Pelvic pain

Pelvic pain is a common problem that can affect anyone. It is usually described as the feeling of discomfort, pain, or irritation anywhere below the belly button but above the legs. It can also start in the genitals or other organs in and around the pelvis.

Pelvic pain can be acute or chronic

  • Acute pelvic pain means the pain is sudden and severe.
  • Chronic pelvic pain means the pain either comes and goes, lasts for 6 months or longer, and doesn’t improve with treatment.

Finding the cause of pelvic pain isn't always easy

While the cause is often not clear, pelvic pain can be a sign of fertility issues, digestive disorders, STDs, or a life-threatening condition that may need hospitalization. In certain cases, no underlying cause can be found.

What causes pelvic pain?

Acute and chronic pelvic pain can have many causes. Female pelvic pain pertaining to the reproductive system can be caused by:

  • Cancers of the reproductive tract, such as uterine cancer.
  • Ectopic pregnancy (a pregnancy that happens outside the uterus).
  • Endometriosis.
  • Endometrial polyps.
  • Menstrual cramps.
  • Miscarriage or threatened miscarriage.
  • Pelvic inflammatory disease (PID), an infection of the reproductive organs.
  • Ruptured fallopian tube.
  • Twisted or ruptured ovarian cyst.
  • Uterine fibroids (growths on or in the uterine wall).

Some of the other conditions that can lead to acute or chronic pelvic pain in anyone may include:

  • Appendicitis.
  • Inflammation, stress, or irritation of nerves caused by injury, fibrosis, pressure, or peritonitis.
  • Muscle cramps.
  • Myofascial pain, muscle pain that affects a connected group of muscle tissues.
  • Other problems in the digestive tract, urinary tract, or nervous systems, such as irritable bowel syndrome (IBS) or a urinary tract infection (UTI).
  • Scar tissue (adhesions) between the organs in the cavity of the pelvis.
  • STDs, notably gonorrhea and chlamydia.

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What are the symptoms of pelvic pain?

Symptoms of pelvic pain can vary widely from person to person.

Pelvic pain may be mild or severe, constant or intermittent, dull or sharp. The following symptoms are examples of commonly-described  types of pelvic pain and their possible cause or origin, but you should talk with your healthcare provider for an accurate diagnosis.

Type of pain & possible causes

Cramping. May be caused by a spasm in the intestine, ureter, or appendix.

Chronic pain. Any pain lasting longer than 6 months is considered chronic, and can be so bad it interferes with your daily life. It can be caused by untreated symptoms, or other hard-to-diagnose conditions.

Pain exists only in one area (local pain). May be caused by inflammation of a certain organ or muscle group.

Pain of the entire abdomen. May be from a buildup of blood, pus, or stool in the bowels.

Pain made worse by movement or during examination. May be from irritation in the lining of the abdomen or pelvic floor muscles.

Slowly developing pain. May be from inflammation of the appendix or blockage in the intestines.

Sudden-onset pain. May be caused by a short-term lack of blood supply due to a problem with blood flow or circulation.

Reproductive pelvic pain and where it’s felt

  • An ectopic pregnancy causes sharp pelvic pain or cramps (notably on one side), accompanied with vaginal bleeding, nausea, and dizziness. An ectopic pregnancy requires immediate medical attention.
  • Endometriosis can cause pain wherever the abnormal endometrial tissue is in the body. Endometriosis can form scar tissue or adhesions that will make it difficult to conceive in the future.
  • Menstrual cramps cause pain in the lower abdomen or back as the uterus lining begins to be shed during a menstrual period.
  • Ovarian cysts, if twisted or ruptured, can cause pain in the abdomen, pressure, swelling, and bloating. When a cyst ruptures, it causes a sudden severe pain that can land you in the emergency room.
  • Pelvic inflammatory disease (PID) is usually the complication of an STD, causing pain in the abdomen, fever, abnormal vaginal bleeding or discharge, and urinary and sexual pain. Pelvic inflammatory disease is the leading preventable cause of infertility.
  • Uterine fibroids or any other fibroid doesn’t usually cause problems, but can be felt as pressure in the abdomen or lower back, paired with heavy menstrual bleeding, pain during sex, and sometimes infertility.
  • Vulvodynia causes burning, stinging, or throbbing around the vaginal opening.

