What Is Pelvic Pain?
Pelvic pain (pain below the belly button in the anterior lower abdomen including the sex organs) may develop from many diseases and conditions. For example, pelvic pain may come from normal menstruation, appendicitis, bladder problems; and may be associated with both benign and emergency medical conditions. For most people, pelvic pain should be investigated by a medical professional. The following slides will present some of the causes of pelvic pain.
Inflammation or infection of the appendix (appendicitis) often produces lower right-sided pelvic or abdominal pain that may occur along with nausea, vomiting, and fever. An infected appendix needs to be removed by a surgeon because it may perforate (burst) and infect the peritoneum and cause life-threatening peritonitis.
Irritable Bowel Syndrome (IBS)
Symptoms of painful cramps in the pelvic and abdominal area, bloating, constipation or diarrhea that may occur off and on over time is often caused by irritable bowel syndrome (IBS). IBS is a chronic functional disease with recurrent symptoms. Changes in diet, stress management, and medications are used to treat the symptoms of IBS.
Painful Ovulation (Mittelschmerz)
Short-term (hours) pelvic pain that occurs during ovulation (release of the egg from the ovary) is termed mittelschmerz, a German word meaning "middle pain." This pain occurs just prior to, and during ovulation as the membrane that covers the ovary stretches to release the egg. The blood and fluid that are released during ovulation also may cause discomfort or pain. The pain varies from woman to woman and may last minutes to hours. The pain eventually resolves without medical treatment and usually does not require emergency medical intervention.
Premenstrual Syndrome (PMS)
In contrast to painful ovulation described previously, premenstrual syndrome (PMS) usually involves longer term (days before menstruation occurs) pelvic pain and discomfort outside the pelvic area such as low back pain, headaches, and tender breasts. Medications, along with lifestyle changes (diet, exercise, stress management) may often reduce PMS symptoms. The slide shows a chart that illustrates the various hormones that increase and decrease during a woman's normal monthly menstrual cycle.
Primary menstrual cramps is pelvic pain that occurs when the uterus contracts to remove the blood and endometrial lining that accumulates monthly when an embryo is not implanted in the uterus. The pains may last about 1 to 7 days during a female's menstrual cycle. Medication, home remedies (OTC medication, heating pads, etc.), lifestyle changes (for example, regular exercise, sufficient sleep), may reduce these symptoms. Secondary menstrual cramps (secondary dysmenorrhea) are caused by other conditions or diseases, not regular menstruation (for example, endometriosis, fibroids, ovarian cysts, pelvic inflammatory disease).
An ectopic pregnancy is growth of an embryo outside of the uterus; it can cause sharp pelvic pain, usually on one side of the body, and may be accompanied by vaginal bleeding, nausea, and dizziness. Ectopic pregnancy, if detected early may be medically treated, but if bleeding or a Fallopian tube ruptures, it is a medical emergency that requires surgery.
Pelvic Inflammatory Disease (PID)
Pelvic inflammatory disease (PID) is an inflammatory and infectious disease, and may be a complication of a sexually transmitted disease (STD) such as gonorrhea. PID can cause damage to the Fallopian tubes, ovaries, and the uterus. Pelvic pain that radiates to the abdomen, an abnormal vaginal discharge, and pain during intercourse or urination are common symptoms. Although antibiotics may cure PID, some women may require surgery. If PID is untreated, it can cause infertility, ectopic pregnancy, and chronic pelvic pain.
Ovarian cysts are fluid-filled areas within the ovary formed by fluid that accumulates when a follicle fails to release an egg, or when the follicle recloses after egg release. There are several types of ovarian cysts. Common symptoms include sharp pelvic pain, irregular menstruation, pelvic pressure, or pain after intercourse. Pelvic pain and painful urination may occur especially with large cysts; although most cysts resolve on their own, some may require treatment with prescription medications or surgery to remove the cyst(s).
Fibroids are tumors that grow in the uterine wall that are almost never cancerous (benign tumors or growths). Some uterine fibroids cause pelvic pain (mild, moderate, or severe), pain during intercourse, pelvic pressure pain, and may interfere with a woman’s ability conceive. Uterine fibroids are most common in women in their 30s and 40s. Women that have symptoms should consult their OB/GYN doctor. Treatment may include medication for symptoms or surgical removal.
Endometriosis is growth of the endometrial tissue (uterine tissue) in areas outside the uterus. This tissue may attach to many other organs such as the ovaries, bladder, or intestines. This tissue breaks down monthly just like normal endometrial tissue, but the tissue remnants and some blood is retained in the pelvis or abdomen and may cause periodic pelvic and abdominal pain. Treatment is with medication to reduce symptoms; sometimes surgery is required. Endometriosis may also decrease a woman's ability to conceive.
