Pelvic pain is experienced in the lowest part of your abdomen and pelvis, below your belly button and above your legs. Pelvic pain can be present in either sex and can stem from many causes occurring suddenly, sharply and briefly (acute) or over an extended period (chronic).
Chronic pelvic pain refers to intermittent or constant pelvic pain that continues for six months or more. In some cases, pelvic pain can radiate down to your lower back, buttocks and thighs. You may notice pelvic pain only at particular times, such as when you urinate or during sexual activity.
Pelvic pain may develop from many conditions or diseases. For example, pelvic pain may be a sign of normal menstruation, appendicitis or bladder complications. It can also be a symptom arising from infection or problems with the reproductive or digestive system. Pelvic pain may be associated with benign and emergency medical problems.
Pelvic pain that begins suddenly for the first time is known as acute pelvic pain. If experienced, contact your doctor and they will be able to investigate and arrange a treatment plan for you. Several types of diseases and conditions can result in pelvic pain. Chronic pelvic pain can develop as a result from more than one condition.
Abdominal pain is generally caused by inflammation, stretching or distention of an organ, or by loss of the supply of blood to an organ. However, abdominal pain can also occur for unknown reasons without visible causes. Some causes of pelvic pain include:
Adenomyosis
The cause of adenomyosis is unknown. Similar to endometriosis, adenomyosis is a condition categorised by inappropriate growth of the endometrium (the lining of the uterus). In some cases, women do not experience any signs or symptoms; however, others may suffer from pelvic pain during intercourse, painful menstruation and heavy periods. In some cases, you can develop a growth inside the uterus called adenomyoma.
Ectopic Pregnancy
This occurs when an embryo implants itself outside of the uterus and begins to grow, usually in the fallopian tubes. Symptoms include sharp pelvic pain (usually on one side), vaginal bleeding, nausea and dizziness. Ectopic pregnancy, if spotted early, can be treated medically. However, if heavy bleeding occurs or a fallopian tube ruptures, this is a medical emergency that may require surgery.
Diverticulitis
Diverticula are small bulges or pockets that develop in the lining of the intestine as you age. Most people with diverticula do not develop any symptoms and only find out they have them following a scan for another reason. Symptoms include abdominal pain, usually in the lower left side. The pain tends to come and go and gets worse whilst eating or shortly after.
Menstrual Cramps
Primary menstrual cramps is a pelvic pain that occurs due to the uterus contracting to remove the blood and endometrial lining that accumulates monthly when an embryo is not implanted into the uterus. The pain can last 1 – 7 days during a menstrual cycle. Medication, home remedies and lifestyle changes can help to reduce these symptoms. Secondary menstrual cramps are a result of other conditions or disease such as endometriosis or ovarian cysts.
Mittelschmerz (Ovulation Pain)
Mittelschmerz is a painful twinge between periods that may be due to your body ovulating. Your ovaries release an egg along with fluid and blood. This can cause irritation but is not harmful and generally goes away with a few hours.
Ovarian Cysts
Ovaries release eggs during ovulation. In some cases, a follicle does not open to release the egg, or it recloses and swells with fluid, causing an ovarian cyst. They are typically harmless and go away on their own. However, they may cause pelvic pain, painful urination, pain after sexual activity, swelling and bloating. If the cyst bursts or twists it can cause severe, sudden pain.
Pelvic Inflammatory Disease
Pelvic inflammatory disease (PID) is an inflammatory and infectious disease, which may be a complication of a sexually transmitted disease (STD) such as gonorrhoea. Common symptoms related to pelvic inflammatory disease include abnormal vaginal discharge, pelvic pain and pain during intercourse or urination. Leaving PID untreated can result in infertility, ectopic pregnancy and chronic pelvic pain. Antibiotics can cure PID; however, some women may require surgery.
Crohn’s Disease
Without treatment, symptoms of Crohn’s disease can be constant or may come and go every few weeks or months. The main symptoms of Crohn’s disease include diarrhoea, fatigue, weight loss, blood in your stool and abdominal aches or cramps, most often experienced in the right side of the lower stomach.
Interstitial Cystitis
Interstitial cystitis (also called painful bladder syndrome) is a condition that causes ongoing pain related to inflammation. Most common in women in their 30s and 40s, people with severe IC may need to urinate several times per hour. Other symptoms include pressure above the pubic area, pain while urinating, and pain during intercourse.
Irritable Bowel Syndrome (IBS)
Irritable bowel syndrome causes abdominal pain, cramping, bloating and diarrhoea or constipation. IBS can be managed with dietary adjustments, stress management and medication.
Sexually Transmitted Diseases
Pelvic pain is a red flag for some STDs. Two of the most frequently seen are chlamydia and gonorrhoea. People often experience both at the same time, although they do not always show symptoms. However, when they do, they may experience pain when urinating, bleeding between periods, and abnormal vaginal discharge.
