Johns Hopkins Health - Solving the Pelvic Pain Puzzle
Issue No. 24
Solving the Pelvic Pain PuzzleDate: April 1, 2014
Pelvic pain can be frustrating, for both the people who have it and the people who treat it. But it doesn’t have to be that way. Johns Hopkins gynecologist Stacey Scheib, M.D., and interventional radiologist Kelvin Hong, M.D., share how experts are solving the mystery
What are the most common causes of chronic pelvic pain?
Many gynecologists immediately suspect endometriosis, a condition in which uterine tissue grows outside the uterus. But that’s only one cause. In addition to being related to the uterus and ovaries, pelvic pain can be caused by problems with the bowels, bladder, muscles, nerves and cardiovascular system. Musculoskeletal issues causing muscle spasms and tenderness in the pelvis are especially common.
Why is it so difficult to diagnose?
The potential causes of pelvic pain are widespread. Plus, some women may have overlapping issues that have to be uncovered one at a time to diagnose and treat the sources of pain. Because pelvic pain can often involve multiple systems of the body, many women spend months or even years going from doctor to doctor in search of an accurate diagnosis.
What’s the best approach?
At Johns Hopkins, we’ve created a multidisciplinary group to coordinate care across every specialty related to pelvic pain. The group includes gynecologists, urogynecologists, interventional radiologists, pain specialists, psychologists, physical therapists and compounding pharmacists. Women usually start with a gynecologist, and then other specialists are brought in as needed.
How do I make the pain go away?
Relieving one source of pelvic pain can reveal another, so we treat each one as we find it. Novel therapies are available at facilities like Johns Hopkins to treat the symptoms while the underlying cause is investigated. When muscle spasms or tenderness are an issue, manipulation with physical therapy can retrain and relax the muscles. Sometimes, we’ll prescribe vaginal Valium (diazepam) suppositories to help women in severe pain tolerate therapy. The suppositories relieve pain for about eight hours, which can also help women sleep better while they’re undergoing diagnosis and treatment. Another treatment option is injections of Botox (botulinum toxin) targeted at spasmodic muscles with the guidance of CT scan imaging. These injections let the muscles relax. The effects last about six months and can be repeated if necessary.
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