In this 'Women's Health' article for Medical Observer, Jean Hailes gynaecologist Dr Janine Manwaring talks about managing the complexities of chronic pelvic pain.
Jean Hailes is proud to provide a bimonthly column in the medical newspaper, Medical Observer. Designed to give GPs and health professionals a short informative summary of important women's health topics and conditions, these articles provide practical information to inform and enhance clinical practice.
Persistent pelvic pain, also known as chronic pelvic pain, is a common condition that affects around 15% of women worldwide.
Despite being poorly understood and underdiagnosed, persistent pelvic pain is the most common cause of days off work for women of child-bearing age and costs Australia around $6 billion annually.1
Persistent pelvic pain occurs in the area below the navel and nguinal ligament for six months or more.
It is a complicated condition, and symptoms can present in the bowel, bladder, reproductive organs, muscles, bones and nerves.
There can be increased sensitivity in pain signals from the pelvis to the brain, which can make the pain more generalised.
Patients can become hard-wired to feel pain and the body may start to feel pain even without a trigger or cause. The pain can also spread to a larger area.
Jean Hailes for Women's Health has opened its first Persistent Pelvic Pain Service in Melbourne, adopting a multidisciplinary team approach for the management of the condition.
Similar health services operate elsewhere, such as Perth (see Resources below), but Jean Hailes's service is unique because women can self-refer.
Research shows persistent pelvic pain is best managed by a team of specialists tailored specifically to the patient and her symptoms.
The team may include a GP, pelvic physiotherapist, psychologist, gynaecologist, pain specialist, acupuncturist, naturopath and clinical nurse.
The aim is for the patient to be able to live with the condition in a manageable way and have a good quality of life.
GPs are well placed to initiate treatment for suspected persistent pelvic pain, referring the patient to a multidisciplinary team if, within six months, medical management fails to sufficiently control symptoms.
The following signs and symptoms may suggest persistent pelvic pain:
Obtain history from the patient, including:
Undertake general examination including:
Conduct investigations including:
Discuss and initiate management options including analgesia, menstrual suppression, initial pain education and medical options.
Simple analgesia options will include regular NSAID use with pain; add paracetamol if necessary.
Other analgesic options can include, but should not be limited to, heat packs, gentle activity and acupuncture.
Menstrual suppression options include hormonal menstrual suppression with the aim of amenorrhoea.
Provide patients with information about useful websites to help familiarise them with pain science, for example the Pelvic Pain Foundation of Australia and Tame the Beast (see Resources at the end of this article).
Medical options for consideration in managing persistent pelvic pain:
Refer to a gynaecologist if the patient:
Referral to the following practitioners may assist the patient: