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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18777
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I have had chronic pelvic and bladder pain

Resolved Question:

Hello,
I have had chronic pelvic and bladder pain for about 5 years. I have had many tests which haven't revealed any medical cause. I believe it was caused and is still caused by stress through divorce but the symptoms have got worse and are intolerable now. My GP has given me various anti-depressants but they have always given me bad headaches and I have never taken them for very long. Everyday when I wake it feels like broken glass in my gut and and bladder which in turn makes me incredibly anxious. Any ideas please?
Nick
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. D. Love replied 1 year ago.
Hello from JustAnswer.I am sorry that you are having so much pain.Could you give more details of the evaluation that has been done?Could you list which antidepressants have been tried?Have you been tried on any other medicines for chronic pain besides the antidepressants?
Customer: replied 1 year ago.
I have had an endoscopy, sigmoid colonoscopy and am under a urology consultant for very low grade prostate cancer but he assures me that isnt causing any of these symptoms. I have been put on Sertraline, Amitryptiline, Nortryptyline but to be fair I havent taken them for more than a couple of weeks as I always get headaches with them. No specific medication for pelvic pain
Expert:  Dr. D. Love replied 1 year ago.
Thank you for the additional information. Since you are being seen by a Urologist, I assume that the endoscopy was of the bladder, also called cystoscopy. Cystoscopy would be important in this situation, as interstitial cystitis would be one of the primary concerns as a cause of chronic pelvic and bladder pain. If interstitial cystitis has been excluded, then another major consideration would be that it is nerve mediated pain, although it is difficult to prove this when it is affecting the pelvic nerves (nerve mediated pain is easier to assess when it affects the nerves in the extremities). If you have not had an imaging test of the pelvis, such as a CT scan or MRI, that would be reasonable. A growth is not a common cause of 5 years of pelvic pain, but should be excluded. Antidepressants are common first-line medicines to help with chronic bladder and pelvic pain, whether due to interstitial cystitis, nerve mediated pain, or from an unknown cause. Another antidepressant that has been shown to be particularly effective is duloxetine, which is in a different chemical class, so may be tolerated when sertraline, amitriptyline, and nortriptyline have not been tolerated. If you do not tolerate any of the antidepressants, then the other class of drugs that is commonly used for chronic pain are certain anticonvulsants that have been shown to help with most causes of chronic pain, and the most commonly used are gabapentin and pregabalin. I would also note that stress can cause a variety of chronic pain syndromes, but it has also been shown to increase the likelihood of developing many specific illnesses. So if someone is having significant stress while having symptoms, the evaluation is still oriented towards the symptoms. Relieving the stress may help, whether it is directly or indirectly related to the stress, but it is also true that it is frequently difficult to reduce stress, so we have to deal with the symptoms or diseases separate from the stress. It is also worth noting that antidepressant can also help ease anxiety and depression related to high levels of stress. So, at this point, if you have not been tried on duloxetine, that would be a reasonable next option. One of the anticonvulsants would be another option to try, as they can help most causes of chronic pain. If I can provide any additional information, please let me know.
Dr. D. Love and 2 other Medical Specialists are ready to help you
Customer: replied 1 year ago.
Thank you
Expert:  Dr. D. Love replied 1 year ago.
You are most welcome. I hope that you get some relief soon.