Pelvic Pain

What is pelvic pain?

Pelvic pain is a common complaint among women. Its nature and intensity may fluctuate, and its cause is often obscure. 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. According to the American College of Obstetricians and Gynecologists, pelvic pain lasting longer than 6 months and showing 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, which 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 acute or chronic trauma, fibrosis, pressure, or intraperitoneal inflammation

• Muscular contractions or cramps of both smooth and skeletal muscles

• Psychogenic factors, which can cause or aggravate pain

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

• Ectopic pregnancy. A pregnancy that occurs 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.

• Adhesions. Scar tissue between the internal organs in the pelvic cavity.

• Endometrial polyps. Protrusions attached by a small stem in the uterine cavity.

• Cancers of the reproductive tract

This long-term and often unrelenting pain may cause a woman's defenses to break down, resulting in emotional and behavioral changes. This is often termed chronic pelvic pain syndrome.

What are the different types 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 consult your health care provider for a diagnosis.

How is pelvic pain diagnosed?

Diagnostic procedures and tests will be performed in order to determine the cause of the pelvic pain. In addition, your health care provider may ask you questions regarding the pain such as:

• When and where does the pain occur?

• 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 health care provider in determining a diagnosis.

In addition to a complete medical history and physical and pelvic examination, diagnostic procedures for pelvic pain may include:

• 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). A noninvasive diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body to detect 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 health care provider can determine the locations, extent, and size of the endometrial growths.

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

• Colonoscopy. A procedure that allows the doctor to 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 doctor to see the lining of the colon, remove tissue for further examination, and possibly treat some problems that are discovered. 

• Sigmoidoscopy. A diagnostic procedure that allows the doctor to examine the inside of a portion of the large intestine, and 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. 

What is the treatment for pelvic pain?

Specific treatment for pelvic pain will be determined by your health care provider based on:

• Your overall health and medical history

• Extent of condition

• Cause of the condition

• Your tolerance for specific medications, procedures or therapies

• Expectations for the course of the condition

• Your opinion or preference

Treatment may include:

• Antibiotic medications

• Anti-inflammatory and/or pain medications

• Relaxation exercises

• Surgery

• Physical therapy

If a physical cause cannot be found, pelvic pain may be diagnosed as a psychological defense or coping mechanism for some type of trauma. In some cases, psychotherapy is recommended. In other cases, health care providers may recommend a multidisciplinary treatment utilizing a number of different approaches, including nutritional modifications, environmental changes, physical therapy, and pain management.