Causes of Pelvic Pain in Women and Men

What's behind that pain down low in your abdomen

Pelvic pain is often described as a dull ache, pain, or pressure located in the abdomen below the navel. The pain may be constant or it may come and go. It can also include other symptoms, such as abnormal vaginal bleeding and lower back pain.

While pelvic pain is often related to conditions affecting the female reproductive system (such as endometriosis or ectopic pregnancy), many other causes exist that affect both men and women.

This article will explain the various causes of pelvic pain, how they are diagnosed, and how to know when urgent medical care is needed.

causes of pelvic pain in women

Verywell / Alexandra Gordon

Causes

Pelvic pain can be associated with several of the body's systems, including the:

  • Reproductive system (both female and male)
  • Gastrointestinal system
  • Musculoskeletal system
  • Urinary tract system

Female Reproductive System

Many different conditions affecting the female reproductive system can cause pelvic pain, including:

  • Ectopic pregnancy: In an ectopic pregnancy, an embryo implants in the fallopian tube instead of the uterus. This often causes pain and vaginal bleeding. If the fallopian tube ruptures, it can be a life-threatening emergency causing severe pain, a drop in blood pressure, fainting, and shock.
  • Pelvic inflammatory disease: This condition is due to an infection of the uterus, ovaries, fallopian tubes, and vagina. It is typically caused by sexually transmitted infections like gonorrhea or chlamydia. Pelvic pain may worsen during sex. If an abscess (an infected lump) develops, severe pelvic pain and fever may result.
  • Endometriosis: This condition causes tissue that's normally found in the lining of the uterus to grow on the ovaries, fallopian tubes, or intestines. Endometriosis can cause pelvic pain during menstruation and sex, and sometimes during urination or bowel movements.
  • Uterine fibroids: Benign (noncancerous) tumors in the uterus called fibroids can cause heavy and/or long periods. They can also cause pelvic discomfort that's often described as a dull pressure or pain.
  • Mittelschmerz pain: Mittelschmerz is a German word that means "middle pain" because it occurs during the middle of the menstrual cycle. It's also called ovulation pain because it describes the one-sided pelvic pain that can occur when an egg is released from an ovary. If the pain is severe, it may be a sign of endometriosis.
  • Ovarian cyst rupture: A ruptured ovarian cyst may cause no symptoms, but it can be associated with one-sided pelvic pain. This is often described as a sudden and sharp pain that begins after sex or strenuous activity.
  • Ovarian torsion: When the ligaments that hold your ovary in place rotate and twist, this is called ovarian torsion. The ovary's blood supply can be cut off, causing sudden and severe pelvic pain that radiates to the lower back or groin. It may also cause low-grade fever, nausea, and vomiting.

Emergency: Ovarian Torsion

Ovarian torsion is sometimes mistaken for a cyst rupture. Unlike a ruptured cyst, ovarian torsion is an emergency that requires immediate surgery.

Gynecologic Cancers

Pelvic pain can be a symptom of one of the gynecologic cancers, but pain is more likely when cancer has progressed. While symptoms may be similar, the various types do have some key differences, outlined here:

  • Ovarian cancer: Unlike other gynecologic cancers, pelvic pain can be an early sign of ovarian cancer, along with symptoms including bloating, lower back pain, and gastrointestinal changes like constipation.
  • Endometrial cancer: Endometrial cancer is cancer of the lining of the uterus that can cause pelvic pain once the cancer has progressed. This cancer is also associated with abnormal vaginal bleeding, such as bleeding after menopause or spotting between periods.
  • Cervical cancer: Abnormal vaginal bleeding, including bleeding after sex, may be a symptom of cervical cancer, with pelvic pain beginning later on.

Recap

Pelvic pain in women is often connected to the reproductive system. Some causes of pelvic pain are uterine fibroids, endometriosis, a ruptured ovarian cyst, and cancers of the ovary and cervix.

Male Reproductive System

Pelvic pain in men is usually related to the prostate, a small gland that creates seminal fluid (the fluid that contains sperm). Two prostate-related causes of pelvic pain include:

  • Prostatitis: The inflammation in prostatitis causes the prostate to swell. It can also cause swelling in the areas around the prostate, leading to pelvic pain and painful or difficult urination.
  • Prostate cancer: Pelvic pain is uncommon until prostate cancer is advanced. Pain may be due to cancer spreading to the bones.

Gastrointestinal System

Several different conditions that affect the gut, especially the large intestine (colon), may cause lower abdominal pain that can feel as if it is located in the pelvis.

  • Appendicitis: The main symptom of appendicitis is sudden pain near the belly button on the lower right side of the abdomen. Other symptoms include loss of appetite, fever, vomiting, and pain with movement. Appendicitis requires immediate medical attention.
  • Irritable bowel syndrome: This functional gastrointestinal disorder causes cramping and abdominal pain that may be worsened by stress or eating. Pain may be eased by a bowel movement. Other symptoms include bloating, diarrhea, and/or constipation.
  • Diverticulitis: Diverticulitis is a condition in which the wall of the large intestine becomes infected or inflamed, causing pelvic pain.
  • Constipation: Infrequent bowel movements (fewer than two to three per week) can cause abdominal discomfort.

Musculoskeletal System

The pelvis is a complex bony structure that consists of many muscles, ligaments, and tendons. If there is a problem with one or more of these parts, pelvic pain can result. Two examples of musculoskeletal problems that may cause pelvic pain are:

  • Nonrelaxing pelvic floor dysfunction: With this, pelvic muscles don't relax and contract properly, leading to pelvic pain. This condition can also result in problems with sexual function, urinating, and having a bowel movement.
  • Iliac crest pain syndrome: The iliac crest lies along the top curved portion of your ilium (the largest bone in your pelvis). Iliac crest pain syndrome occurs as a result of weak muscles in the back, hip, and abdomen, or from inflamed tendons and ligaments in the area.

