Study Finds High Prevalence of Chronic Pelvic Pain
Nov. 17, 1999 (Atlanta) -- Despite a wealth of medical knowledge and
considerable psychological speculation, a complete understanding of the causes
of chronic pelvic pain continues to elude medical researchers.
Defined as pain in the lower abdomen lasting six months or more, chronic
pelvic pain should always signal a trip to the doctor's office, say physicians
interviewed by WebMD.
According to a statistical analysis published in the November issue of the
British Journal of Obstetrics and Gynaecology, the number of women in
the United Kingdom suffering from chronic pelvic pain is similar to the number
of people experiencing back pain, migraine headaches, and asthma.
The researchers also write that many women are not seeking treatment for it:
"The condition is still not well understood and therefore is often
inadequately managed. Its epidemiological characteristics are particularly
"That's right, it's called chronic pelvic pain without obvious
pathology," Jill Maura Rabin, MD, tells WebMD. "In those cases we do an
entire workup to rule out infection, malignancies, or pregnancy. Usually
there's a chronic infection related to the ovaries or occasionally in the
bladder or bowels. But if we can't make a diagnosis we can manage it through
pain management by mild tranquilizers, [injections], or acupuncture."
Rabin -- associate clinical professor of obstetrics and gynecology at Albert
Einstein College of Medicine, in New York -- says psychological factors are
also considered during evaluation. "There's a lot of psychological
literature on this, but eventually we usually figure out what it is," says
Still, Rabin says that in her practice, about 3-5% of patients fall into the
category of chronic pelvic pain without obvious pathology.
The U.K. study analyzed data on physician contacts made by 284,162 women
aged 12-70 over a five-year period. After excluding diagnoses of
sexual-intercourse causes, pregnancy, menstruation, chronic bowel disease, or
malignancy, they found 24,053 cases of chronic pelvic pain.
Overall, the researchers calculated an annual rate of just under 40 cases
for every 1,000 women. The prevalence was highest in women over 60. These
findings were similar to those of a smaller American study published in 1996.
That study found that only 25% of women with chronic pelvic pain sought medical
The researchers in the current study speculate that many more women suffer
from chronic pelvic pain in the general population than are found in medical
records. They describe it "as a condition that many people cope with
themselves without seeking health care."
"Absolutely, people should come in," says Rabin. "If medical and
psychological causes are ruled out, patients can be referred to pain management
Says William Andrews, MD, past president of the American College of
Obstetricians and Gynecologists, "It's hard to pin down, either as
functional bowel pain, nervousness, or bowel spasms, and it's much more common
in women. The need is to talk to the patient about how this is something they
are not imagining -- the corollary can be [that it's] like a headache. The big
thing is trying to understand."