Causes of Pelvic Pain and Treatment Options

What women need to know about pain in the pelvis

Pelvic Exam
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Pelvic pain is a symptom that affects many women and can be caused by a wide variety of conditions and diseases, from endometriosis or fibroids to more serious conditions, like an ectopic pregnancy or cancer. Women typically describe it as a dull ache or pressure that may or may not include sharp pains located anywhere in the abdomen below the navel. The pain may be intermittent or constant and can be accompanied by other symptoms, such as abnormal vaginal bleeding, lower back pain, and vaginal discharge.

Causes

While it may seem obvious that pelvic pain in women can arise from reproductive organs, like your uterus or ovaries, bear in mind that it can also stem from a problem within the gastrointestinal, musculoskeletal, or urinary tract systems.

Breaking the causes of pelvic pain down by system is perhaps the best way to get a grasp on why you are experiencing pain.

Reproductive System

Your reproductive system is comprised of the following internal organs:

  • Uterus (womb), which carries an embryo, allowing it to develop into a fetus
  • Ovaries: Every month, an egg is released from an ovary.
  • Fallopian tubes, where fertilization of an egg and sperm occurs
  • Vagina, which connects to your uterus via the cervix

Inflammation, infection, or abnormal tissue or tumor growth within any of these organs may cause pelvic pain, amongst other symptoms.

Ectopic Pregnancy

Perhaps one of the most important diagnoses to exclude in a woman with sudden pelvic pain is an ectopic pregnancy, where an embryo attaches to the fallopian tube instead of the uterus.

In addition to pelvic pain, a woman with an ectopic pregnancy often experiences vaginal bleeding. That said, some women have no symptoms until the fallopian tube ruptures, causing severe pain and a sudden drop in blood pressure from blood loss, which can lead to fainting and shock.

Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is an infection that affects the organs of a woman's reproductive system including her uterus, ovaries, fallopian tubes, and vagina. The majority of cases are caused by a sexually transmitted infection, like gonorrhea or chlamydia.

The hallmark symptom of PID is pelvic pain, which may worsen during sex. Other potential symptoms include abnormal vaginal discharge, spotting between periods, or bleeding after sex. A small percentage of women with PID develop a pelvic abscess (a collection of pus) within the ovaries or fallopian tubes. This usually causes severe pelvic pain and fever.

Endometriosis

Endometriosis is a condition where the tissue that normally grows within your uterus begins to grow outside it, like on the ovaries, fallopian tubes, and your intestines. Pelvic pain is a common symptom of endometriosis, especially during menstruation and sex. The pain can sometimes be felt with a bowel movement or while urinating. Besides pelvic pain, women with endometriosis may experience difficulty getting pregnant.

Uterine Fibroids

Uterine fibroids are benign pelvic tumors that most commonly cause heavy and/or longer than normal periods. Fibroids may also cause pelvic discomfort, often described as a dull pressure or pain.

Ovarian Cyst Rupture

Ovarian cyst rupture is common in women in their reproductive years. It may cause no symptoms or it may be associated with one-side pelvic pain, often described as a sudden and sharp pain that begins after sex or strenuous physical activity.

Mittelschmerz Pain

There is also a type of pain called mittelschmerz pain, which refers to the mild, one-sided pelvic pain felt when an egg is released from an ovary each month. This symptom is not worrisome, although if the pain is severe, it may be a sign of endometriosis.

Ovarian Torsion

Ovarian torsion occurs when the ligaments that hold your ovary in place rotate and twist, cutting off the ovary's blood supply. The cardinal symptom is sudden and severe pelvic pain that may be sharp, dull, or crampy. Sometimes the pain radiates to the lower back or groin, and some women develop a low-grade fever, nausea, and vomiting.

It's important for a doctor to distinguish ovarian cyst rupture from torsion, as ovarian torsion is an emergency that requires surgery right away.

Gynecologic Cancer

Pelvic pain can be a symptom of most types of gynecologic cancer, though it usually only manifests when the cancer has progressed. Some researchers believe that ovarian cancer may be an exception, however, and that pelvic pain may be an early sign of the disease. Unfortunately, since there is no adequate ovarian cancer screening tool and pelvic pain is common in many conditions, there is often be a delay in diagnosis.

Keep in mind, however, that pelvic pain, although common, is just one of a handful of possible early ovarian cancer symptoms. Other potential symptoms include bloating, lower back pain, and gastrointestinal changes like constipation.

Another gynecologic cancer, endometrial cancer is also associated with symptoms other than pelvic pain. In fact, according to the American Cancer Society, approximately 90 percent of women diagnosed with endometrial cancer report abnormal vaginal bleeding, such as bleeding after menopause or spotting between periods.

Likewise, abnormal vaginal bleeding, including bleeding after sex, may be a symptom of cervical cancer.

Gastrointestinal System

Several different conditions that affect the gut, especially the large intestines (colon), may cause lower abdominal pain that can feel as if it is located in the pelvis. Appendicitis and irritable bowel syndrome are two examples.

Appendicitis

Appendicitis can produce sudden pain that begins near the belly button and moves to the lower right part of the abdomen (which is why it may be mistaken for pelvic pain). Other potential symptoms include a loss of appetite, fever, vomiting, and pain with movement, like walking or rolling in bed. Like an ectopic pregnancy or ovarian torsion, appendicitis is serious and requires immediate medical attention.

