Chronic Pelvic Pain

Chronic pelvic pain is not a specific condition, but rather a major symptom of possible underlying medical conditions. Some of the possible causes of chronic pelvic pain include:

• Gynaecological disorders: chronic pelvic pain is often associated with several gynaecological disorders such as endometriosis, adenomyosis (link to adenomyosis page), pelvic inflammatory disease, pelvic adhesion, pelvic congestion syndrome, ovarian cyst, gynaecological cancer etc.  Early diagnosis and early intervention are crucial to prevent irreversible consequences, such as infertility, damage to organ function,  and severe impact on quality of life. 
• Myofascial pain syndrome
• Irritable bowel diseases
• Interstitial cystitis 

If you have been experiencing pelvic pain for the last 3 months or longer, then we encourage you to have it examined to receive a proper diagnosis and treatment.

One of the most common causes of chronic pelvic pain is endometriosis– an estrogen-dependent progressive disease. Endometriosis frequently causes fibrosis and adhesion leading to distortion of pelvic anatomy. This phenomenon is also known as a “frozen pelvis”. 

Deep infiltrating endometriosis  is an aggressive form of endometriosis, which tends to invade other organs such as the rectum, sigmoid, bladder and ureter–  causing functional damage. Thus patients often struggle with persistent pelvic pain even when they are not menstruating. 

While frozen pelvis is not a medical term per se, it is often synonymous with “stage IV  endometriosis” or “severe endometriosis” in the pelvis. A frozen pelvis occurs when deep fibrotic nodules and infiltrative endometriosis replace pelvic soft tissue with dense fibrosis. This causes the pelvic organs to become firmly attached, rendering them immobile.  

Possible causes of how endometriosis could cause pelvic pain  include; 

• Endometrial adhesions: endometriosis can trigger endometrial adhesions (scar tissue) to form, and bind organs together. This inherently restricts the movement of these organs, causing severe pain, especially during menstruation.
• Inflammation: when endometrial-like tissue grows outside the uterus, it releases inflammatory chemicals that can irritate the surrounding tissues. As a result, it causes severe pelvic pain and discomfort.
• Nerve damage: the growth of endometrial-like tissue can cause nerve damage as it adds pressure on them. Aside from resulting in nerve pain, it can also cause chronic pelvic pain, on top of increasing the sensitivity level in the pelvic region.