Pelvic Pain

The pelvis is located in the abdominal area, below your belly button and between your hips. Pelvic pain can occur in women and men, and it can originate in the urinary, reproductive, gastrointestinal, and musculoskeletal systems. 

Pelvic pain intensity varies based on the cause and can be sudden, constant, or come and go. 

This article discusses pelvic pain, causes, tests, treatment, and when to see your healthcare provider. 

Symptoms of Pelvic Pain

Characteristics of pelvic pain vary based on the underlying cause. It can be acute (sudden), chronic (lasting more than six months), persistent, or intermittent (come and go). 

Pelvic pain may be sharp, dull, crampy, or throbbing and can radiate to the lower back, groin, or upper thighs. Sometimes the pain occurs during certain activities, such as urinating (peeing), having sexual intercourse, or exercising.

Causes of Pelvic Pain

Pelvic pain develops from inflammation, injury, or pressure from organs or structures in different body systems. Noting symptoms that accompany it can help identify the source.

Appendicitis 

Appendicitis occurs when the appendix, a small tube attached to the large intestine, becomes inflamed. This is an emergency and typically requires surgery.

The pain starts in the mid-abdominal region but usually moves to the lower-right abdomen or pelvis. It usually gets worse with time and movement. Other symptoms include:

• Fever 
• Upset stomach
• Constipation
• Abdominal swelling

Ovarian Torsion

Ovarian torsion is rare, but it is an emergency. It occurs when an ovary rotates around the ligaments holding it in place. This restricts blood flow and causes severe pain, nausea, and vomiting.

Ruptured Ovarian Cyst

Ovarian cysts are sacs that develop around the ovary. They often resolve on their own but become an emergency when they rupture, causing severe sudden pain. Before they rupture, ovarian cysts may cause pressure on one side.

Ectopic Pregnancy

Ectopic pregnancies occur when a fertilized egg implants outside of the uterus, typically in the fallopian tubes. This becomes an emergency when the fallopian tube ruptures and causes:

• Sudden, severe pelvic or abdominal pain 
• Shoulder pain
• Weakness, dizziness, fainting

Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is an infection in the female reproductive system typically caused by sexually transmitted infections (STIs). In addition to pelvic pain, symptoms include:

• Foul-smelling vaginal discharge 
• Urinary urgency or discomfort
• Bleeding between periods
• Pain during sexual intercourse

PID becomes an emergency when it causes severe pain, fainting, vomiting, and a fever over 101 degrees Fahrenheit. 

Urinary System 

Infections, inflammation, and stones in the urinary system can cause pelvic pain. For example, kidney stones cause cramping or sharp pains that come and go in the lower back and can radiate to the pelvis. 

Other symptoms include:

• Urinary urgency, pain, burning, or loss of bladder control 
• Cloudy, bloody, or foul-smelling urine
• Cystitis (bladder inflammation) that worsens with menstruation

Female Reproductive System

In addition to the previously mentioned female reproductive system problems, other concerns include:

• Miscarriage
• Vaginal fibroids
• Menstrual cramps 
• Endometriosis 

Male Reproductive System 

Trauma, infection, or inflammation in male reproductive organs such as the testicles or prostate can cause acute or chronic pelvic pain.

Accompanying symptoms may include:

• Problems urinating
• Urinary urgency or pain
• Stomach upset
• Fatigue
• Pain during ejaculation
• Blood in semen
• Pain or swelling in one or both testicles 

Sexually Transmitted Infections (STIs)

With STIs such as gonorrhea and chlamydia, the following symptoms may accompany pelvic pain:

• Unusual vaginal or penile discharge 
• Vaginal bleeding outside of period or after sexual intercourse
• Burning or itching around the opening of the penis
• Rectal bleeding
• Painful urination 
• Blood in the urine

Gastrointestinal 

Gastrointestinal disorders include irritable bowel syndrome (IBS), diverticulitis, constipation, and more. The pain is often described as crampy and accompanied by bloating, diarrhea, or constipation. IBS may worsen with a woman’s period or go away after a bowel movement.

