Authored By: Dr. K. Shilpi Reddy
Clinical Director – Obstetrics & Gynaecology, Fertility Specialist & High-Risk Pregnancy Care, Minimal Invasive Surgeon (Mini Lap, Laparoscopy, Robotic Team)
Pelvic pain is pain in the lower part of the abdomen and pelvis. It can stem from multiple causes. Pelvic pain arises from the conditions associated with reproductive, urinary or digestive systems, or from muscles and ligaments in the pelvis. Pelvic pain can be due to irritation of nerves in the pelvis.
Chronic pelvic pain is constant or intermittent pelvic pain for six months or more. Pelvic pain may spread to lower back, buttocks or thighs. Pelvic pain can also be situational, such as while using the bathroom or have sex.
More than one condition can lead to Pelvic pain.
- Common causes of acute pelvic pain
- Ovarian cyst– it is fluid-filled bubble arising from an ovary and causes pelvic pain when it ruptures or becomes twisted
- Acute pelvic inflammatory disease– a bacterial infection of the reproductive organs, which often follows a chlamydia or gonorrhoea infection and needs immediate treatment with Antibiotics.
- Ectopic Pregnancy (or other pregnancy-related conditions)
- Miscarriage or intrauterine fetal death
- Menstrual cramps (dysmenorrhea)
- Mittelschmerz (ovulation pain)
- Appendicitis – a painful swelling of the appendix which usually causes pain on the lower right-hand side of your abdomen
- Peritonitis– inflammation of the peritoneum; it causes sudden abdominal pain that gradually becomes more severe and requires emergency treatment
- Urinary tract infection – it will cause pain or a burning sensation while urination
- Kidney stones
- Constipation or bowel spasm – this could be due to changes in diet, medication, irritable bowel syndrome or, in rare cases, a bowel obstruction
Less common causes include:
- Pelvic abscess –it is collection of pus in between pelvic organs requiring urgent treatment
- Endometriosis – a condition where bits of endometrium is found outside the uterus, such as on the ovaries, leading to painful periods
- Uterine fibroids
- Long-term pelvic pain
If pelvic pain persist for 6 months or more that is either intermittent or continuous, it’s known as chronic pelvic pain.
The most common causes of chronic pelvic pain are:
- Chronic pelvic inflammatory disease – a bacterial infection of female reproductive organs which often follows a chlamydia or gonorrhoea infection and needs immediate treatment with antibiotics
- Irritable bowel syndrome – a common condition of the digestive system that can cause cramps, bloating, diarrhoea and constipation
- Conditions involving the muscles, joints, and ligaments in the pelvis, lower back, or hips.
Less common causes of chronic pelvic pain are:
- Recurrent ovarian cysts
- Recurrent urinary tract infection
- Lower back pain
- Prolapse of the uterus– where the uterus slips down along with other organs from its normal position and usually causes a “dragging” pain
- Adenomyosis – endometriosis that affects the muscle of the uterus, causing painful, heavy periods
- Fibroids – tumours(non-cancerous) of the uterus, fibroids can be painful if they twist, but uncomplicated fibroids aren’t usually painful
- Chronic interstitial cystitis – chronic inflammation of the bladder
- Inflammatory bowel disease (IBD) –It includes ulcerative colitis and Crohn’s disease, which affect the gut
- Trapped or damaged nerves in the pelvic area
- Uterine cancer
- Cervical cancer
- Worsening of menstrual cramps
- Menstrual pain
- Vaginal bleeding, spotting or discharge
- Painful or difficult urination
- Constipation or diarrhoea
- Bloating or gas
- Blood seen with a bowel movement
- Blood in urine
- Pain during intercourse
- Fever or chills
- Pain in the hip area
- Pain in the groin area
To begin with, your doctor will do a complete examination to look for problems with your reproductive system. The doctor will need complete information about past and present health and symptoms. You might need to undergo some tests, such as:
- Blood and urine tests for signs of infection.
- A pregnancy test.
- Tests for sexually transmitted infections (STIs)– vaginal culture
Emotional issues can be a big part in chronic pain. Inform your doctor about any depression or stress that is adding to your problem. Your Doctor will need to know about any past or current sexual or physical abuse. It can be tough to talk about these things, but all this information is needed to provide right treatment.
If initial tests don’t suggest anything significant, then you might have to go for other tests that show pictures of the organs in your belly. These may include:
- Abdominal and pelvic X-rays.
- Diagnostic laparoscopy
- Hysteroscopy (procedure to examine the uterus).
- Stool guaiac test- tests microscopic blood in stool sample
- Lower endoscopy such as colonoscopy or sigmoidoscopy
- CT scan of the abdomen and pelvis
Finding the cause of pelvic pain can take long time. You should keep record about the type of pain you have, timings and any precipitating factors.
Once your condition is diagnosed- you will be treated for that problem. Some common treatments include:
- Birth control pills or hormone treatment for problems related to your periods.
- Surgery for removal of a growth, cyst, or tumor.
- Medical management- such as an antibiotic for infection or medicine for irritable bowel syndrome.
If you are not diagnosed foe the condition causing pelvic pain-you can be offered treatment to help you manage the pain. Best results are seen from a combination of treatments such as:
- Pain relievers called NSAIDs, like ibuprofen or naproxen.
- Tricyclic antidepressant medicine or anticonvulsants, which can help with pain and with depression.
- Cognitive-behavioural therapy or biofeedback, to help you change the way you think about or react to pain.
- Counselling, to give you emotional support and reduce stress.
- Physical therapy to help you relax your muscles, improve your posture, and be more active.
- Pain relievers that are injected (local anaesthetic) into specific areas to help with pain.
You may need to try many treatments before you find the ones that help you the most. If the things you’re using aren’t working well, ask your doctor what else you can try. Taking an active role in your treatment may help you feel more hopeful.