Pelvic Pain

Minnesota Urology has providers specializing in pelvic pain.

Because we believe pelvic pain is real, and we can do something about it. We try to approach each patient with an open mind, and feel that that there are simple tests and strategies that can make a big difference, even when patients have suffered chronically and have “been through the mill”. Many times it is not a hard problem to deal with, and just a fresh perspective and conservative approach can make a huge difference. That makes us very happy to help. Sometimes it is not so easy, and solutions are challenging. We offer options that are safe, tested, have been accepted by the medical and scientific community, and are part of a holistic approach. We do not emphasize the use of surgery or untested procedures, even when patients are desperate and would be willing to take a chance on them. We will collaborate with other providers in order to team up against your problem when that is what’s needed. We want to help you.

What is pelvic pain?

Pelvic pain includes pain or pressure in the area above the pubic bone (suprapubic region), bladder, urethra, and in the genital region. Sometimes it is referred to as “pain down there”. It may also include pain in the abdomen, lower back, hips and legs. Many times there are associated problems with frequent or painful urination, pain after urination, pain with intercourse, and problems with bowel or sexual function. It can frequently be associated with other conditions or labels such as interstitial cystitis, irritable bowel, vulvodynia, endometriosis, pudendal neuralgia or prostatitis.

Who gets pelvic pain?

Anyone can! Sometimes it can be a sudden or temporary problem, and other times it is a chronic condition that has a lasting and debilitating impact on day-to-day function and health.

How is it diagnosed?

We always start with a history and physical exam. Often something specific (like the realtor who starting having problems after pulling a “for sale” sign out of the ground) has set it off. Other times it may come about after pregnancy or pelvic surgery. Many times we just can’t pinpoint the exact cause. The pattern, related factors, and things that make it better or worse are all important clues to what may be happening and how to approach the issue for a particular patient. On physical exam, there are often findings such as muscle spasm or tenderness, problems with pelvic and hip alignment, or other conditions that can be very telling. Urine tests for both bacterial and non-bacterial infections, and cancer cells can be useful. X-rays, CT scans, MRI’s, and ultrasounds all have a role in certain instances, but often these tests have been performed and do not lead to a clear-cut diagnosis. Other tests such as cystoscopy, laparoscopy, and colonoscopy (telescope inspections of the bladder, intra-abdominal area, or colon) can be of some help, but often these tests show nothing of certain importance.

What can be done about it?

There are many options for our patients with pelvic pain. We sometimes see patients who have had surgeries that were unsuccessful to treat their condition, and find that simple things such as physical therapy for pelvic floor muscle dysfunction, muscle relaxants, nerve stabilizing medications, and heat can make a much greater impact for them. There is often a reluctance to try these options, when patients have been mentally prepared to accept even the most invasive options (“take my bladder out if it would just take the pain away”). More major surgery is almost never the right solution. There are medications to help treat chronic pain that help to mute or filter out abnormal pain signaling within the nervous system. The use of opiates or painkillers is usually not a good strategy for coping with chronic pain, and if/when our patients need these, we are very strict about insisting experts who can detect or prevent addiction manage them in a pain clinic. In addition, we encourage our patients to seek support for their emotional and social needs as part of an overall coping strategy.