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Fibromyalgia frequently overlaps with other conditions that cause chronic pain, including chronic pelvic pain. Here's why you should go to the doctor, and what you can expect from the diagnostic process.

Fibromyalgia, a chronic functional pain disorder that strikes women much more frequently than men, is characterized by widespread pain, fatigue, sleep problems, cognitive changes, and not uncommonly depression. It is, unfortunately, far from rare to suffer from another medical condition alongside fibromyalgia — patients may also be plagued by migraines, restless leg syndrome, temperomandibular disorder, and lupus, at rates that far exceed those seen in the general population. 

Chronic pelvic pain is another problem fibromyalgia sufferers can encounter. It is best to see your doctor if you have been dealing with pelvic pain for some time now, especially if the pain is so bad that it interferes with your ability to carry out normal tasks or with your quality of life. 

Fibromyalgia and chronic pelvic pain: Shared features

Studies do indicate that many women who have fibromyalgia suffer from pelvic floor and urinary issues. The reason for this overlap has not been fully explored as of yet, but there is research that points to the idea that the two conditions may have a common or similar cause. That is, chronic pelvic pain and fibromyalgia may both fall under a wider umbrella of "central sensitivity syndromes", caused by central nervous system changes that lead to a hypersensitization of the senses. Not only can central sensitivity syndromes make you much more sensitive to pain, they also amplify the depth with which you experience visual, auditory, and other stimuli. 

A very interesting study of more than 1,000 MRI scans revealed that:

  • Participants diagnosed with fibromyalgia had more gray matter — which facilitates the sending of signals — in their brains, something that also held true for patients diagnosed with chronic urological pelvic pain. 
  • Those diagnosed with chronic urological pelvic pain had brain patterns that were indistinguishable from those seen in fibromyalgia patients. 
  • Participants diagnosed with pelvic pain actually indicated that they experienced widespread pain — just like fibromyalgia sufferers do — even though they really shouldn't, given their diagnosis.  
We can conclude, from this, that some patients only diagnosed with chronic urological pelvic pain suffer from symptoms, and have other features, associated with fibromyalgia. This in turn leads to the obvious conclusion that an unknown percentage of those only diagnosed with pelvic pain actually have fibromyalgia. 

What medical conditions lead to chronic pelvic pain?

Numerous different conditions can lead to pelvic pain. Among them are those that only occur in females:

  • Vulvodynia is a chronic pain that affects all or part of the vulva, and for which the cause is not known yet. 
  • Dysmenorrhea means painful menstruation, and this can in turn be caused by numerous different things, including endometriosis and pelvic inflammatory disease. 
  • Endometriosis is a condition in which the endometrium, the tissue that usually lines the uterus, also proliferates in other parts of the reproductive system, leading to pain and often infertility. 
  • Uterine fibroids are benign growths in the uterus. 
  • Pelvic joint instability as a result of vaginal birth. 

Conditions that can lead to pelvic pain in males, meanwhile, include:

  • Chronic prostatitis, a long-term prostate inflammation that can be bacterial but the cause of which can also remain unclear — in the latter case, it is called chronic pelvic pain syndrome. 
  • Pain syndromes that affect the penis, testicles, or both, which post-vasectomy pain syndrome being one example.
Some causes of chronic pelvic pain aren't sex-specific. These include irritable bowel syndrome, which is incidentally more common in fibromyalgia patients, and interstitial cystitis, the cause of which is unclear — no identifiable infection is present in people diagnosed with this condition. Kidney stones, tumors, neuropathic pain (due to nerve damage), and previous injuries or damage in the pelvic region can also be responsible. In the last case, trauma can be the cause, but also a history of pelvic surgery. 

Pelvic pain and fibromyalgia: What are your treatment options?

Assuming that you have already been diagnosed with fibromyalgia when you begin experiencing pelvic pain, you will go through a diagnostic process to attempt to determine the cause of your pelvic pain before any other steps are undertaken. As you've seen, a number of conditions that cause chronic pelvic pain are still unknown in origin. This means that your diagnostic process will begin by ruling those that are more easily tested for out. You can expect:

  • A thorough discussion about the nature of your symptoms, and about your personal and family medical history. 
  • A pelvic examination. 
  • Ultrasound tests to check for damage or pathology, and in some cases also more detailed scans like MRI or CT scans. 
  • Lab tests. 
  • To be asked to keep a journal of your symptoms and the circumstances under which they occur. 
  • Laparoscopy may be performed to get a closer look. 

Because so many different conditions can cause chronic pelvic pain, it may take a while before you receive a diagnosis. This can be incredibly frustrating, not in the least because chronic pelvic pain can exacerbate your fibromyalgia symptoms. After your wait is over, you and your doctor can set about determining the right treatment for you. This may involve:

  • Painkillers, over the counter or prescription. 
  • In some cases, antibiotics. 
  • Antidepressants. 
  • Hormonal treatments, including in some cases the birth control pill. 

Non-steroidal anti-inflammatories, are, alongside antidepressants and certain opiates, also frequently used as part of fibromyalgia treatment plans. It is possible, therefore, that you can "catch two birds with one stone". Certain non-pharmacological treatments can likewise help you in treating both your fibromyalgia and chronic pelvic pain. Treatments that may help you achieve a better quality of life include:

  • Talk therapy, with cognitive behavioral therapy being recommended especially frequently. This can be helpful, among other reasons, because stress aggravates chronic pain, and therapy can help you work through current and past sources of stress and trauma. 
  • Physical therapy, to help you become more flexible, improve your posture, and increase your strength. 
  • Relaxation techniques and therapies such as yoga and massage.
  • In some cases, trigger point injections can offer relief from pelvic pain. 
  • Neurostimulation, in which electrical signals are used to ease chronic pain. 

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