Other pelvic pain and where it’s felt

  • Appendicitis is characterized by a sharp pain in the lower-right side of the abdomen, paired with vomiting and fever. An infected appendix requires surgery and can cause severe complications if left untreated.
  • Interstitial cystitis (IC) refers to a painful bladder syndrome characterized by inflammation and pain above the pubic area and painful intercourse or urination.
  • Irritable Bowel Syndrome (IBS), or a spastic colon, causes pelvic pain as well as abdominal pain, bloating, diarrhea, painful bowel movement, or constipation.
  • Pelvic Congestion Syndrome causes swelling and pain in the veins of the pelvic region, most notable when you sit or stand.
  • Pelvic organ prolapse refers to when the bladder or uterus drops to a lower position, causing vaginal pressure and bloating.
  • Scar tissue or pelvic adhesions cause pain anywhere they are located, most often somewhere in the abdomen or pelvic region.
  • STDs such as gonorrhea and chlamydia pelvic pain, bleeding, and abnormal vaginal bleeding or discharge.
  • Urinary tract infections (UTIs), if left untreated, can cause a kidney infection. Pain is usually felt in one area of the lower back paired with fever, nausea, and vomiting.

How is pelvic pain diagnosed?

To diagnose pelvic pain, your healthcare practitioner will start by going over your medical history, doing a physical exam, and asking you questions about the pain, such as:

  • When and where does the pain happen?
  • How long does the pain last?
  • Is the pain related to your menstrual cycle, urination, and/or sexual activity?
  • What does the pain feel like? For example, is it sharp or dull?
  • What was happening when the pain started?
  • How suddenly did the pain start?

Doctor sharing information with patient

Tell your healthcare provider all you can about the timing of the pain and other symptoms related to eating, sleeping, sexual activity, and movement. This can help with a diagnosis.

The healthcare provider will likely also perform a pelvic examination. During a pelvic exam, the doctor will examine your reproductive organs for swelling or scarring to determine if your pain is caused by an infection.

You may have additional diagnostic tests such as:

  • Blood tests to check your blood cell count, or to evaluate if you may have an STD.
  • Culture swab of cells from the cervix to check for cancerous cells.
  • Pregnancy test to determine if the cause of pain may be from an ectopic pregnancy or other complication with pregnancy.
  • Urinalysis to check bladder function or for bladder or other urinary infections.

You may also have imaging tests performed, including:

  • Colonoscopy. In this test, the healthcare provider can view the entire length of the large intestine. It can often help find growths, inflamed tissue, ulcers, and bleeding. It is done by putting a long, flexible, lighted tube (colonoscope) in the rectum and up into the colon. The colonoscope lets the healthcare provider see the lining of the colon, remove tissue to test, and treat some problems that are found.
  • CT scan. This is an imaging test that uses X-rays and a computer to make detailed images of the body. A CT scan shows details of the bones, pelvic muscles, fat, and organs, and any abnormalities that may not show up on an ordinary X-ray.
  • Laparoscopy. A minor surgical procedure in which a laparoscope, a thin tube with a lens and a light, is inserted into an incision in the abdominal wall. Using the laparoscope to see into the pelvic area, the healthcare provider can determine the locations, extent, and size of any endometrial growths.
  • MRI. A noninvasive procedure that produces a 2-D view of an internal organ or structure.
  • Pelvic ultrasound. This test uses high-frequency sound waves to create an image of organs.
  • Sigmoidoscopy. This test lets the healthcare provider examine the inside of a part of the large intestine. It can find the causes of diarrhea, abdominal pain, constipation, abnormal growths, and bleeding. A short, flexible, lighted tube (sigmoidoscope) is put into the rectum. The scope blows air into the intestine to inflate it and make viewing the inside easier.
  • X-ray. A small amount of radiation is used to produce images of bones and internal organs onto film.

How can pelvic pain be relieved?

Pain management for your pelvic problems will depend on what is causing your pain, whether you have normal or severe pelvic pain, and if your pain is acute or chronic.

The most common treatments for different conditions are outlined below:

Antibiotics to treat symptoms associated with PID, UTI and kidney infection.

Birth control to treat symptoms associated with cramping during or before menstruation and endometriosis.

Counselling to help manage chronic pelvic pain.

Dietary changes to treat symptoms associated with IBS.

Physical therapy to treat vulvodynia.

Surgery to treat:

  • Ectopic pregnancy.
  • Endometriosis.
  • Fibroids.
  • Pelvic organ prolapse.
  • Ruptured appendix.
  • Ruptured cyst.
  • Scar tissue.

Your doctor can provide more information about various treatments for pelvic pain.