What is pelvic pain?

Pelvic pain is a common problem among women. Its nature and intensity may fluctuate, and its cause is often unclear. In some cases, no disease is evident. Pelvic pain can be categorized as either acute, meaning the pain is sudden and severe, or chronic, meaning the pain either comes and goes or is constant, lasting for a period of months or longer. Pelvic pain that lasts longer than 6 months and shows no improvement with treatment is known as chronic pelvic pain. Pelvic pain may originate in genital or other organs in and around the pelvis, or it may be psychological. This can make pain feel worse or actually cause a sensation of pain, when no physical problem is present.

What causes pelvic pain?

Pelvic pain may have multiple causes, including:

• Inflammation or direct irritation of nerves caused by injury, fibrosis, pressure, or intraperitoneal inflammation

• Contractions or cramps of both smooth and skeletal muscles

• Some of the more common sources of acute pelvic pain, or pain that happens very suddenly, may include:

  • Ectopic pregnancy (a pregnancy that happens outside the uterus)

  • Pelvic inflammatory disease (also called PID, an infection of the reproductive organs)

  • Twisted or ruptured ovarian cyst

  • Miscarriage or threatened miscarriage

  • Urinary tract infection

  • Appendicitis

  • Ruptured fallopian tube

Some of the conditions that can lead to chronic pelvic pain may include:

• Menstrual cramps

• Endometriosis

• Uterine fibroids (abnormal growths on or in the uterine wall)

• Scar tissue between the internal organs in the pelvic cavity

• Endometrial polyps

• Cancers of the reproductive tract

Other causes may be related to problems in the digestive, urinary, or nervous systems.

What are the symptoms of pelvic pain?

The following are examples of the different types of pelvic pain most commonly described by women, and their possible cause or origin. Always talk with your healthcare provider for a diagnosis.

How is pelvic pain diagnosed?

Tests will be done to determine the cause of the pelvic pain. In addition, your healthcare provider may ask you questions regarding the pain such as:

• When and where does the pain happen?

• How long does the pain last?

• Is the pain related to your menstrual cycle, urination, and/or sexual activity?

• What does the pain feel like (for example, sharp or dull)?

• Under what circumstances did the pain begin?

• How suddenly did the pain begin?

Additional information about the timing of the pain and the presence of other symptoms related to activities such as eating, sleeping, sexual activity, and movement can also help your healthcare provider in determining a diagnosis.

In addition to a complete medical history and physical and pelvic exam, you may have other tests including:

• Blood tests

• Pregnancy test

• Urinalysis

• Culture of cells from the cervix

• Ultrasound. A diagnostic imaging technique that uses high-frequency sound waves to create an image of the internal organs.

• Computed tomography (CT or CT scan). This is an imaging test that uses X-rays and a computer to make detailed images of the body. A CT scan shows details of the bones, muscles, fat, and organs, and any abnormalities that may not show up on an ordinary X-ray.

• Magnetic resonance imaging (MRI). A noninvasive procedure that produces a two-dimensional view of an internal organ or structure.

• Laparoscopy. A minor surgical procedure in which a laparoscope, a thin tube with a lens and a light, is inserted into an incision in the abdominal wall. Using the laparoscope to see into the pelvic area, the healthcare provider can determine the locations, extent, and size of any endometrial growths.

• X-ray. Electromagnetic energy used to produce images of bones and internal organs onto film.

• Colonoscopy. In this test, the healthcare provider can view the entire length of the large intestine, and can often help identify abnormal growths, inflamed tissue, ulcers, and bleeding. It involves inserting a colonoscope, a long, flexible, lighted tube, in through the rectum up into the colon. The colonoscope allows the healthcare provider to see the lining of the colon, remove tissue for further exam, and possibly treat some problems that are discovered.

• Sigmoidoscopy. A diagnostic procedure that allows the healthcare provider to examine the inside of a portion of the large intestine. It is helpful in identifying the causes of diarrhea, abdominal pain, constipation, abnormal growths, and bleeding. A short, flexible, lighted tube, called a sigmoidoscope, is inserted into the intestine through the rectum. The scope blows air into the intestine to inflate it and make viewing the inside easier.

How is pelvic pain treated?

Specific treatment for pelvic pain will depend on the cause of the pain and will be discussed with you by your healthcare provider based on:

• Your overall health and medical history

• Extent of condition

• Cause of the condition

• Your tolerance for specific medicines, procedures or therapies

• Expectations for the course of the condition

• Your opinion or preference

Treatment may include:

• Antibiotic medicines

• Anti-inflammatory and/or pain medicines

• Relaxation exercises

• Oral contraceptives

• Surgery

• Physical therapy

If a physical cause can’t be found, your healthcare provider may refer you for counseling to help you better cope with chronic pain. In other cases, healthcare providers may recommend a multidisciplinary treatment using a number of different approaches, including nutritional modifications, environmental changes, physical therapy, and pain management.

Key points about pelvic pain

• Pelvic pain is a common problem among women. Its nature and intensity may fluctuate, and its cause is often unclear.

• Pain can be acute or chronic.

• Specific treatment will depend on the cause as determined by the physical exam and tests.

• Treatment may include medicines, surgery, physical therapy and pain management techniques.