The aim of this unit is to solve the multiple disorders that affect the whole pelvic area, either osteoarticular, gynaecological, urological or coloproctological.

What is Chronic Pelvic Pain?
Chronic pelvic neuropathic pain disorders are syndromes of localized pain in the pelvic region, between the hips and the navel, that persist for 6 or more months. They include conditions such as vulvodynia (vulvar pain), coccydynia (pain in the coccyx), pudendal nerve pain and sciatic nerve pain.

This pain can be of different types:

– Persistent but mild or sharp, like cramp.
– Occasional, appearing and disappearing in time, or continuous.
– Located in a specific point, or general, felt throughout the pelvic region.
– You may also feel pressure in the pelvic region.

It is estimated that 12% of women worldwide suffer from chronic pelvic pain (CPP). A first step in treating these patients is to identify the cause of pain in order to determine the correct treatment.

What are the possible causes of Chronic Pelvic Pain?
The causes of this type of pain can be classified into cyclic and non-cyclic gynecological causes. Cyclical causes are those that have some relationship with the menstrual cycle, while non-cyclical bear no relationship of any kind with menstruation.

Cyclical gynecological causes

Pain during menstruation. Primary dysmenorrhea appears from the first menstruation and no apparent cause is found. while in secondary dysmenorrhea there is apparent pelvic pathology.

This is the appearance of pelvic pain, and series of physical and psychological symptoms in the second phase of the ovulatory cycle of women.

Premenstrual syndrome
Consiste en la aparición de dolor pélvico, así como una serie de síntomas físicos y psíquicos en la segunda fase del ciclo ovulatorio de la mujer.

Non-cyclical gynecological causes

Scar tissues that join together unusually after surgical procedures.

It may be cyclical, but the pain can also be unrelated to the menstrual cycle.

Salpingo Oophoritis
This refers to simultaneous acute or chronic fallopian tube and ovary inflammation.

Remaining ovary syndrome
It is the appearance of pelvic pain in patients who have previously undergone a hysterectomy, and the ovaries are preserved.

Pelvic congestion syndrome
Pelvic Congestion Syndrome is a set of symptoms of CPP responsible for the presence of varicose veins at ovarian or uterine level.

Ovarian and uterine neoplasms
Most tumors of the reproductive organs, whether benign or malignant, can cause acute or chronic pain.

Pelvic inflammatory disease
Chronic pain arising from pelvic inflammatory disease due to recurrent episodes of urinary tract infections, or residual damage from past episodes of pelvic infection.

Gastrointestinal causes
The main cause of gastrointestinal pelvic pain is the irritable bowel syndrome. It is a functional disease, which means that the pain arises from a change in bowel habit rather than an organic component.

Genitourinary causes
The CPP of urological origin is due to the close anatomical and embryological relationship that exist at the urological and pelvic level. The urethra, bladder and vagina derive from the urogenital sinus, which is the embryonic structure where the external genitals and urethra originate. In males this leads to the prostate and the prostatic urethra, while in women it leads to the urethra and a portion of the vagina.

Neurological causes
The trapping of a nerve in a scar can lead to pain in the scar or nerve distribution.

Musculoskeletal causes

Muscle Pain
Pain may be caused by primary muscle dysfunction, ie alteration in the relaxation-contraction of opposing muscle groups.

Pelvic Mechanic Pain
Pregnancy or trauma can lead to an altered alignment of the central part of the body (chest, spine, pelvis, etc.).

Psychological factors

CPP is influence by numerous factors: physical, psychological and social. The influence of each varies depending on the patient and can be modified in the same patient throughout his illness.

Neurological factors

Apart from gynecological and urological factors, there are also neurological factors that can cause pelvic nerve disorders. Nerve damage during surgery is a major cause of neuropathic pain. This type of nerve damage may occur during radical surgery (radical hysterectomy due to gynecologic cancer, surgery for deep infiltrating endometriosis) or less radical surgery (simple hysterectomy or surgery due to uterine prolapse).
Nerve damage can lead to untreatable nerve pain, such as vulvodynia (vulvar pain), coccydynia (pain in the coccyx), pudendal nerve pain (pain in the pubic area) and sciatica (pain in the buttocks, back and legs).

How is it diagnose?
In Inebir we consider essential the treatment of patients with this disorder from a multidisciplinary approach that allows our physicians to make an individualized diagnosis and determine the appropriate medical or neurosurgical treatment. Our team will compile a detailed medical history and a complete physical examination to diagnose this condition. In addition, throughout the study, you can count on the support of our psychology unit.

What is the treatment?
Once a differential diagnosis has been developed, there are different ways to treat this condition, depending on many factors.
While the treatment of acute pelvic pain syndromes is relatively simple, such as antibiotics for infectious conditions or surgical exploration when a certain condition is suspected, CPP management requires greater effort, experience and skill.
In Inebir, we have a highly trained and specialized multidisciplinary team in performing laparoscopic surgery and other minimally invasive surgical techniques that are used to identify common causes of neuropathic chronic pelvic pain, providing safe access to the pelvic anatomy. In this way, our doctors will analyze each case individually and decide what is the best option for treating this condition: drugs, hormone treatments and/or surgery to relieve pain.