18.7 Chronic Pelvic Pain

Chronic pelvic pain (CPP) is a condition characterized by persistent or recurrent pain in the pelvic area lasting for at least six months. Pain may be constant or can come at regular intervals, such as during specific times during the menstrual cycle, or related to certain activities, such as during or after sexual intercourse. CPP can significantly impact a person’s physical, emotional, and social well-being.^[1]

CPP can be caused by disorders of the reproductive, urinary, or gastrointestinal systems, such as the following^[2]:

• Endometriosis
• Fibroids
• Ovarian cysts
• Dysmenorrhea
• Pelvic inflammatory disease (PID)
• Irritable bowel syndrome
• Urinary tract infection
• Interstitial cystitis
• Cancer
• Musculoskeletal problems

Diagnosing CPP requires a comprehensive evaluation involving medical history, physical examination, and targeted diagnostic tests based on the client’s symptoms, as well as precipitating and alleviating factors. Imaging studies such as pelvic ultrasound, computed tomography (CT) scan, and magnetic resonance imaging (MRI) may be ordered to identify structural abnormalities, such as ovarian cysts, fibroids, or endometriosis. Diagnostic laparoscopy may be performed for direct visualization of underlying conditions.^[3]

Treatment for CPP is based on the underlying cause and may include antibiotics for pelvic inflammatory disease or urinary tract infection; hormonal contraceptives for dysmenorrhea or endometriosis; surgical removal of cysts or fibroids; physical therapy for musculoskeletal issues; or medications for irritable bowel disease or interstitial cystitis. If no specific cause for the pain is found, treatment focuses on pain management and improving quality of life with medications such as NSAIDs, gabapentin, or pregabalin.^[4]

Nonpharmacological interventions such as physical therapy, pelvic floor exercises, and relaxation techniques can help manage CPP by improving muscular function, alleviating pain, and reducing stress. Regular exercise and weight loss can improve musculoskeletal or gastrointestinal issues contributing to CPP. Other pain management strategies, such as acupuncture, acupressure, nerve stimulation, biofeedback therapy, and nerve blocks, may be helpful in some cases.^[5]

Nurses help clients cope with the impact of chronic pain on their daily life. Research indicates fifty-three percent of clients with CPP experience moderate to severe depression and anxiety.1 Nurses provide health teaching about CPP, potential treatment options, and nonpharmacological strategies for managing pain. Nurses also encourage counseling and support groups to help clients manage the psychological impact of CPP.^[6]