by Betty Russell

Odds are you wouldn't hesitate to talk with your doctor about chronic back pain or migraines. But if you're like many women, you don't mention chronic pelvic pain that's making your life miserable.

Doctors define chronic pelvic pain as pain in the low abdomen that lasts six months or more. The National Pain Foundation says as many as one in five women have chronic pelvic pain. The problem leads more than half of them to limit activities at least once a month.

"Chronic pelvic pain can be debilitating and can wear women down," says Judy Chamberlain, M.D., F.A.A.F.P., a member of the board of directors of the American Academy of Family Physicians. "It affects women physically and emotionally. Yet many of them are reluctant to bring it up to their doctors because they're embarrassed or they're afraid of what the diagnosis might be."

A Medical Puzzle
The key to easing chronic pelvic pain is to find and treat the ailment that causes it. But a quick, correct diagnosis is often hard to pin down.

"Chronic pelvic pain baffles many physicians," says William Parker, M.D., author of A Gynecologist's Second Opinion: The Questions and Answers You Need to Take Charge of Your Health. "It can be very difficult to diagnose because there are so many conditions that can cause chronic pelvic pain, and these possible causes cross several medical specialties—including gynecology, urology, and gastroenterology."

Why is diagnosing chronic pelvic pain such a challenge? Just look at the list of conditions that can cause it. They include heavy menstrual bleeding, endometriosis, pelvic inflammatory disease, uterine fibroids, irritable bowel syndrome, interstitial cystitis, and pelvic muscle spasms. Pelvic pain can also be "referred pain," which starts elsewhere in the body. If the nerve fibers from that area take paths close to the nerve fibers from the pelvic area, the brain may find it hard to tell where the pain signals came from.

Finding Answers
If you have chronic pelvic pain, don't suffer in silence. This pain isn't normal, it's not all in your head, and it's not part of aging. Treatment is vital because some conditions that may be causing your symptoms can lead to fertility problems, sexual dysfunction, anemia, depression, low self-esteem, and other problems.

Talk with your doctor. He or she may be able to assess and treat your pain or refer you to the right specialist.

"There are a growing number of physicians who specialize in pelvic pain," Dr. Parker says. "There are also multidisciplinary teams of physicians who work together to evaluate, diagnose, and treat women with chronic pain."

After learning the source of your pain, your doctor can suggest a treatment. For example, a doctor may perform a minimally invasive treatment for endometriosis. Or you may need physical therapy to strengthen pelvic muscles. Even alternative treatments—such as massage, acupuncture, and relaxation techniques—may help you feel better.

"Physicians have to be open to trying new things and working with patients to find what works," Dr. Chamberlain says. "Fortunately, the majority of women do get better. Either they get the right treatment and their symptoms go away, or their symptoms improve enough that they can live full, productive lives."

Track Your Symptoms
Keeping a pain diary will make it easier for you to give your doctor complete information that can aid in a diagnosis. It can also help you and your doctor see how well treatments are working.

Here are some types of information you may want to put in your pain diary:

• When you have pain
• Where the pain is located
• What type of pain you feel (such as aching, stabbing, throbbing, or cramping)
• How long your pain lasts
• What triggers your pain
• What helps relieve your pain
• How the pain affects you (you limit activities or miss work, for instance)

Five Top Causes of Chronic Pelvic Pain

Here are some of the sites in a woman's pelvic area where reproductive, digestive, or urinary problems can lead to pain.

• Endometriosis—Tissue from the lining of the uterus (womb) moves to other areas of the pelvic region
• Pelvic inflammatory disease—Infections in the uterus, fallopian tubes, or ovaries
• Uterine fibroids—Noncancerous growths in the uterine wall that can be very small or as large as a melon
• Irritable bowel syndrome—A digestive disorder that occurs when the intestines don't contract as they should
• Interstitial cystitis—Inflammation of the bladder wall

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