Urinary Tract System

The two most likely sources of pelvic pain within the urinary tract system are kidney stones and infection.

  • Kidney stones: Minerals in the urine can build up and form crystals, resulting in kidney stones. If a stone is large enough to get stuck in the urinary tract system, it can cause severe pain plus blood in the urine, nausea, and vomiting.
  • Urinary tract infection: Symptoms of a urinary tract infection (UTI) include pain over the bladder along with urinary frequency, a burning pain with urination, having an urge to urinate, and blood in the urine.

UTIs in Older Adults

In older people, the symptoms of a urinary tract infection may be less obvious, such as:

  • General discomfort
  • Disorientation
  • Fatigue
  • Weakness
  • Incontinence
  • Falling
  • Behavioral changes


When to See a Healthcare Provider

If you experience sudden, severe pelvic pain, seek medical care immediately. Three possible causes are appendicitis, ectopic pregnancy, and ovarian torsion—all of which are life-threatening emergencies that require immediate surgery.

If you experience pain that isn't going away or is getting worse, you should be evaluated by a healthcare provider so you can receive a diagnosis and proper treatment. Many causes of pelvic pain can become serious over time if left untreated.

If you are menstruating, it's important to note that mild cramping and pain associated with your period are normal and don't require medical attention unless you have high levels of pain (a condition called dysmenorrhea).

Recap

Pelvic pain can be caused by almost any system in the body. In men, prostate problems can be responsible for the pain. Men or women can experience pelvic pain due to appendicitis, urinary tract infections, or muscular conditions.



Diagnosis

Because there are so many possible causes of pelvic pain, your healthcare provider may need different types of tests to give you an accurate diagnosis. Here's what you can expect:

Medical History

Your healthcare provider will ask you questions about when the pain occurs, what triggers it, what relieves it, and how long you've been experiencing it. Before you seek a diagnosis, it can be helpful to keep a journal that records these things.

They will also want to know if fibroids, cancer, or other conditions run in your family. You may be asked to provide information about the number of sexual partners you have and if you have ever had a sexually transmitted infection.

Physical Examination

For women, a key part of the physical exam is the pelvic exam. A pelvic exam allows your doctor to check for any abnormalities (for example, tenderness or masses) within your reproductive system.

Your provider will also want to palpate your abdomen and your lower back (where the kidneys are) in case those are the source of the pain.

Tests

Based on the findings from your medical history and pelvic/physical exam, your healthcare provider may want to do more tests to discover the cause of your pelvic pain. If you could be pregnant, that's likely to be one of the first tests your healthcare provider orders.

Other tests that may be performed include:

  • Colonoscopy to check for growths, obstructions, or abnormalities in the bowel
  • Sigmoidoscopy to check the lower part of the colon for causes of pain, bleeding, and changes in bowel habits
  • Urinalysis to check for urinary tract infections and kidney problems
  • Pelvic exam and vaginal swabs to screen for infections (and a pap smear if needed to screen for cervical cancer)

Imaging

Imaging tests may be ordered to look at your pelvic area. 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 ultrasound.

Recap

A healthcare provider will diagnose the reason for your pelvic pain based on your medical history, a physical exam, and possibly imaging tests as well.

Treatment

There are numerous ways to treat pelvic pain depending on what's causing it. For example, urinary tract infections are treated with antibiotics. Surgery is needed to treat ectopic pregnancy, ovarian torsion, or appendicitis.

Surgery is also often the first-line therapy for some cancers and is used to treat severe cases of endometriosis and fibroids.

Summary

Pelvic pain is often caused by conditions that affect the female reproductive system, but not always. Both men and women can experience pelvic pain due to a urinary tract infection, appendicitis, or muscular problems. Diagnosing the source of pelvic pain requires a physical examination and may also require imaging and other types of diagnostic procedures.

A Word From Verywell

If you are experiencing pelvic pain with no known cause, call your healthcare provider. If your pain is sudden or severe, you should go to the emergency room.

Frequently Asked Questions

  • What is the cause of pelvic pain?

    Several different bodily systems can cause pelvic pain. It can be related to reproductive organs, the gastrointestinal system, or the urinary tract. Muscle pain in the pelvic region can also be a culprit. To help determine the cause of your pelvic pain, your doctor will review your symptom history and perform a physical exam before ordering other tests. 

  • When should I be concerned about pelvic pain?

    Pelvic pain that is sudden and severe is concerning and should be seen by a doctor promptly. It could be appendicitis, ectopic pregnancy, or an ovarian torsion—life-threatening conditions that require immediate medical attention. 

    A doctor should also evaluate chronic or persistent pelvic pain not related to menstrual cramps. If it is unclear what the source of the pain is, start with a visit to your primary care doctor. If the pain appears to be gynecological, see your gynecologist. If the pain is related to digestion, see a gastroenterologist. 

  • What causes pelvic pain during pregnancy?

    If you are pregnant and feel a lot of pressure or pain in your pelvis accompanied by low back and abdominal pain, it could be a sign of labor, and you should call your healthcare provider. However, in your second trimester, it could also be round ligament pain, which happens when the ligament that runs from the groin to your uterus is stretched.

  • What treatment options are available for pelvic pain?

    The treatments for pelvic pain depend on the cause. Pain medication and muscle relaxers may be helpful for specific pelvic pain causes, and hormonal therapies can be used in conditions like endometriosis. Physical therapy and pelvic floor exercises can help with muscle strengthening in the pelvis also provide pain relief.

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