Chronic abdominal or pelvic pain is pain that persists for more than 3 months in an area that includes the lower abdomen, pelvis, genital or perineal region. It can be continuous or intermittent, deep or burning, and often cannot be explained by a single cause visible on standard examinations.

This type of pain can have multiple causes simultaneously and requires a multidisciplinary approach.

Possbile Causes

• Post-surgical pain (e.g. after hysterectomy, laparoscopy, prostatectomy, childbirth)
• Scar tissue adhesions, fibrosis, or neuropathic pain from local nerve damage
• Pelvic floor dysfunction or myofascial pain
• Pudendal nerve neuralgia (in some selected cases)
• Visceral pain syndrome or chronic nerve irritation
• Pre-existing gynecological, urological, or gastrointestinal conditions

Pelvic pain can have both an inflammatory or mechanical component and a neuropathic component, with alterations in pain perception.

How is it Diagnosed?

• Specialist clinical assessment of pain with targeted physical examination
• Imaging exams: ultrasound, pelvic MRI or lumbosacral MRI (if indicated)
• In some cases: targeted diagnostic blocks to identify the source of pain (e.g., pudendal nerve, abdominal wall)
• Collaboration with gynecologists, urologists, or gastroenterologists if necessary

How is it Treated?

Drug treatment

• Medications for neuropathic pain (e.g., pregabalin, gabapentin, amitriptyline)
• Anti-inflammatories or muscle relaxants
• Combined therapies based on the predominant cause

Physical Therapies and Support

• Pelvic floor physiotherapy (if indicated)
• Myofascial therapy and muscle relaxation
• TENS (transcutaneous electrical nerve stimulation) for daily use

Mini-invasive Interventional Therapies

• Targeted ultrasound-guided injections (e.g., abdominal wall blocks: TAP block)
• Selective pelvic nerve blocks (ilioinguinal, genitofemoral, pudendal)
• Pulsed radiofrequency of the involved nerves, in resistant cases
• Injections on painful scars (post-cesarean, laparotomy, episiotomy)
• Spinal cord neuromodulation

Prognosis

Chronic pelvic pain is a complex condition, but manageable with a personalized approach. Early identification of the neuropathic or myofascial component is crucial for achieving lasting improvements.