Chronic Pelvic Pain Diagnosis & Treatment

Risk Factors

Risk factors for chronic pelvic pain include:

• History of endometriosis or pelvic inflammatory disease
• Previous abdominal or pelvic surgery causing adhesions
• History of physical or emotional trauma
• Irritable bowel syndrome or inflammatory bowel disease
• Pelvic floor dysfunction
• Psychological factors including anxiety or depression

Who Is at Risk?

Chronic pelvic pain predominantly affects women of reproductive age, particularly those with endometriosis, pelvic inflammatory disease, or previous abdominal surgery. Women with a history of trauma or psychological conditions may also be at increased risk.

Diagnosis

Diagnosis of chronic pelvic pain involves:

• Comprehensive medical history and symptom diary review
• Pelvic examination and cervical screening
• Pelvic ultrasound to identify structural causes
• MRI pelvis for detailed soft tissue evaluation
• Cystoscopy or colonoscopy if urological or bowel cause is suspected
• Diagnostic laparoscopy to identify endometriosis or adhesions

Treatment Options

Treatment requires a multidisciplinary approach. Medical management includes hormonal therapy for gynaecological causes and analgesics for pain control. Physiotherapy addresses pelvic floor dysfunction. Laparoscopic surgery treats endometriosis and adhesions. Psychological support and cognitive behavioural therapy also play an important role in comprehensive pain management.

Laparoscopic Pain Management

Laparoscopic assessment and treatment for chronic pelvic pain includes:

• General anaesthesia by specialist team
• Small keyhole incisions made in the abdomen
• Laparoscope inserted for direct inspection of pelvic organs
• Identification and excision of endometriotic lesions
• Division of pelvic adhesions restricting organ movement
• Treatment of ovarian cysts or fibroids if present
• Nerve ablation procedures when clinically indicated
• Biopsy of suspicious tissue for histological analysis

This minimally invasive approach reduces pain and improves quality of life for patients with identifiable pelvic pathology.

After the Surgery

Post-operative care after laparoscopic pelvic pain treatment includes:

• Discharge usually within 24 hours for diagnostic procedures
• Pain relief with prescribed analgesics for 3-5 days
• Return to light activities within 1-2 weeks
• Physiotherapy referral for pelvic floor rehabilitation
• Hormonal therapy commenced or continued as appropriate
• Follow-up at 6 weeks to assess treatment response

Possible Complications

Possible complications of laparoscopic treatment include:

• Risk of bowel, bladder, or blood vessel injury during surgery
• Anaesthesia-related risks
• Recurrence of adhesions or endometriosis after treatment
• Wound infection at port sites
• Incomplete pain relief if multiple causative factors are present
• Psychological impact requiring ongoing support