Appendicitis
Appendicitis usually involves a slow onset of a dull ache or cramps throughout the abdomen. As it becomes more swollen and inflamed, a sharp pain in the right lower part of the abdomen is felt. This tends to be more constant and severe than the initial dull ache that occurs when symptoms start.
Kidney Stones
Kidney stones are lumps of salt and minerals that your body tries to get eliminate in urine. Varying in size, most will pass out of your system on their own; however, in some cases they will require treatment. If the stone becomes lodged, it may block the urine flow and cause the kidney to swell, resulting in sharp, severe pain in the side, radiating to the lower abdomen and groin.
Inguinal Hernia
An inguinal hernia is the most common type of hernia that occurs when soft tissue pushes through a weak spot in the lower abdominal muscles, often developing in or around the groin area. Anybody can develop an inguinal hernia, however, it is seen more frequently in men than women. If left untreated, it can lead to life threatening complications.
Other causes of pelvic pain include:
Symptoms of Pelvic Pain
Pelvic pain affects the lower part of the abdomen, between the belly button and the groin. There are a number of symptoms that are experienced alongside or related to pelvic pain. Some of these symptoms include:
- Menstrual disorders
- Nausea
- Vaginal bleeding, spotting, or abnormal discharge
- Painful urination or trouble urinating
- Constipation or diarrhoea
- Lower back pain
- Bloating
- Blood in stool
- Discomfort or pain during and after intercourse
- Fever or chills
- Pain in the hip area
- Pain experienced in the groin area
Diagnosis of Pelvic Pain
When diagnosing the cause of pelvic pain, the doctor will review your symptoms and medical history. A physical exam and other tests may also be used to help diagnose the cause of your pelvic pain. During a physical exam, your doctor will feel for areas of tenderness. It is important to let your doctor know if you feel any discomfort or pain during the exam. The specific tests carried out will depend on what the suspected cause is.
Diagnostic tools may include:
- Urine tests
- Blood tests
- Pregnancy tests
- Vaginal or penile cultures to check for sexually transmitted diseases
- Abdominal and pelvic X-rays
- Diagnostic Laparoscopy
- Hysteroscopy
- Stool guaiac test (checking of a stool sample for presence of microscopic blood)
- Lower endoscopy such as colonoscopy or sigmoidoscopy
- Ultrasound
Finding the primary cause of pelvic pain can sometimes be a long process, and in some cases, an explanation may never be found. With time however, your doctor will be able to come up with a treatment plan that helps you live a full life with minimal discomfort.
Treatment of Pelvic Pain
Treatment of pelvic pain varies, depending on the cause, intensity of pain is and its frequency. In some cases, pelvic pain can be treated with medication such as antibiotics. If the pain and symptoms are caused by a problem with one of the pelvic organs, surgery may be involved in the treatment. In some cases, physical therapy can be helpful with the goal of treatment aiming to reduce symptoms and improve quality of life. If a cause cannot be identified, treatment will focus on managing your pain and other symptoms. In many cases, the ideal approach involves a combination of treatments.
Treatment options include:
Medication
Depending on the cause, your doctor may recommend a number of medications to treat your condition, such as pain relief (ibuprofen or aspirin), hormone treatments (some women find their pelvic pain is linked to a particular phase of their menstrual cycle) and antibiotics (if an infection is the cause of your pain).
Surgery
Surgery may be suggested to correct an underlying problem that causes chronic pelvic pain. Your doctor may recommend surgical techniques such as laparoscopic surgery or a hysterectomy. Your doctor will be able to remove adhesions or endometrial tissue using laparoscopic surgery. In rare, complicated circumstances, your doctor may recommend removing your uterus (hysterectomy), fallopian tubes (salpingectomy), or ovaries (oophorectomy). Your doctor will discuss your options with your and explain the benefits and risks of each procedure.
Alternative Therapies
Your doctor may recommend specific therapies or procedures as a part of your treatment for chronic pelvic pain. Physical therapy (to help develop coping strategies for the pain), trigger point injections (to help block discomfort in the painful spots) and psychotherapy (if your pain is intertwined with depression or any stress in life) can all help manage and lessen symptoms.
Outlook
Typically, pelvic pain in women appears because of a common issue such as menstrual cramps or pain during ovulation. However, if you suspect that a more serious underlying problem is causing the pain, you should consider seeing a doctor as soon as possible. A thorough diagnosis is necessary to avoid potentially serious complications and start the best treatment.
Need Help?
Our Consultant Gynaecologists are highly experienced in diagnosing and treating women that are currently experiencing pelvic pain, with our medical team and nursing staff offering support in a sensitive and caring manner at all times.
To make an appointment to see a Consultant Gynaecologist consultant, please contact the reservations team on 01233 364 036 or email ashford.info@onehealthcare.co.uk
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