Symptoms of Chronic Abdominal Pain

Chronic pelvic pain exhibits many different characteristics. Among the signs and symptoms are:

• Severe and steady pain
• Pain that comes and goes (intermittent)
• Dull aching
• Sharp pains or cramping
• Pressure or heaviness deep within your pelvis

In addition, you may have pain during intercourse, while having a bowel movement or even when you sit down. The pain may intensify after standing for long periods and may be relieved when you lie down. The pain may be so bad that you miss work, can’t sleep and can’t exercise. The pain may vary from mild to severe, from annoying to disabling.

Causes of Chronic Abdominal Pain

Several gynecologic problems may be the source of chronic pelvic pain. However, other diseases can cause pelvic pain, such as irritable bowel syndrome and interstitial cystitis. In addition, psychological factors may contribute to your pain.

Some of the more common causes of chronic abdominal pain include:

• Endometriosis. This is a condition in which tissue from your uterine lining (endometrium) grows outside your uterus. These deposits of tissue respond to your menstrual cycle, just as your uterine lining does — thickening, breaking down and bleeding each month as your hormone levels rise and fall. Because it’s happening outside your uterus, the blood and tissue can’t exit your body through your vagina and become trapped in your abdomen. This can lead to painful cysts and adhesions (fibrous bands of scar tissue).

• Tension in your pelvic floor muscles. Spasms or tension of the pelvic floor muscles can lead to recurring pelvic pain.

• TChronic pelvic inflammatory disease. This can occur if a long-term infection, often sexually transmitted, causes scarring involving the pelvic organs.

• Pelvic congestion syndrome. This is a condition that may be caused by enlarged, varicose-type veins around the uterus and ovaries.

• Ovarian remnant. During a complete hysterectomy — surgical removal of the uterus and ovaries — a small piece of ovary may be left inside, which can later develop tiny, painful cysts.

• Fibroids. These noncancerous uterine growths may cause pressure or a feeling of heaviness in your lower abdomen. They rarely cause sharp (acute) pain unless they become deprived of nutrients and begin to die (degenerate).

• Irritable bowel syndrome. Symptoms associated with irritable bowel syndrome — bloating, constipation or diarrhea — can be a source of uncomfortable pelvic pain and pressure.

• Interstitial cystitis. Chronic inflammation of the bladder and a frequent need to urinate characterize interstitial cystitis. You may experience pelvic pain as your bladder fills, which may improve temporarily after emptying your bladder.

• Psychological factors. If you are depressed, experience chronic stress or have been sexually or physically abused, you may be more likely to experience chronic pelvic pain. Emotional distress makes pain worse, and likewise living with chronic pain makes emotional distress worse. So chronic pain and emotional distress frequently get locked into a vicious cycle.

Treatments and drugs

If your doctor can pinpoint a specific underlying cause, your treatment will focus on eliminating that particular cause. However, if no cause for your pelvic pain can be found, your treatment goals will focus on managing the pain.

Possible treatments for chronic abdominal pain include:

• Pain relievers
• Hormone treatments
• Antibiotics
• Antidepressants
• Physical therapy
• Counseling
• Trigger point injections
• Nerve separation (ablation)
• Surgery