Urinary Tract Infection
A urinary tract infection (UTI) may cause pelvic pain, but usually has associated painful urination (dysuria), frequent urge to urinate, and lower pelvic pressure. UTI's that involve the kidney may have flank pain in addition to fever and nausea. Almost all UTI's can be effectively treated with antibiotics, but delays in treatment can result in kidney damage.
Kidney stones are composed of crystals that usually form in the kidneys or ureters (the tubes that carry urine from the kidneys to the bladder); most are very small but some can be as big as a golf ball. Most small stones cause intense flank and pelvic pain as they irritate the ureters as they pass through them. The urine may contain blood caused by the kidney stone irritating the tissue in the kidney or ureter. Although most stones smaller than 6mm pass spontaneously, they do so with a great deal of pain. Some stones, especially if they are causing an obstruction, may require a urologist to evaluate the patient because the stones may need to be broken up or removed surgically.
Interstitial Cystitis (IC)
Chronic mid-pelvic recurrent pelvic pain is a sign of interstitial cystitis (IC). Pressure and pain in the pelvic area, the urge to urinate, painful urination, and pain during intercourse also may occur. Although the cause of IC is unknown, there are medications to reduce the symptoms. Like uterine fibroids described previously, IC occurs mainly in women aged 30 to 40, and the cause is unknown.
Sexually Transmitted Diseases (STDs)
Although sexually transmitted diseases (STDs) do not always cause pelvic pain, if a person develops pelvic pain and has an STD, the pain suggests that complications such as pelvic inflammatory disease, described previously may be developing. The most common STDs are chlamydia and gonorrhea. Recently, some strains of bacteria that cause gonorrhea have developed multiple drug resistance and have become very difficult to treat with antibiotics.
Pelvic Organ Prolapse
Pelvic prolapse is a condition where a pelvic organ such as the bladder or uterus drops into a lower than normal position and in some instances protrude into the vaginal canal. This condition results in pelvic pain that is pressure-like and may include vaginal and back pressure. Usually there is pain with sex. This condition may occur in older women; treatments range from techniques to strengthen pelvic musculature to surgery.
Pelvic Congestion Syndrome
Pelvic congestion syndrome occurs when pelvic veins become swollen and painful due to low blood flow, just like varicose veins that can develop in the legs. The pelvic pain caused by these veins usually increases with sitting or standing and may be reduced by lying down flat. The treatment may involve medication or embolization (stoppage of blood flow to the affected vein).
Scar Tissue (Abdominal Adhesions)
Scar tissue (also termed abdominal adhesions) forms after abdominal surgery and may make tight connections between organs and other body tissues in the abdomen. Scar tissue may form after any type of abdominal surgery (for example, hysterectomy, C-section, appendectomy). It can cause pelvic and abdominal pain and even compromise blood flow. Some individuals require surgery to remove these adhesions.
Vulvodynia (Vaginal Pain)
Vulvodynia (vaginal pain) is chronic vulvar pain that includes throbbing, aching, or burning pain in the area around the vulva and vaginal opening. Women also may experience vaginal itching. The pain may be constant or intermittent and is often worsened during sex or when pressure is placed on the vaginal area (bicycle riding, for example). The diagnosis is made by excluding other pelvic pain causes because the cause of vulvodynia is unknown. Treatment is symptom reduction; methods range from home remedies, prescription medication, biofeedback, exercises, and nerve blocks.
Pain During Sex
Pelvic pain during sex (dyspareunia) has been discussed as a symptom in most of the conditions described previously. Other causes of painful intercourse not discussed previously include vaginal dryness or atrophy that occurs during menopause or changes in sexual behavior. Diagnosis and treatment of the causative condition usually will reduce or stop pelvic pain that occurs during sex (for example, vaginal estrogen creams or rings to increase vaginal lubrication during menopause). However, some individuals have no medical condition diagnosed as the cause of painful intercourse may benefit from consultation with a qualified sex therapist.
Chronic Pelvic Pain
Chronic pelvic pain is often defined as pelvic pain that occurs below the belly button for 6 or more months. It usually interferes with sleep, it may increase or decrease daily or change due to some specific stimulus or position, and it may interfere with sexual relations. Seeking medical help to obtain a diagnosis and appropriate treatments are the key to diagnosing the cause and resolving chronic pelvic pain.