Pelvic pain can be experienced by both men and women as the result of numerous conditions, including a simple infection. In women, specifically, pelvic pain is often associated with a condition with one of the reproductive organs in the pelvic area (uterus, ovaries, fallopian tubes, cervix, or vagina).
Pelvic pain is a pain in the lowest part of your abdomen and pelvis. It is a common problem among women, but can also occur in men. It may originate in the genital area or other organs in and around the pelvis. The pain is primarily in the lower abdomen and can be steady or come and go. Doctors categorize the pain as either acute (sudden and severe) or chronic (comes and goes or is constant, lasting for six months or longer). Pelvic pain can be sharp and stabbing in a specific spot, or it can be a dull pain over a larger area. It is possible for pelvic pain to be so severe that it interferes with daily activities.
What Causes Pelvic Pain?
Although the nature and intensity of the pain may fluctuate, the cause of pelvic pain is often unclear. There are many possible causes of pelvic pain, which can make it difficult to determine the specific cause or causes. The pain may originate from a single disorder, or it can be the result of multiple medical conditions occurring at the same time. In some cases, no disease is evident.
Some doctors believe psychological factors may be a contributing factor. Depression, chronic stress or a history of sexual or physical abuse, may increase the risk of chronic pelvic pain. Emotional distress can make the pain worse, while living with chronic pain can likewise contribute to emotional distress, often becoming a vicious cycle.
Pelvic pain may originate in the genital area or other organs in and around the pelvis. The pain can arise from the digestive, reproductive, or urinary systems. The problems can include infections or inflammation.
Some pelvic pain, particularly chronic pelvic pain, can arise from muscles and connective tissue (ligaments) in the structures of the pelvic floor. Occasionally, pelvic pain might be caused by irritation of the nerves in the pelvis.
For women, pelvic pain may occur during their period or intercourse. Possible causes of pelvic pain in women can include:
Adhesions that form between internal tissues and organs.
Cancers of the reproductive tract.
Ectopic pregnancy (pregnancy that happens outside the uterus).
Miscarriage or threatened miscarriage.
Ovarian cysts or other ovarian disorders.
Mittelschmerz (pain associated with ovulation).
Pelvic inflammatory disease (PID), an infection of the reproductive organs.
Ruptured fallopian tube.
Scar tissue between the organs in the pelvic cavity.
Uterine fibroids (growths on or in the uterine wall).
Vulvodynia (pain that affects the vulva).
In women, the intensity of pelvic pain may not necessarily correlate with the severity of what is causing the pain. As an example, a woman with a small area of endometriosis may experience intense pain.
For men, pelvic pain could be the result of an infection or inflammation of the prostate.
For both men and women, the pain could be a symptom of an infection, or a problem with the urinary tract, lower intestines, rectum, muscle, or bone. Some examples of other possible causes of pelvic pain for both men and women include:
Contractions or cramps of both smooth and skeletal muscles.
Inflammation or irritation of nerves caused by injury, fibrosis, pressure, or peritonitis.
Interstitial cystitis (also called painful bladder syndrome).
Intestinal disorders or obstruction.
Irritable bowel syndrome.
Kidney infection or kidney stones.
Pelvic congestion syndrome.
Pelvic floor muscle spasms.
Sexually transmitted diseases.
Ulcerative colitis (a type of inflammatory bowel disease).
Urinary tract infection (UTI).
What are the Symptoms of Pelvic Pain?
Often, a patient may indicate the pain is in the entire pelvic area rather than a single spot. Some have pain that is mild and annoying, and others have pain that is so severe they miss work, can’t sleep, and can’t exercise. Common symptoms associated with chronic pelvic pain include:
Bloating or gas.
Blood seen with a bowel movement.
Constipation or diarrhea.
Fever or chills.
Pain in the groin area.
Pain in the hip area.
Painful or difficult urination or bowel movement.
Pressure or heaviness deep within your pelvis.
Severe and steady pain.
Sharp pains or cramping.
Vaginal bleeding, spotting or discharge.
Worsening of menstrual cramps.
Pelvic pain may become more intense after standing or sitting for extended periods but may ease upon lying down. Some examples of the different types of pelvic pain most commonly described by women, and their possible cause or origin include:
Localized pain could be due to inflammation.
Cramping may be caused by a spasm in a soft organ, such as the intestine, ureter, or appendix.
Sudden onset of pain could be the result of a temporary deficiency of blood supply due to an obstruction in the circulation of blood.
Slowly-developing pain could be from an inflammation of the appendix or an intestinal obstruction.
Pain involving the entire abdomen could be from an accumulation of blood, pus, or intestinal contents.
Pain aggravated by movement or during exam may be a result of irritation in the lining of the abdominal cavity.
In some cases, pelvic pain can be a result of nerve damage or a problem with the nervous system. It is essential that an accurate diagnosis of pelvic pain is made, since some of the causes of pelvic pain can be reversible.
How is Pelvic Pain Diagnosed?
In most cases, the initial diagnosis of pelvic pain is made after a pelvic examination, lab testing, and ultrasounds or CT-scans of the abdomen and pelvis. Identifying the underlying cause of the pain can be a long process. Often it involves the process of elimination because of the many different disorders that can cause pelvic pain. In some cases, a clear explanation may never be found.
