Pelvic Pain

Pelvic pain is a common problem in women. The cause is often not
clear. It can have many causes. In some cases, no disease can be found. Pelvic pain
can
be either acute or chronic. Acute means the pain is sudden and severe. Chronic means
the
pain either comes and goes or lasts for months or longer. Pelvic pain that lasts longer
than 6 months and doesn’t improve with treatment is known as chronic pelvic pain.
Pelvic
pain may start in genital or other organs in and around the pelvis. In some cases,
it
may be psychological. This can make pain feel worse or cause pain when no physical
problem is found.

Pelvic pain can have many causes,
such as:

  • Inflammation or irritation of nerves
    caused by injury, fibrosis, pressure, or peritonitis
  • Muscle cramps
  • A pregnancy that happens outside the
    uterus (ectopic pregnancy)
  • Pelvic inflammatory disease (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 (growths on or in the
    uterine wall)
  • Scar tissue between the organs in the
    pelvic cavity
  • Endometrial polyps
  • Cancers of the reproductive tract
  • Other problems in the digestive, urinary, or nervous
    systems
  • Myofascial pain

These 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.

Type of pain

Possible cause

Local pain

May be from an
inflammation

Cramping

May be caused by a
spasm in the intestine, ureter, or appendix

Sudden start of
pain

May be caused by a
short-term lack of blood supply because of a problem with blood
flow

Slowly developing
pain

May be from
inflammation of the appendix or blockage in the intestines

Pain of the entire
abdomen

May be a buildup of
blood, pus, or stool in the bowels

Pain made worse by
movement or during exam

May be from irritation
in the lining of the abdomen

Tests will be done to find the
cause of the pelvic pain. Your healthcare provider may ask you questions about 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, is it sharp or dull?
  • What was happening when the pain
    started?
  • How suddenly did the pain start?

Tell your healthcare provider all
you can about the timing of the pain and other symptoms related to eating, sleeping,
sexual activity, and movement. This can help with a diagnosis.

The healthcare provider will give
you a physical and pelvic exam. You may have tests such as:

  • Blood tests
  • Pregnancy test
  • Urinalysis
  • Culture of cells from the cervix

You may also have tests such as:

  • Ultrasound. This test uses
    high-frequency sound waves to create an image of organs.
  • 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.
  • MRI. A noninvasive procedure that
    produces a 2-D 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. A small amount of radiation
    is 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. It can often
    help find growths, inflamed tissue, ulcers, and bleeding. It is done by putting a
    long, flexible, lighted tube (colonoscope) in the rectum and up into the colon. The
    colonoscope lets the healthcare provider see the lining of the colon, remove tissue
    to test, and treat some problems that are found.
  • Sigmoidoscopy. This test lets the
    healthcare provider examine the inside of a part of the large intestine. It can find
    the causes of diarrhea, abdominal pain, constipation, abnormal growths, and bleeding.
    A short, flexible, lighted tube (sigmoidoscope) is put into the rectum. The scope
    blows air into the intestine to inflate it and make viewing the inside easier.

Treatment may include:

  • Antibiotics
  • Anti-inflammatory medicines
  • Pain medicines
  • Muscle relaxants
  • Relaxation exercises
  • Birth control pills
  • Surgery
  • Physical therapy
  • Trigger point injections
  • Botox
  • Neuromodulators

If a physical cause can’t be found,
your healthcare provider may refer you for counseling. This can help you cope with
chronic pain. In other cases, you may benefit from:

  • Nutrition changes
  • Environmental changes
  • Physical therapy
  • Pain management
  • Pelvic pain is a common problem in
    women. Its cause is often unclear.
  • Pain can be acute or chronic.
  • Treatment will depend on the cause, as
    found by the physical exam and tests.
  • Treatment may include medicines,
    surgery, physical therapy, or pain management.

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells
    you.
  • At the visit, write down the name of a
    new diagnosis and any new medicines, treatments, or tests. Also write down any new
    instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also
    know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that
    visit.
  • Know how you can contact your provider if you have questions.