An inguinal hernia is a bulge from the intestine into the groin. It is more common in men and can cause pain in the testicles. Symptoms may worsen with lifting, coughing, or bending.

Musculoskeletal 

Musculoskeletal problems include a broken pelvis, inflammation, nerve entrapment, and fibromyalgia. Pain characteristics range from muscle spasms to burning nerve pain.

What Medications Can Cause Pelvic Pain?

Medications that can affect organs within the pelvic or abdominal area include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Motrin and Advil (ibuprofen) can irritate the stomach lining.
• Anticholinergics such as Bentyl (dicyclomine) may cause constipation.
• Opioids such as Oxaydo (oxycodone) may cause opioid-induced constipation.
• Femiron (iron supplement) can cause constipation.
• Antibiotics such as Amoxil (amoxicillin) can cause diarrhea.
• Antibiotics such as Cipro (ciprofloxacin) and Bactrim (sulfa) can cause kidney stones.

How to Treat Pelvic Pain

Treating pelvic pain depends on the cause and may include:

• Surgery: Appendicitis, ovarian torsion, broken bones, and ruptured ovarian cysts require surgery. Some ectopic pregnancies are treated with medications, but they require emergency surgery when fallopian tubes rupture.
• Medications: Medications might include antibiotics, pain relievers, muscle relaxers, laxatives, hormones, or steroids. 
• Nerve blocks: Nerve blocks are epidural injections used to prevent or manage pain. 

Complications and Risk Factors Associated With Pelvic Pain 

Ectopic pregnancy, ovarian torsion, and ruptured appendix are emergencies and typically require surgery. 

Pelvic inflammatory disease can increase the risk of ectopic pregnancies, chronic pelvic pain, and infertility. Early diagnosis and treatment can help decrease those risks. 

When ovarian cysts rupture, an infection that leads to sepsis can develop.

Are There Tests to Diagnose the Cause of Pelvic Pain?

Exams

In addition to a history and physical, your healthcare provider may also perform the following:

• Pelvic exam 
• Pap smear
• STI screening 

Labwork

Diagnostic lab testing such as urine, blood, and stool tests check for pregnancy, infection, inflammation, and more.

Imaging

Imaging tests may include:

• X-rays 
• Ultrasound
• Computed tomography (CT scan)
• Magnetic resonance imaging (MRI)
• Bone density

Advanced Testing 

A colonoscopy or laparoscopic surgery may be needed to visualize your internal organs if imaging results are not clear.

When to See a Healthcare Provider 

See a healthcare provider when pelvic pain does not quickly resolve on its own or if you have any of the following symptoms:

• Abnormal vaginal or penile discharge
• Blood in semen
• Bulging in the groin area
• Severe constipation or rectal bleeding
• Stomach upset
• Testicular pain or swelling or painful ejaculation
• Urinary bleeding, pain, or problems
• Vaginal bleeding after sex, between periods, or after menopause
• Worsening or disruptive pain
• Worsening pain during or after sex
  
• Worsening pain with period
  

Summary 

Characteristics of pelvic pain vary based on the cause. Severe, persistent pelvic pain can indicate an emergency such as appendicitis, ovarian torsion, ruptured ovarian cysts, or ectopic pregnancy. Problems in the organs or structures in the reproductive, urinary, gastrointestinal, and musculoskeletal systems cause pelvic pain. The cause of pelvic pain determines treatment.

A Word From Verywell 

Sudden, severe pain can be unbearable and scary. It's essential to seek immediate medical help by calling 911 when this happens. Early diagnosis and intervention help decrease risks such as sepsis or infertility. 

Other types of pelvic pain can be extremely uncomfortable and interrupt your daily life. It may feel awkward to talk with your healthcare provider about topics such as sex or bowel movements. Rest assured, they are used to this type of conversation and want to know your symptoms so they can help you.