The only male-specific cause of pelvic pain is prostatitis. This is a condition characterised by the inflammation of the prostate gland, and it only happens in men because women don’t have prostrate. Gland. In women, there are several causes of pelvic pain, including dysmenorrhea, ovarian cysts, and endometriosis (more on these under causes of pelvic pain): factors that can cause pelvic pain in men and women pudendal neuralgia, and appendicitis.

How is pelvic pain felt?

Pelvic pain is a blanket term that describes pain felt in the general pelvic region. This extends from the lower abdomen and covers the genitals. Pain occurring in the lower part of the body is very broad and can vary in terminology due to where it is most felt. For example, if the pain is felt in the posterior lower part of the body, it is considered as low back pain. Pain felt in front of the body below the chest is known as anterior abdominal pain. Sometimes, individuals who have pain in these areas have trouble distinguishing the areas from each other. 

Appendicitis reflects as pain in the pelvic area, although some children and adults describe it as a stomach ache. Other conditions also have this effect, like menstrual cramps and colitis.

Causes of pelvic pain

As mentioned earlier, the causes of pelvic pain are very numerous and can range from muscular pain like muscle tension and strain to the pain of nerve origin (conditions like pudendal neuralgia and even some kinds of spinal arthritis). 

The other culprits of pelvic pain are soft tissues. In fact, soft tissues are the origins of most of the pelvic pain felt, as we will see shortly. There is also pelvic pain that’s not really pelvic pain. This includes referred pain originating from other parts of the body and reflecting at the pelvis. 

Causes of pelvic pain in men

Even though there are several causes of pelvic pain, prostatitis is the only male-specific one. Prostatitis is inflammation of the prostate gland and surrounding tissues. There are different types of prostatitis:

• Chronic prostatitis. This is also known as chronic pelvic pain syndrome
• Acute bacterial prostatitis
• Chronic bacterial prostatitis
• Asymptomatic inflammatory prostatitis. As the name suggests, this type of prostatitis doesn’t present any symptoms, has no complications, and often requires no treatment. 

Causes of pelvic pain in women

The causes of pelvic pain in women include gynaecological processes like 

• Dysmenorrhea (menstrual cramps)
• Pre-menstrual syndrome. This refers to physical pain that occurs between one to two weeks before menstruation
• Endometriosis. This is when the normal lining of the uterus grows outside the uterus
• Pelvic inflammatory disease
• Ovarian cysts. A cyst is a large tissue that contains air, fluid and other substances. They can grow anywhere on the body and are very painful
• Ovarian torsion. Ovarian torsion is when the ovary twists in a way that it restricts its blood supply
• Ectopic pregnancy. This is a condition in which a pregnancy is implanted outside the uterus. Ectopic pregnancies can be quite painful and can lead to serious complications. The pregnancies are often terminated as soon as they are discovered, to protect the mother
• Mittelschmerz. This is also known as painful ovulation.
• Urinary tract infections
• Dyspareunia. This is pain experienced during sexual activity

Causes of pelvic pain in both sexes

Since pelvic pain is caused by tissues in the body, the sources of pelvic pain common to both sexes are tissues like the bladder, appendix, bowels, and others

• Sexually transmitted diseases

• Colitis
• Proctitis
• Appendicitis
• Irritable bowel syndrome
• Pudendal neuralgia

How common is pelvic pain and who is at risk?

Females

Most women will experience pelvic pain at some point in their lives. Puberty is an especially important phase when it comes to pelvic pain because it marks the onset of ovulation and menstruation. As mentioned earlier, different conditions cause different kinds of pelvic pain, and these have varying occurrences. Dysmenorrhea accounts for between 17% and 81% of all pelvic pains. 

Dyspareunia accounts for between 8% and 22%. Noncyclical pain is responsible for between 2% and 24%. In 2017, about 9 out of every hundred visits to the gynaecologist were due to chronic pelvic pain. Chronic pelvic pain is also responsible for 20% to 30% of all laparoscopies in adults.

Males

In men, about 90% of prostatitis conditions present with chronic pelvic pain. 

Risk factors

Pelvic pain is more common in women, and they are at greater risk of developing the condition. Most women will develop pelvic pain at some point in their lives due to menstruation other physiological changes. Some factors that can increase the changes are

• Sexually transmitted diseases
• Abuse
• Previous miscarriage
• Pregnancy

For men, the risk factors include

• Prostatitis
• Inflammatory conditions in or around the pelvis

What are the symptoms of pelvic pain?

The kinds of pelvic pain felt depend on the structures causing the pain, and the sources of the pain. The pain could be

• Sharp and piercing
• Dull
• Aching
• Burning. Burning pain is usually associated with nerve-related causes like compressions, impingements and inflammations.  It could also be associated with several sexually transmitted diseases
• Pressure. Sometimes, individuals can feel pelvic pain as intense pressure in their abdomen. This is common in causes like constipation. The pain usually resolves when the bowels are emptied.

How is pelvic pain diagnosed?

The diagnosis of pelvic pain begins with a history and examination. The next step is usually a pregnancy test in women. Other tests include imaging scans and blood tests. Diagnosing pelvic pain in men usually involves a process of elimination, ruling out other diseases until the cause is found.

History

The kind of pain felt can point to the source, like burning during urination can point to Urinary tract infections and sexually transmitted diseases. Pain around or during menstruation in women points to PMS and dysmenorrhea.

Physical assessment

This includes assessing the way the individual sits, stands and walks, as well as feeling several parts of the abdomen to try and elicit the pain. A vaginal and rectal exam may also be conducted.

Tests

Several tests can be conducted to confirm the source of the pain. Without proper identification, the pain cannot be properly treated. Some of the tests include

• Laparoscopy 
• Ultrasound
• Hysteroscopy
• Other imaging scans like MRIs, X-rays and CT scans
• Blood tests

What are the treatment options available?

Successful treatment of pelvic pain is often contingent upon successful diagnosis. Treatment options can include

• Physiotherapy
• Nerve stimulation
• Trigger point injections
• Myofascial release
• Pain relievers
• Hormone treatments
• Antibiotics
• Surgery

The treatments administered depend on the underlying cause. 

Learn More about ongoing clinical studies sponsored by R3 Stem Cell HERE.

References

https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostatitis-inflammation-prostate 

https://www.verywellhealth.com/male-pelvic-pain-associated-with-prostatitis-2564565 

https://www.medicalnewstoday.com/articles/323796.phhttps://www.webmd.com/women/ss/slideshow-pelvic-pain-causes 

https://medlineplus.gov/pelvicpain.html 

https://www.ncbi.nlm.nih.gov/pubmed/16824213 

https://www.ncbi.nlm.nih.gov/pubmed/27661020 

https://www.webmd.com/pain-management/guide/pelvic-pain#1 

https://www.mayoclinic.org/diseases-conditions/chronic-pelvic-pain/diagnosis-treatment/drc-20354371 

https://www.onhealth.com/content/1/pelvic_pain_causes 

https://www.nhs.uk/conditions/pelvic-pain/