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Chronic Abdominal Pain and Chronic Pelvic Pain

Abdominal Pain Pelvic pain cramps

In this blog post, I’d like to address two lesser known conditions that have a variety of causes, sometimes without clear reason, but painful nonetheless.

Chronic abdominal pain and chronic pelvic pain are two very painful long term conditions that a pain specialist is uniquely able to address, first to help in the diagnosis and then to aid in the symptom relief and maybe even being able to eliminate and end the cause of the pain.

These conditions both tend to affect females somewhat more often than males, however both sexes can suffer with this unfortunate affliction.

What does chronic abdominal pain or chronic pelvic pain feel like? Patients might experience deep boring or crampy achy pain in a particular area, however sometimes the pain might be all over. Pain can be associated with meals, between meals, or bowel movements. Pain might be continuous or not associated with any time of day or event. Pain might be associated with a female’s monthly cycle or perhaps with intercourse. Regardless, taking a thorough history, with special attention given to the nature of the pain, the timing of the pain, and what has been tried in the past by the person suffering with the condition.

Generally, patients have already seen multiple specialists, starting from their primary care doctor, and perhaps seeing a gastroenterologist, a gynecologist, a urologist, or maybe even a neurologist or surgeon.

Frequently, patients come with no diagnosis at all and might feel estranged from their previous healthcare providers. Maybe a diagnosis was made but nothing that was tried actually helped or kept helping after the first phase.

Abdominal pain can come from the alimentary tract, also known as the gut or the GI tract. It’s possible there is a physical lesion causing this pain but sometimes there might be no identifiable lesion and the pain is related to the movement of peristalsis, also known as normal forward flow, however certain people have hyperactive gut nerves and their body can interpret this movement as pain. Sometimes, the reason might be an ulcer, a kidney stone, or a UTI. Sometimes a patient has food allergies or intolerances, such as Celiac disease or gluten allergy, or might have ulcerative colitis or Crohn’s disease.

Pelvic pain can be very distressing. In females, the areas around the uterus and ovaries may hurt, however sometimes the external anatomy may be the area of pain, including the vulva, vagina, labia or clitoris. This obviously has the potential to impact sexual function. If the patient is a female, a gynecologist’s input is necessary to check for endometriosis and other female pelvic conditions that may be anatomically correctable. Dyspareunia, or painful intercourse, can sometimes be due to something easily treatable, like a common pelvic infection.

Interestingly, musculoskeletal conditions can be confused with pelvic pain, in particular the sacroiliac joints, the hip joints, and possible lumbar spine sciatica or pinched nerves. These diagnoses would need to be checked for and ruled out. Coccyodynia is another cause of pelvic pain, again more often in females, which may demonstrate a coccygeal fracture or possibly an anteverted coccyx. Anteverted coccyx, or forward pointing, is a “normal” variant however is associated with coccygeal pain.

Treatment options typically follow after diagnosis, or lack thereof, have been made. Certain medications, including traditional pain medications and non-opioid pain relief can be tried. 

Frequently these conditions, due to the long term nature and fundamental cause clinically significant depression and treating the depression can partially alleviate the impact of the pain on daily function and mood. 

If the pain is functional and there is no obviously treatable area, certain specialized injections to blunt the pain can be performed for areas from the stomach (celiac plexus block), to the lower abdomen (lumbar sympathetic block), to the pelvic area (hypogastric plexus block, ganglion impar block, pudendal nerve block) can all be attempted to lessen the severity of the pain.

Patients experiencing low back pain or neck pain, joint pain, such as knee pain, hip pain, shoulder pain, or have headache or migraine or who require evaluation for injections, such as back injections, joint injections, epidural injections, trigger point injections, knee radiofrequency ablation, back radiofrequency ablation can call this Seattle Bellevue area pain clinic for an evaluation by the doctor.

If you or a loved one are suffering from these issues, please give us a call today at 425-998-7884 or visit our website at https://www.bellevuepainwellness.com or send us a message at https://www.bellevuepainwellness.com/contactus.

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Robert Bowers MD

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