Both men and women can be plagued pelvic pain, but it is more common in women. Common causes include bladder infections, stones, and bowel issues. In women it can include endometrial issues and ovarian cysts. Treatment is based on the cause, and these pains usually end once the acute condition resolves. Pelvic pain is usually caused by issues like:

• Hormonal changes

• Tissue scarring

• Bladder issues

• Hernias

• Sensory nerve degeneration, entrapment, etc.

Below, we examine these causes.

Hormones, Bladder and Hernia Issues Causing Pelvic Pain

Chronic pelvic pain in women is often related to several problems related to the unique pelvic anatomy. Endometriosis and fibroids are uterine tissues that form outside the normal uterine location. Their growth is stimulated by the normal hormonal cycles. The tissue eventually causes scar tissue in the pelvic region and the scarring can cause sporadic pelvic pain. Surgery is often used to help resolve some of the problems. Physical therapy and neuropathic medications can be helpful for long-term management.

Chronic interstitial cystitis is an issue in mainly women, and is often referred to as irritability of the bladder. The lining in the bladder becomes scarred, has pinpoint bleeding, and then the bladder becomes shrunken and stiff. Frequency of urination (up to 60 or more times a day) and constant pelvic pain occur. Bladder distention can be helpful and sometimes medication is instilled into the bladder. Bladder stimulators are sometimes implanted to help control symptoms.

Hernias more commonly appear in men than in women in the pelvic region. The muscle wall in the groin region weakens and abdominal contents push out of the injured area. The patient and doctor can decide if surgery is the best option, but if left to heal on its own, nerves can get entrapped in the resulting scar tissue. Physical therapy to release scarring, medications, and sometimes steroid injections are used to relieve symptoms.

Nerve Problems

There are multiple small sensory nerves in the pelvic region and they can become entrapped, irritated, or damaged by trauma in the area. Feedback from these sensory nerves can cause ongoing pain. Evaluation by a pain specialist or neurologist often clarifies the specific nerves involved. Sometimes physical therapy or manipulation of pelvic tissue can release these nerves or relieve the pain. Medications including anti-inflammatories and neuropathics (seizure or antidepressant drugs). At times, local steroid injections help or more regional sympathetic nerve blocks are useful.

Pelvic pain can be extremely difficult to diagnose and treat. Virtually any of the structures in the pelvis can be the eventual source of pain. Often it is a combination of structures causing pain. When the initial treatment is not working, the problem may be more complex, and a pain specialist may be helpful at finding the sources and recommending a combination of interventions that manage the symptoms. Sometimes there are permanent changes in the body and damage that is not reversible, and the goal needs to be managing the symptoms. A pain specialist can be especially helpful in designing a program that meets the needs of any particular individual.