The doctor will begin by asking about the patient’s symptoms and past medical problems. The doctor will want to understand the timing of the pain and the presence of other symptoms related to activities such as eating, sleeping, sexual activity, and movement.
In addition to a complete medical history, the doctor will perform a physical exam. The doctor may perform other tests to determine the cause of the pain.
Tests for diagnosing pelvic pain include:
Blood and urine tests.
Colonoscopy. A procedure to examine the entire colon which also allows the doctor to remove tissue for testing.
Sigmoidoscopy. A procedure to examine the lower portion of the large intestine. A short, flexible, lighted tube (sigmoidoscope) is inserted into the intestine through the rectum.
Culture of cells from the cervix.
Hysteroscopy. A procedure to examine the uterus.
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 to see into the pelvic area.
Pelvic exam. This can reveal signs of infection, abnormal growths or tense pelvic floor muscles.
Stool test to check for microscopic traces of blood.
Vaginal or penile cultures to check for sexually transmitted diseases.
Imaging tests to help detect abnormal structures or growths include:
X-ray. Electromagnetic energy used to produce images of the abdominal cavity and pelvic area.
Bone density screening. A special type of X-ray for determining bone strength.
Computed tomography (CT or CT scan). A test using X-rays and a computer to make detailed images of the bones, muscles, and organs, to look for abnormalities that may not show up on an ordinary X-ray.
Magnetic resonance imaging (MRI). A non-invasive procedure that produces a two-dimensional view of an internal organ or structure.
Ultrasound. A test using high-frequency sound waves to create an image of internal organs.
How is Pelvic Pain Treated?
The treatment of pelvic pain will depend on the cause, the intensity of the pain, and how often the pain occurs. Treatment can include medications, physical therapy, biofeedback, and nerve blocks. If the pain results from a problem with one of the pelvic organs, the treatment may involve surgery or other procedures.
The goal of treatment is to reduce symptoms and improve quality of life. If a specific cause is identified, treatment will focus on that cause. However, if a cause can’t be determined, treatment will focus on managing the pain and symptoms. For many women, the optimal approach involves a combination of treatments.
Common medications used to treat pelvic pain include:
Over-the-counter pain relievers. Remedies, such as aspirin, ibuprofen, or acetaminophen, may provide relief. Sometimes a prescription pain reliever is necessary. However, pain medication alone seldom resolves chronic pain.
Hormone treatments. Some women find that the days when they have pelvic pain may coincide with a particular phase of their menstrual cycle. If this is the cause of the pain, birth control pills or other hormonal medications may help.
Antibiotics. If an infection is the source of the pain, antibiotics may be beneficial.
Antidepressants. Some types of antidepressants are helpful for chronic pain. Tricyclic antidepressants, such as amitriptyline, nortriptyline (Pamelor) and others, seem to have pain-relieving as well as antidepressant effects. They may help improve chronic pelvic pain even in women who don’t have depression.
Often, specific therapies or procedures are a part of the treatment plan for chronic pelvic pain. These may include:
Nerve block. The injection or application of anesthetics or other medications to block nerve pathways along the spinal cord to prevent pain from reaching the brain.
Trigger point injection. The injection of a numbing medicine injected into specific painful areas (trigger points). The medication, usually a long-acting local anesthetic, can block pain and ease discomfort.
Transcutaneous electrical nerve stimulation (TENS). A procedure to deliver electrical impulses to nearby nerve pathways.
Spinal cord stimulation (neurostimulation). A type of permanent nerve block. A device is implanted in the body to deliver an electrical current to block nerve pathways so that the pain signal does not reach the brain.
Physical therapy. Stretching exercises, massage, and other relaxation techniques may improve chronic pelvic pain.
It may be necessary to try a combination of treatment approaches before finding what works best. If appropriate, a doctor may recommend a pain rehabilitation program.
Sometimes it is necessary to correct an underlying problem that is causing chronic pelvic pain. In these cases, a surgical procedure may be necessary, such as:
Laparoscopic surgery. In cases of endometriosis, doctors can remove the adhesions or endometrial tissue. After inserting a slender viewing instrument (laparoscope) through a small incision near the navel, instruments are then inserted to remove endometrial tissue through one or more additional small incisions.
Hysterectomy. In rare, complicated cases, it may be necessary to remove the uterus (hysterectomy), fallopian tubes (salpingectomy), or ovaries (oophorectomy).
Chronic pain can have a major impact on your daily life by causing trouble sleeping, exercising, or performing physical tasks. Chronic pain can further cause anxiety and stress, which can also worsen the pain. Relaxation techniques can help release tension, reduce pain, calm emotions, and induce sleep. Many techniques can be learned on your own, such as meditation and deep breathing.
Biofeedback. Physical therapists may use this technique to help identify areas of tight muscles so that the patient can learn to relax those areas.
Psychotherapy. If your pain is intertwined with depression, abuse, a personality disorder, or family problems, it may be helpful to talk with a psychologist or psychiatrist. Regardless of the underlying cause of your pain, psychotherapy can help you develop strategies for coping with the pain.
Acupuncture.There is limited evidence suggesting that inserting tiny needles into the skin at precise points may relieve pain by releasing endorphins, the body’s natural painkillers. However, it is only one of many theories about how acupuncture works.
If a physical cause cannot be found, healthcare providers often recommend using different approaches to treat the pain. These techniques include:
Nutritional changes or modifications.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating pelvic pain. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.