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For the latest cutting-edge research, innovative collaborations and remarkable discoveries in child health, read stories from across all our areas of study in Q: Advances and Answers in Pediatric Health.
Gynecology
Chronic Pelvic Pain
We specialize in the big things, the small things and everything in between.
What is chronic pelvic pain?
Chronic pelvic pain occurs in the lower abdomen or pelvis. 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.
What are some signs and symptoms of chronic pelvic pain?
- Recurrent pain in the middle of each menstrual period (related to an ovulation cyst) or a few days prior to a period (related to menstruation) are common with chronic pelvic pain. You or your child may also experience pain with:
- Movement
- Urination
- Bowel movements
- Tampon insertion (may cause nerve sensitivity and muscle spasm)
When is it time to see a doctor about pelvic pain?
Visit the doctor if pelvic pain is not relieved with over-the-counter medicines or currently prescribed medicines from you or your child’s doctor.
What tests do we use to diagnose pelvic pain?
We can diagnose chronic pelvic pain 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.
- An ultrasound can helps us assess structural causes in the uterus and ovaries, including ovarian cysts, uterine abnormalities and other conditions.
We can also perform abdominal wall tests to demonstrate nerve sensitivity and muscle spasm. Another option for diagnosis is a laparoscopy, which involves outpatient surgery. For laparoscopy, the doctor makes a small incision and inserts an instrument called a laparoscope through the incision. The laparoscope has a camera attached to it that allows the doctor to look directly at the pelvic structures. We can use this 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 children, teens and young adults with chronic pelvic pain and can 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 do we treat chronic pelvic pain?
Treatment is different for each patient, but common options include:
- Menstrual suppression of ovulation and menstruation if pain is provoked by the menstrual cycle
- 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 Colorado to treat chronic pelvic pain?
Our board-certified pediatric and adolescent gynecologists have specialized training in the reproductive health concerns no matter the age. We understand the complex changes that occur before and during puberty and can recognize both common and rare causes of pelvic pain.
We will put both you and your child at ease by carefully explaining the medical condition and discussing the various options for treatment. We will also support your family with follow-up care or consultation with the primary care doctor as needed.
- 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
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Stephen Scott, MD
Ob/Gyn Obstetrics & Gynecology
Veronica Alaniz, MD
Ob/Gyn Obstetrics & Gynecology