Chronic pelvic pain is a complex, often misunderstood condition that affects 1 in 6 women, lasting for six months or more. It can disrupt every aspect of life – physical, emotional, social. It is often caused by a combination of conditions rather than a single issue.
Common causes include:
- Endometriosis
- Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS)
- Pelvic floor dysfunction
- Adhesions, IBS, or prior infections/surgery
- Psychosocial factors such as trauma, depression, or stress
Importantly, some women may have no visible pathology, yet still experience debilitating pain. All experiences are valid and deserving of careful, individualised care.
Endometriosis: A Hormonal and Immune Disorder
Endometriosis occurs when tissue similar to the lining of the uterus grows outside the womb—on ovaries, bowel, bladder, or pelvic lining—causing inflammation, scarring, and severe pain. Symptoms include:
- Painful periods
- Pain with sex
- Chronic pelvic or back pain
- Infertility
- Bowel and bladder discomfort
In a research study led by Dr Karmakar, elevated immune markers (leptin and IL-8) were found in the pelvic fluid of women with endometriosis, particularly in early and advanced stages. This provides was one of the studies that provided early insight into the inflammatory and angiogenic nature of the disease, and supported future immunomodulatory approaches to treatment.
Citation:
Malhotra, N., Karmakar, D., Tripathi, V., Luthra, K., & Kumar, S. (2011). Correlation of angiogenic cytokines-leptin and IL-8 in stage, type and presentation of endometriosis. Gynecological Endocrinology, 28(3), 224–227. https://doi.org/10.3109/09513590.2011.593664
Management includes:
- Hormonal therapies (e.g. IUD, oral contraceptives, implants)
- Excision surgery for deep disease or endometriomas
- Fertility support, if needed
- Pelvic physiotherapy and pain psychology
- Lifestyle strategies and dietary review
Interstitial Cystitis / Bladder Pain Syndrome (IC/BPS)
IC/BPS is a chronic bladder condition characterised by pain, pressure, urgency, and frequent urination, often without infection. It affects mostly women and can overlap with endometriosis, IBS, or pelvic floor dysfunction.
Symptoms include:
- Pelvic or bladder pain, especially as the bladder fills
- Urgent and frequent urination (day and night)
- Painful intercourse
- Sensitivity to certain foods or drinks
Diagnosis is clinical, supported by cystoscopy, bladder diaries, or urodynamic testing. Importantly, it is a diagnosis of exclusion—ruling out infection, cancer, or neurological causes.
Treatment options include:
- Dietary adjustments to avoid bladder irritants
- Bladder training and pelvic physiotherapy
- Medications (e.g. amitriptyline, antihistamines)
- Bladder instillations
Dr Karmakar’s Long-Term Study on DMSO Cocktail Therapy
Dr Deb Karmakar was a key investigator in a long-term follow-up study evaluating a bladder instillation “cocktail” using DMSO, heparin, hydrocortisone, and bupivacaine for women with IC/BPS.
Over a median of 5 years of follow-up:
- 34.5% of women were symptom-free and needed no further treatment
- Another 21.8% had sustained symptom improvement requiring only oral medications
- The treatment was most effective in patients with better baseline bladder capacity and less frequent urination
This study highlights a valuable, well-tolerated treatment option for carefully selected IC/BPS patients seeking long-term relief.
A Holistic and Personalised Approach
Because chronic pelvic pain often stems from multiple sources, Dr Karmakar takes a multidisciplinary approach, working closely with:
- Pelvic physiotherapists
- Pain management specialists
- Dietitians and psychologists
Every care plan is unique and co-designed with you. Whether your pain is related to a known condition like endometriosis or remains unexplained, your experience is valid, and your treatment should reflect both science and compassion.
