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Many of us suffer from pelvic pain. Although common, it is a poorly understood disease. At best it may be described as a discomfort somewhere below the umbilicus and above the pubis. It may be constant or intermittent, dull or sharp, and aggravated by sitting or standing for long periods. Lying down usually brings relief. The condition is called chronic if it is present for six months or more. However, such pain should not be confused with dysmenorrhea — the pain that accompanies menstruation — or pregnancy pains.
Pelvic pain has many causes. In women, it may be due to a pelvic infection. Organisms such as bacteria, viruses, chlamydia or spirochetes may affect the body. The infection may not have been treated or may have been inadequately treated, resulting in chronicity and adhesions.
Endometriosis is another reason. This is a condition where the endometrium, a tissue that forms the inner lining of the uterus, grows outside it — in the pelvis and abdominal cavity. But it behaves as though it were in the uterus and bleeds during the menstrual cycle. As this blood cannot exit the body, it breaks down wherever it is and forms adhesions and scars that distort the pelvic architecture. This can cause severe pain.
The cause may also lie in the urinary bladder (cystitis) or in the bladder wall (interstitial cystitis). There is pain if the bladder is full. Sometimes, pelvic pressure or pain is felt if the person suffers from irritable bowel syndrome (IBS). Then there may be uncomfortable or painful bloating, with constipation or diarrhoea. Another reason is pelvic congestion, which is due to enlarged veins. This can be picked up by doppler or ultrasound studies.
In men, pelvic pain may be due to urinary tract, bladder or prostrate problems. Urinary tract or acute prostate infections can be identified and treated. Chronic prostatitis is difficult to diagnose and treat. The infecting organisms are tough to identify. Prolonged treatment with antibiotics like quinolones (ciprofloxacin) or Septran may be needed, although the symptoms may persist.
A pelvic examination helps identify infections, tumours or an enlarged prostate. There may be trigger areas which when pressed produce the pain. Cultures of urine from samples taken by prostatic massage, from the cervix or vagina may grow bacteria. An ultrasound will estimate the size of the pelvic organs and tumours, if any. If nothing shows up, X-rays and CT scans or MRIs may be done. If all the tests are negative, a laparoscopy may be needed to see into the pelvis.
While diagnosis is pending, one may explore other avenues. Sitz baths — sitting in a basin of warm water for 10 minutes two or three times a day — often help. Another technique is alkanisation of the urine with alkalising solutions got from the pharmacy. Or else dissolve a teaspoonful of baking soda (sodium bicarbonate) in a tall glass of warm water (300ml) and drink it at bedtime. Those who have high blood pressure or are on salt-restricted diets cannot do this. The trigger points on the abdomen may be numbed by applying ice packs. Sometimes a local anaesthetic can be injected to provide temporarily relief.
The sensation of pain travels through nerves up the spinal cord to the brain. Mild antidepressants like amitriptyline and gabapentin can block these transmissions and relieve the pain. They are especially effective if combined with anti-inflammatory medications like ibuprofen.
IBS and food allergies should also be tackled. Sometimes avoiding milk or wheat or both, and tackling abnormal gut motility works.
Physical activity reduces pain to an extent. Walking, jogging or running for 40 minutes a day is important. This should be combined with stretching and pelvic exercises. And if there is stress, cut it down with yoga and meditation.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
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