Understanding chronic pelvic pain

“Pain is a more terrible lord of mankind then even death.”-Albert Schweiter, 1931.

During their lifetime, 15-20% of women experience chronic pelvic pain at least once. Most of these women see at least five health care providers and suffer for up to 4-7 years before a diagnosis is made.

Chronic pelvic pain (pain in the pelvis area spanning from the lower abdomen to the muscles of the pelvic floor lasting for six months or more with incomplete relief despite prior therapy) can affect all aspects of a person’s life and can be extremely costly to affected women. Chronic pelvic pain (which often doesn’t have a defined onset of pain and is unpredictable in duration) can be frustrating to patients and providers, as the multifactorial nature of the problem and its complexities can be overwhelming and time consuming to manage. This disease can affect patients physically, emotionally, behaviorally and mentally.

Acute pelvic pain, on the other hand, usually has a defined onset and lasts less than one month.

Understanding more about your pain 

Understanding the past and present status of your pain and how it developed is important and is the first step to take before seeking help.

  • How and when did your pain begin?
  • What actions or activities make it better or worse?
  • What time of the day is it worse?
  • Is it affected by your menstrual cycle?
  • Is your sleep affected?
  • Has it changed your daily routine at home or work?
  • What have you tried in the past to help with the pain?
  • What do you think is causing the pain and what concerns you most about the pain?

Symptoms of chronic pelvic pain

The following symptoms are associated with chronic pelvic pain. If you have experienced one or more of the following, you should seek help from a specialist:

  • Pain with intimate activity, pain with initial touch or deep penetration and or both
  • Urinary frequency, urgency, and nocturia- feeling like you have to use the restroom frequently; sensations of an urge to urinate after you have already urinated; and waking up from sleep at night to urinate
  • Irregular or painful periods, pain at onset, during, or after your cycle finishes
  • Pelvic “aches” or soreness in lower abdominal area
  • Bloating, pressure or heaviness in lower abdominal or vaginal area
  • Vaginal pain, burning and itching that persists
  • Pain when bladder is filling
  • Feeling like you have a urinary tract infection and urine cultures have been negative
  • Feeling like you have a vaginal infection and vaginal cultures have been negative
  • Feeling of exhaustion, fatigue and overwhelming sense of doom with pain

When these symptoms persist and traditional therapies have not relieved your pain, then you may need to seek help from a pelvic pain specialist. These providers have expertise in pelvic pain neurophysiology, diagnosis and treatment of nerve and muscle dysfunctions.  We can offer you treatment options including medications, trigger point injections, alternative medication, physical therapy and surgery.

A detailed, specialized history and comprehensive examination will be performed. This usually takes longer then a standard gynecological evaluation because we want to thoroughly investigate all potential causes of your symptoms.

Goals 

The goals of treatment are to alleviate suffering and improve quality of life by managing symptoms and restoring normal function. Successful treatments means decreasing your pain to a low level so you are able to enjoy the things you want to do again. Chronic pelvic pain is not all in your head. You can get specialized help with effective treatments options.


Visit UofLPhysicians.com/urogynecology or call 502-588-7660 to schedule an appointment.

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About Alyce Goodman Abraham, APRN, WHNP

Alyce Goodman Abraham, APRN, WHNP, is a nurse practitioner specializing in pelvic pain with UofL Physicians—Urogynecology. She is the recipient of the prestigious American Association of Nurse Practitioner’s State Award for Excellence for 2020. Alyce pioneered and innovated the role of Pelvic Pain Nurse Practitioner, and is nationally recognized for her cutting-edge work. Alyce graduated from Vanderbilt University’s MSN program and is board certified in women’s health and pelvic muscle therapy. She is a member of the International Pelvic Pain Society and has been a guest lecturer locally, regionally, and nationally, speaking and raising awareness about pelvic pain. In addition, she serves as the regional director of the Kentucky Coalition of Nurse Practitioners and Nurse Midwives (KCNPNM) and received the Ellen Bailey Award for Leadership in 2014 for that role.

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