Children's Hospital Colorado

Chronic Pelvic Pain

What is chronic pelvic pain?

Chronic pelvic pain occurs in the lower abdomen or pelvis in females. The pain is recurrent, distressing and interferes with the ability to perform daily activities.

How does the body send pain signals?

Our bodies contain many types of nerves that give information to our brain about what is going on around us and inside us. Some nerves that send sensations, such as touch, pressure, and temperature, send signals to make us aware of our surroundings. These nerves are set to fire at lower thresholds, which means they are working most of the time and sending signals with even the smallest amount of stimulation.

Nerves that signal pain are meant to fire only when there is a true threat that our body could be harmed. For example, serious infections and injuries that cause bleeding and bruising usually create enough inflammation to turn on pain nerves. These nerves send signals to the spinal cord and turn on other nerves to forward pain signals to the brain.

Once the body has healed and inflammation has gone away, the pain nerves will stop sending their alert signals to the brain and the feeling of pain will go away.

However, pain nerves sometimes become too sensitive and do not stop sending signals to the brain even after inflammation is gone. These sensitive nerves recruit other nerves in the spinal cord to send their own pain signals. This leads to painful areas in other parts of the body.

Sensitive nerves that lie near muscle groups can irritate muscles to the point where they spasm and create new pain signals leading to chronic pain conditions. Depressed mood, stress and anxiety from chronic pain or other factors can stimulate nerve pain signaling and worsen muscle spasms.

What causes pelvic pain?

There are many conditions that can create inflammation in the pelvis and lower abdomen. This inflammation can turn on pain-signaling nerves in the pelvic area. Ovulation, cyst rupture, endometriosis, bladder infections and inflammation of the bowel and bladder are just a few problems that create enough inflammation to turn on pain-signaling nerves.

What makes the management of pain tricky is that the amount of inflammation present doesn’t always create the same amount of pain in all people. People with sensitive nerves may have very little inflammation, but have severe pain because their nerves are more sensitive and fire more easily.

Helpful resources

  • A Headache in the Pelvis: A New Understanding and Treatment for Chronic Pelvic Pain Syndromes, 6th edition, David Wise, PhD and Rodney Anderson, MD
  • What to expect at your visit at Children’s Colorado Pediatric and Adolescent Gynecology

What are some signs and symptoms of chronic pelvic pain?

  • Recurrent pain in the middle of each period (related to an ovulation cyst) or a few days prior to a period (related to menstruation) are common with chronic pelvic pain. Young women may also experience pain with:
    • Movement
    • Urination
    • Bowel movements
    • Tampon insertion (they may feel nerve sensitivity and muscle spasm)

The pain can vary from dull aching to stabbing, and it can be constant or come and go.

When should my daughter see a doctor about pelvic pain?

Your daughter should see her doctor if pelvic pain is not relieved with over-the-counter medicines or currently prescribed medicines from her doctor.

What tests are used to diagnose pelvic pain?

Chronic pelvic pain can be diagnosed in a variety of ways:

  • A physical exam is usually done without the need for a pelvic exam.
  • A urine culture is a test that detects and identifies bacteria in urine.
  • A vaginal culture is a test that helps to identify an infection in the female genital tract using a sample of mucus and cells from the vagina.
  • Ultrasounds may be used to assess for structural causes in the uterus and ovaries, including ovarian cysts, uterine abnormalities and other conditions.

Abdominal wall tests can also be used to demonstrate nerve sensitivity and muscle spasm. Another option for diagnosis is a laparoscopy, which involves outpatient surgery. The doctor will make a small incision and insert an instrument called a laparoscope through the incisions. The laparoscope has a camera attached to it that allows the doctor to look directly at the pelvic structures. This may be used to confirm or rule out internal inflammation conditions such as endometriosis, appendicitis or scar tissue.

Why choose Children’s Colorado for tests to evaluate chronic pelvic pain?

Our adolescent gynecologists have extensive experience in evaluating girls and teens with chronic pelvic pain and are able to correctly interpret and explain test results. When needed, we also work closely with our urology, gastrointestinal and anesthesia specialists to look for and treat all causes of pain

How is chronic pain treated?

Treatment is different for each young woman, but common options include:

  • Hormonal suppression of ovulation and menstruation if pain is provoked by the menstrual cycle
  • Use of oral medicines to modify nerve signaling
  • Local anesthetics to block nerve signaling using topical applications or injections
  • Muscle relaxation management using medicines, heat, massage and physical therapy
  • Removal of internal scar tissue and endometriosis during laparoscopic surgery
  • Reduction of anxiety and depression using counseling, medicines or both

Why choose Children’s Hospital Colorado for your daughter’s pelvic pain?

Our board-certified pediatric and adolescent gynecologists have specialized training in the reproductive health concerns of girls of all ages. We understand the complex changes that occur before and during puberty, and can recognize both common and rare causes of pelvic pain in girls, teens and young women.

We will put both you and your daughter at ease by carefully explaining her medical condition and discussing the various options for treatment. We will also support your family with follow-up care or consultation with your primary care doctor as needed.