Tests and Procedures for Diagnosing Pelvic Pain

Chronic pelvic pain is not something that only affects women. In fact, men and women alike may be diagnosed with pelvic pain. Chronic pelvic pain is characterized by pain in the abdomen or pelvis that has lasted for longer than six months, is not easily controlled with over-the-counter pain medications and interferes with your quality of life. It can be caused by female disorders, such as endometriosis, or other disorders like irritable bowel syndrome (IBS).

The testing your healthcare provider may perform to diagnose your problem depends on what he is looking to find out. Some tests are designed to pinpoint suspected pelvic pain diagnosis, while others are designed to rule out other potential causes of pelvic pain. The examination may also vary depending on whether you are a man or a woman.

Physical Exam

One of the first stages of diagnosing chronic pelvic pain is a physical exam. For women, this often includes a pelvic exam, much like you would expect from your gynecologist. Your healthcare provider will check the muscles around the pelvis for signs of weakness, tension or damage. He will also check for any abnormal sensations, such as tingling or numbness, and tender points.

Lab Tests

When diagnosing chronic pelvic pain, your healthcare provider may run one or even a series of tests. Here are some of the most common lab tests for diagnosing chronic pelvic pain.

• Pregnancy test: Women may be tested in the early stages of their pelvic pain to rule out an ectopic pregnancy, a pregnancy that occurs outside of the uterus.
• Vaginal and cervical cultures: During the pelvic exam, the healthcare provider may take samples of a woman’s tissues for analysis to rule out cancerous growth, bacterial infections or other potential tissue abnormalities.
• Urinalysis: A urinalysis may be performed in men or women to rule out types of infections, such as urinary tract infection or those that cause some kinds of prostatitis.
• Semen analysis: In men, the presence of white blood cells in the semen can be a sign of prostatitis. Semen analysis may be ordered to diagnose or rule out prostatitis.
• Biopsy: Your healthcare provider may order a biopsy of any of the structures in your pelvis, including the cervix, bladder, and colon, to rule out cancerous tumors as the cause of your pelvic pain.

Scans

Some pelvic pain may be caused by abnormalities in the abdominal or pelvic cavities. Scans can help your healthcare provider get a peek inside the cavities, which allows him to check for problems with the pelvic bones themselves or the tissues that connect them. Scans for diagnosing pelvic pain can include one or more of the following:

• X-ray
• MRI
• CT scan
• Ultrasound

Surgery

Sometimes a scan is not enough for your healthcare provider to get a clear picture of what is going on in your abdominal and/or pelvic cavity. In some cases, he might order exploratory surgery for a closer look at what might be causing your pelvic pain.

During exploratory surgery, a tiny camera is inserted through a small incision. Your healthcare provider may perform a laparoscopy by inserting the camera through your belly button. Alternatively, depending on what he is looking for or trying to rule out, he may insert the camera into the bladder (cystoscopy) or into the colon (sigmoidoscopy).

Nerve Conduction Testing

Because some pelvic pain conditions are caused by pelvic nerve damage or dysfunction, your healthcare provider may order nerve conduction testing. These tests measure the rate and speed at which the nerves in the pelvis and groin carry impulses. Discrepancies in these impulses can indicate nervous problems as the cause of your pelvic pain. If the impulses are normal, nerve dysfunction can be ruled out as the cause of pelvic pain.

Bladder Testing

In addition to urine analysis or a cystoscopy, your healthcare provider may want to see how well your bladder is performing. In addition to questions about urinary frequency and incontinence, your healthcare provider may perform tests to see how your bladder fills and empties. He may also check the performance of your bladder sphincters, which are the muscles that release during urination and contract to hold the contents of the bladder in place. Bladder testing can help diagnose prostate problems or other bladder dysfunctions as a cause of pelvic pain.

Bowel Testing

In addition to a sigmoidoscopy, your healthcare provider may perform tests to see how well the sphincters of your anus are working. These sphincters relax during a bowel movement but should remain contracted otherwise to keep the contents of the bowels in place. Bowel testing may also be useful when ruling out conditions such as IBS.

How Long Will It Take to Diagnose Your Pelvic Pain?

It’s hard to say. Some pelvic pain causes can be determined immediately, as is sometimes the case with conditions caused by infection or pelvic tissue damage. Other causes of pelvic pain, such as nerve disorders, may take longer to pinpoint. Some people may go for many months or even years before you are accurately diagnosed.

To help your healthcare provider during the diagnosis stage, document your pain using a pain journal. Be sure to include which activities increase your pelvic pain, and which provide relief. It is often useful to track your bowel and bladder function as it relates to your pain, as well as documenting your menstrual cycle.