Common Causes of Chronic Pelvic Pain

Chronic pelvic pain has a variety of potential causes -- some are female-only (endometriosis and uterine fibroids), but other disorders and diseases equally affect both women and men. These include scar tissue irritation from abdominal surgeries, pelvic fractures or even irritable bowel syndrome (IBS). Here are some of the most common types of chronic pelvic pain.

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Female Disorders

Often when women experience chronic pelvic pain, the cause is dysfunction in one or more of the sexual organs. These include the ovaries, fallopian tubes, associated ligaments, and tissues, or the uterus. The most common types of chronic pelvic pain caused by female disorders include:

  • Vulvodynia: vulvodynia is the term for chronic vulva pain or discomfort. Vulvodynia may feel like burning or stinging. This type of chronic pelvic pain may move around a bit, and it may come and go.
  • Endometriosis: endometriosis occurs when uterine tissue, called endometrial tissue, grows outside the uterus. Unlike the uterine lining, endometrial tissue outside your uterus does not leave your body during your menstrual period. This type of chronic pelvic pain can cause dysmenorrhea (painful menstruation), abnormal bleeding during your period, and painful sex. Endometriosis may even cause infertility.
  • Fibroids: fibroids are tissue growths inside the uterus wall, though they are sometimes found around the cervix or on the ligaments that support the uterus. Fibroids range in size and can cause dysmenorrhea (abnormally heavy bleeding during your period) or sharp pains in the abdomen and back. Chronic pelvic pain associated with fibroids may be treated with medications including hormones, while others may require surgical removal.

Male Disorders

Men can experience chronic pelvic pain from their reproductive organs as well, though the most common male-exclusive chronic pelvic pain disorder is chronic prostatitis. Chronic prostatitis is the term for swelling of the prostate gland. It can cause difficult or even painful urination and may lead to sexual dysfunction.

Nerve Disorders

Damage or dysfunction or nerves in the pelvic cavity can cause chronic pelvic pain in both men and women. The more common types include:

  • Pudendal neuropathy: damage to the pudendal nerve, which supplies the sexual organs, rectum, and perineal area (think of this as the area that touches a bicycle seat) can cause pain between the legs in both men and women. People with this type of chronic pelvic pain may experience pain during sex, when sitting or when having a bowel movement.
  • Ilioinguinal and iliohypogastric nerve disorders: both of these nerves lie in the pelvic cavity and can lead to chronic pelvic pain if damaged. Damage to the ilioinguinal or the iliohypogastric nerves may occur during abdominal surgery, after an abdominal trauma (such as a car accident).
  • Genito-femoral neuropathy: this type of chronic pelvic pain is caused by damage to one of the genitor-femoral nerves and can cause sharp pains that run between your legs, into your back or into the abdomen.

Other Causes

There are many other potential causes of chronic pelvic pain that are not exclusive to men or women and are not caused by nerve damage. These include:

  • Irritable Bowel Syndrome (IBS): IBS not only causes diarrhea, constipation, and cramping but is a leading cause of chronic pelvic pain as well. It can occur in men or women. Chronic pelvic pain from IBS may be worse during intercourse, during a bowel movement or menstruation.
  • Urinary system problems: problems with the urinary system in men or women can cause chronic pelvic pain. These include interstitial cystitis, kidney stones, bladder tumors, and urethral problems. Chronic pelvic pain caused by urinary system problems may be worse during sex, or as the bladder fills.
  • Osteitis pubis: osteitis pubis is a type of chronic pelvic pain caused by swelling of the pubic bone, which is located at the bottom front of the pelvis. It may occur in men or women but is more common in people who are active in sports. Osteitis pubis causes pelvic pain in the pubic area and may be worse when the legs are adducted (squeezed together) or when going up stairs.
  • Pelvic joint instability: pelvic joint instability can occur after childbirth when the pelvic ligaments have been stretched to make room for a baby. It can also occur after the pelvis is broken or damaged, such as from a car accident or a fall. Pelvic instability can lead to chronic pelvic pain, especially if the pelvic muscles and ligaments are weakened.
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  • National Institute of Child Health and Human Development. Pelvic Pain. 4/12/2013.

  • National Pain Foundation. Pelvic Pain: Causes.

By Erica Jacques
Erica Jacques, OT, is a board-certified occupational therapist at a level one trauma center.