Irritable Bowel Syndrome

Irritable bowel syndrome causes crampy abdominal pain that may be worsened by stress or eating. For many people, the pain is eased with a bowel movement. Besides pain, other symptoms of irritable bowel syndrome include bloating, diarrhea, and/or constipation.

Musculoskeletal System

The pelvis is a complex bony structure that consists of many muscles, ligaments, and tendons. With so many elements comes the potential for several musculoskeletal problems that may cause pelvic pain. Here are two examples:

Nonrelaxing Pelvic Floor Dysfunction

Your pelvis consists of bone, muscles, and tissues that work together to ensure normal sexual function, urination, and defecation. When the pelvic muscles do not relax and contract appropriately, pelvic pain may arise, along with problems with sexual function, urinating, and having a bowel movement.

Iliac Crest Pain Syndrome

Your iliac crest is the top curved portion of your ilium, which is the largest bone in your pelvis. Iliac crest pain syndrome may occur as a result of weak muscles in the back, hip, and abdomen, or from inflamed iliolumbar ligaments, which connect the spine to the pelvis. Iliotibial band syndrome and piriformis syndrome may also cause iliac crest pain, often described as an aching pain along the hips.

Urinary Tract System

The two most likely sources of pelvic pain within the urinary tract system are an infection and a stone.

Urinary Tract Infection

Besides pelvic pain, especially suprapubic pain (located over the bladder), other symptoms of a urinary tract infection include urinary frequency, a burning pain with urination, having an urge to urinate, and blood in the urine.

Keep in mind that in older women, the symptoms of a urinary tract infection may be subtler, such as malaise and urinary incontinence (losing urine involuntarily).

Kidney Stones

Kidney stones develop when substances in the urine, like calcium, oxalate, cystine, or uric acid, build up and form crystals. A stone can cause pain if it becomes large and gets stuck in the urinary tract system.

The pain of a kidney stone comes in waves that last around a half an hour to an hour. The pain is often severe, and while it is felt in the lower back or pelvis, the pain can radiate to the groin area. Besides pain, the majority of people with kidney stones experience blood in their urine, and some people have nausea and vomiting.

When to See a Doctor

If you experience sudden, severe pelvic pain, especially if it is on one side or if you suspect or know you are pregnant, you need to seek medical treatment immediately. This is a dangerous symptom of an ectopic pregnancy. Ectopic pregnancies are not common, but they can be life-threatening if untreated. Ovarian torsion and appendicitis, as well, cause sudden pelvic or abdominal pain and require emergency surgery.

Seek emergency care for sudden, severe pelvic pain, especially if it is one-sided or you may be pregnant.

Moreover, women who experience persistent or long-term pelvic pain should be evaluated by a physician. It is important to note that mild cramping and pain associated with menstruation is normal and does not require medical attention unless it is very painful (a condition called dysmenorrhea).

Diagnosis

To help your doctor accurately diagnose the cause of your pelvic pain, before your appointment, try to record information like when the pain occurs, what you are doing when it strikes, and what helps alleviate it.

In the end, creating a symptom/pain journal is an excellent method of tracking your pain and can make the first step of the diagnostic process (your medical history) that much more efficient.

Medical History

When you do see a doctor about your pelvic pain, be prepared to answer questions about when the pain occurs, what triggers it, what relieves it, and how long you've been experiencing it. In addition, during your medical history, your doctor may ask you questions about your family, like whether you have a family history of fibroids or cancer. Your doctor will also take a sexual history, inquiring about the number of sexual partners you have and if you have ever had a sexually transmitted infection.

Physical Examination

When evaluating pelvic pain, a key part of the physical exam is the pelvic exam, whereby your doctor will check for any abnormalities (for example, tenderness or masses) within the vagina, cervix, ovaries, and uterus. Due to the fact that the "why" behind your pelvic pain may be due to other organs besides those within your reproductive system, your doctor will also likely perform an abdominal and lower back exam to evaluate for an intestinal or kidney source of your pain.

What to Expect From a Pelvic Exam at Your OB/GYN

Tests

Based on the findings from your medical history and pelvic/physical exam, your doctor may want to do more tests to discover the cause of your pelvic pain. The first big test your doctor will consider is a pregnancy test.

Your doctor may also perform a Pap smear during your pelvic exam (in order to screen for cervical cancer) and take vaginal swabs (to check for infection). She may also check a urine test for the presence of blood and/or infection.

Imaging

Depending on the suspected cause of your pelvic pain, an imaging test may be ordered. An ultrasound is often the first imaging test used to evaluate pelvic pain, but other tests may include a computed tomography (CT) scan of the abdomen and pelvis or a pelvic laparoscopy.

Treatment

There are numerous therapies for pelvic pain, and the precise treatment needed depends on the underlying cause. For example, pelvic inflammatory disease, one of the more common causes of pelvic pain, is treated with antibiotics, while surgery is needed to treat emergent causes like ectopic pregnancy, ovarian torsion, or appendicitis. Surgery is also often the first-line therapy for gynecologic cancer, like uterine or cervical cancer, and is used to treat severe cases of endometriosis and fibroids.

A Word From Verywell

Experiencing pelvic pain is physically and emotionally distressing, and with all the potential causes, it's no wonder you may feel overwhelmed. Do what you can to provide your doctor with as much information about your pain as possible and leave honing in on a diagnosis to her.

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