Causes of Pelvic Pain in Women and Men

What's behind that pain down low in your abdomen

Pelvic pain is a symptom that's most often associated with women's health, from endometriosis or fibroids to more serious conditions, like an ectopic pregnancy or cancer. Many other causes exist, though—including appendicitis and kidney stones—and men can experience these just the same as women. Other causes of pelvic pain are exclusive to men.

Pelvic pain is often described 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 or discharge and lower back pain.

causes of pelvic pain in women

Verywell / Alexandra Gordon

Causes

Multiple systems can lead to pelvic pain, 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: An embryo implants in the fallopian tube instead of the uterus, often causing vaginal bleeding. Fallopian tube rupture is a life-threatening emergency that can cause severe pain, a drop in blood pressure, fainting, and shock.
  • Pelvic inflammatory disease: This condition is an infection of the uterus, ovaries, fallopian tubes, and vagina, typically caused by sexually transmitted infections like gonorrhea or chlamydia. Pelvic pain may worsen during sex. Abscesses may develop, causing severe pelvic pain and fever.
  • Endometriosis: Tissue that's normally found in the lining of the uterus grows on the ovaries, fallopian tubes, or intestines, causing pelvic pain during menstruation and sex, and sometimes during urination or bowel movements.
  • Uterine fibroids: Benign pelvic tumors in the uterus can cause heavy and/or long periods and pelvic discomfort that's often described as a dull pressure or pain.
  • Mittelschmerz pain: Mild, one-sided pelvic pain 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 cyst may cause no symptoms or be associated with one-sided pelvic pain, often described as a sudden and sharp pain that begins after sex or strenuous activity.
  • Ovarian torsion: Ligaments that hold your ovary in place rotate and twist, cutting off the ovary's blood supply and causing sudden and severe pelvic pain that may be sharp, dull, or crampy and 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, but it's a critical distinction as ovarian torsion is an emergency that requires immediate surgery.

Gynocologic Cancers

Pelvic pain can be a symptom of most types of gynecologic cancer, though it usually only manifests when cancer has progressed. While symptoms may be similar, the various forms do have some key differences.

  • 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: Pelvic pain may come on later. 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.

Male Reproductive System

Reproductive-system-related causes of pelvic pain in men mainly come from the prostate, which is a small gland that creates seminal fluid.

  • Prostatitis: Inflammation causes swelling of the prostate and sometimes surrounding areas, leading to pelvic pain and painful or difficult urination.
  • Prostate cancer: Pelvic pain is uncommon until the cancer is advanced. Earlier 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: Inflammation in the appendix produces sudden pain near the belly button that moves to the lower right part of the abdomen (which is why it may be mistaken for pelvic pain). 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 crampy 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: Infection or inflammation that develops in the wall of the large intestine.
  • Constipation: Infrequent bowel movements (less than two to three times per week) can cause abdominal discomfort.

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: Pelvic muscles don't relax and contract appropriately, leading to pelvic pain plus problems with sexual function, urinating, and having a bowel movement.
  • Iliac crest pain syndrome: Pain along the top curved portion of your ilium (the largest bone in your pelvis) may occur 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 build up and form crystals. 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 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 persistent or long-term pelvic pain, 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 if left untreated.

For those who menstruate, 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).

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

Diagnosis

To help your healthcare provider accurately diagnose the cause of your pelvic pain, 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 healthcare provider 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 healthcare provider may ask you questions about your family, like whether you have a family history of fibroids or cancer.

Your healthcare provider 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 healthcare provider will check for any abnormalities (for example, tenderness or masses) within your reproductive system.

Due to the fact that pelvic pain may be related to other organs besides the reproductive system, your healthcare provider will also likely perform an abdominal and lower back exam to evaluate for an intestinal or kidney source of your 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

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 ultrasound.

Treatment

There are numerous therapies for pelvic pain, and the precise treatment needed depends on the underlying cause. For example, urinary tract infections are 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 some cancers and is used to treat severe cases of endometriosis and fibroids.

Frequently Asked Questions

What causes pelvic pain during pregnancy?

If you are pregnant and feel a lot of pressure or pain in your pelvis that is accompanied by low back and abdominal pain, it could be a sign of labor, and you should call your healthcare provider. However, if you are 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 certain pelvic pain causes, and hormonal therapies can be used conditions like endometriosis. Physical therapy and pelvic floor exercises can help with muscle strengthening in the pelvis and pain relief.

A Word From Verywell

Experiencing pelvic pain is physically and emotionally distressing, and with all the potential causes, you may worry that it's something serious. See your healthcare provider, provide them with as much information about your pain as possible, and expect them to run a battery of tests to figure out what's causing it. And remember that sudden, severe pelvic pain warrants a trip to the emergency room.

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