There are many possible reasons for one to experience ongoing pain in the bladder and genital area. The causes of pain and the perception of pain severity vary tremendously from person to person. Because there are so many structures that pass thru the pelvis it is often difficult to determine the underlying source or multiple sources of the pain. Because both urologic and gynecologic sources may be involved it is very important to see the “whole picture” and not approach this only thru the eyes of a gynecologist or urologist, therefore our doctors are the best and most capable of developing a treatment plan for your chronic pelvic pain.
Some of the main pain categories include:
INTERSTITIAL CYSTITIS (IC) - also known as the painful bladder syndrome. It affects women of all ages. In general it feels like a bladder infection (UTI) that never seems to go away. It is often misdiagnosed as a recurrent UTI. Patients often experience pain in the mid lower pelvis and or in the vaginal area. Please see the Interstitial Cystitis section of our website for more information.
VULVODYNIA - This condition results in ongoing vaginal pain. The pain is often exacerbated by any contact to the vaginal area such as wearing tight clothing or sitting on a hard seat. It often times makes sexual intercourse very painful or impossible.
Helpful links: http://www.nva.org/about_vulvodynia/what_is_vulvodynia.html
LEVATOR SYNDROME - (pelvic floor dysfunction) This condition is thought to be caused by spasms in the pelvic floor muscles. These muscle spasms result in ongoing vaginal pain that is often felt deep in the vagina or at the bladder. Often times pelvic floor muscle spasms will feel like a urinary tract infection. Stress, sexual intercourse, a full bladder, constipation or any of the many pelvic pain syndromes often exacerbates it. In addition to pain, the tightening of the pelvic floor (levator) muscles may make it difficult to pass urine and stool.
ENDOMETRIOSIS - This condition often results in either constant pain or more commonly pain that fluctuates with the menstrual cycle. It is believed to be caused by abnormal deposits of endometrium (the hormone sensitive lining of the uterus) throughout the pelvis. The endometrial tissue may even deposit in the bladder and cause you to have blood in your urine at the time of your period.
Helpful links: http://www.endometriosis.org/endometriosis.html
URETHRITIS / URETHRAL SYNDROME - Pain that originates from the urethra- often results in burning during urination and sexual intercourse. Again, the symptoms may be similar to those of a UTI however the urine culture is negative.
Helpful links: http://www.emedicine.com/med/topic3081.htm
URETHRAL DIVERTICULUM - The urethra is the tube that carries urine from the bladder out of your body. A diverticulum is an out pouching or a pocket that forms in the urethra. It may present as a firm mass protruding from the vagina. It is associated with causing pain during sexual intercourse, recurrent UTIs and dribbling urine when you stand after urinating (post void dribbling). When they are symptomatic that may be treated surgically. In many cases they are found during a gynecological exam and otherwise do not cause any symptoms- and can be left alone.