A problem shared

I’ve been in pain for a year. Why won’t my GP help?

QI’M IN constant pain with a deep, dull ache in my lower belly. I often have to resort to over-the-counter painkillers, but am reluctant to take anything stronger. My GP has done scans and investigations and can’t tell me why I’m still in pain. This has gone on for nearly a year and it’s getting me down. Could it all be in my head?

A WHaT you describe sounds like chronic pelvic pain syndrome (CPPs), which affects the lower abdomen or pelvis, and that lasts over six months. It is thought to strike up to 16 per cent of women. sadly, only a third of them seek advice.

Less commonly, CPPs can affect men too, causing aches in the bladder and prostate.

The pains are often varied in nature and intensity, from mild to disabling, sometimes leading to nausea, vomiting or fainting.

CPPs can be felt all over the pelvic area, or just in one place. some experience sharp pains and cramps, others a dull ache and pressure deep in the pelvis. It can be triggered by urinating, a bowel movement or sexual intercourse.

CPPs may be set off by endometriosis, as well as inflammation, irritable bowel, scarring or interstitial cystitis (bladder inflammation without infection). It can also be related to dilated veins in the pelvis. Pressure on a nerve, fibroids in the womb or infections in the pelvis can also set off pain.

Psychological issues can be involved, too: anxiety, depression, post-traumatic stress disorder (PTsD) and insomnia.

I imagine your GP will already have asked you about any unusual bleeding, weight loss, abdominal swelling or blood in the urine. I would expect you to have had an internal examination, blood tests and scans.

Unfortunately, despite such tests, a cause often can not be found. There may have been a

n I love the opportunity for a short snooze in the afternoon. Just ten or 15 minutes is enough to leave me feeling relaxed and revived. So I was pleased to read that recent research in five-year-olds shows that not only does a quick nap calm them down when tired and irritable, but it is also integral to their brain development. It helps to free up brain space for memory storage and learning. As they get older and their brains mature, children nap less often. But I would like to think that my afternoon snooze might be freeing up much-needed brain space, too. trigger, which is no longer there, but has meant the nerves sending pain signals to your brain have become ultra-sensitive.

so what can you do to manage and reduce symptoms? Treatment should be focused on both the psychological and physical aspects of the pain.

You say everyday painkillers don’t work. There are stronger prescription painkillers, but they may lead to tolerance or dependence. Nerve blocks or steroid jabs can help in severe cases. Botox can also be used to lessen pain with sexual activity, reduce pelvic pressure and alleviate persistent pain. some patients opt for a hysterectomy — but up to 40 per cent still have pain afterwards.

You could also try pelvic floor physiotherapy, which has been shown to lead to a 22 per cent reduction in pain. a psychological approach, such as cognitive behavioural therapy (CBT) can have a big impact. Mindfulness can help, too, as can talking therapies and/or antidepressants.

Lifestyle changes, such as adopting a Mediterranean diet, keeping active and prioritising sleep, will reduce inflammation in the body and your pain.

Do seek further professional advice if the pain is getting worse, affecting your work and home life. You shouldn’t feel you have to just ignore it.