Pelvic pain, especially chronic pelvic pain – i.e. pain that occurs below the umbilicus with at least six months’ duration and severe enough to cause functional disability or require treatment – is a common and serious health problem. It is responsible for approximately 10% of referrals to a gynecologist and is a common indication for diagnostic and therapeutic surgery. As much as 40% of all gynecological laparoscopies are warranted for pelvic pain in the US.
Dr. Robert J. Echenberg is a pelvic pain specialist that advocates for an integrative approach to pelvic pain. It is known that some of the most frequent causes of chronic pelvic pain involve endometriosis, interstitial cystitis/painful bladder syndrome, and irritable bowel syndrome. Moreover, these conditions often overlap in the same patient.
Painful bladder syndromes are characterized by higher urinary frequency, urgency to urinate, painful intercourse and otherwise unexplained pain located anywhere in the pelvic region. Furthermore, chronic pelvic pain often causes other disabling symptoms such as fatigue and sleep disorders.
The fact that the pelvic region is responsible for many bodily functions that go from urine and fecal elimination to reproduction and sexual pleasure is associated to a compartmentalization among medical specialties, with as much as six or seven different specialists being responsible for the treatment of different pelvic diseases. Few of them have specific pain training, which can prove to be a challenge when managing the patient.
Dr. Echenberg supports the pivotal role of the primary care physician on the management of pelvic pain. These physicians should have knowledge in most pelvic pain syndromes so they can perform a first-line approach and be able to refer to the proper specialist such as urologist or uro-gynecologist, gynecologist, rheumatologist, sleep specialist, psychiatrist, physical therapist, acupuncturist and other mind/body practitioners.
Several important medical organizations, such as the American Urological Association and the International Pelvic Pain Society, have good pelvic pain management guidelines. The first treatments can be introduced by the general practitioner or primary care physician. These include education for the disease and behaviour modifications (ie, avoiding dietary triggers in painful bladder syndrome), stress management and pain control, including pain medications (or contraceptive pill in endometriosis) and physical therapy.
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