Sooner or later, as women, most of us experience some
degree of pain in our pelvic region. How we respond to pain varies among
us, some women are more bothered by pain than others. If pelvic pain is
severe enough to disrupt your daily life for either a few days a month
or for longer amounts of time, if pelvic pain increases overtime, or if
you have experienced a recent increase in pain, you should talk with
your healthcare provider to determine the cause.
There can be many causes of pelvic pain, so be prepared for a long
diagnostic process. Many times there is more than one reason for pelvic
pain and it can be difficult to pinpoint the exact source. It may be
necessary for your physician to consider other parts of your body when
determining the cause of pelvic pain. Pelvic pain can be caused by
problems in the digestive or urinary systems, as well as the
To help your physician diagnose the cause of your pelvic pain, it's
important that you can answer a few questions:
1. When did the pain begin?
2. Is it constant pain, or does it come and go?
3. How long does the pain last?
4. How severe is the pain?
5. Is it a sharp stabbing pain or a dull ache?
6. Is the pain always in the same place?
7. When do you typically experience pelvic pain?
Causes of Pelvic Pain
Acute pelvic pain is pain that starts over a short period of time anywhere from
a few minutes to a few days. This type of pain is often a warning sign that
something is wrong and should be evaluated promptly.
Pelvic pain can be caused by an infection or inflammation. An infection doesn't
have to affect the reproductive organs to cause pelvic pain. Pain caused by the
bladder, bowel, or appendix can produce pain in the pelvic region;
diverticulitis, irritable bowel syndrome, kidney or bladder stones, as well as
muscle spasms or strains are some examples of non-reproductive causes of pelvic
or lower abdominal pain. Other causes of pelvic pain can include pelvic
inflammatory disease (PID), vaginal infections, vaginitis, and sexually
transmitted diseases (STDs). All of these require a visit to your healthcare
provider who will take a medical history, and do a physical exam which may
include diagnostic testing.
Women who have ovarian cysts may experience sharp pain if a cyst leaks fluid or
bleeds a little, or more severe, sharp, and continuous pain when a large cyst
twists. Fortunately, most small cysts will dissolve without medical intervention
after 2 or 3 menstrual cycles; however large cysts and those that don't rectify
themselves after a few months may require surgery to remove the cysts.
An ectopic pregnancy is one that starts outside the uterus, usually in one of
the fallopian tubes. Pain caused by an ectopic pregnancy usually starts on one
side of the abdomen soon after a missed period, and may include spotting or
vaginal bleeding. Ectopic pregnancies can be life-threatening if medical
intervention is not sought immediately. The fallopian tubes can burst and cause
bleeding in the abdomen, if left untreated. In some cases surgery is required to
remove the affected fallopian tube.
Chronic pelvic pain can be intermittent or constant. Intermittent chronic pelvic
pain usually has a specific cause, while constant pelvic pain may be the result
of more than one problem. A common example of chronic pelvic pain is
dysmenorrhea or menstrual cramps. Other causes of chronic pelvic pain include
endometriosis, adenomyosis, and ovulation pain. Sometimes an illness starts with
intermittent pelvic pain that becomes constant over time, this is often a signal
that the problem has become worse. A change in the intensity of pelvic pain can
also be due to a woman's ability to cope with pain becoming lessened causing the
pain to feel more severe even though the underlying cause has not worsened.
Women who have had surgery or serious illness such as PID, endometriosis, or
severe infections sometimes experience chronic pelvic pain as a result of
adhesions or scar tissue that forms during the healing process. Adhesions cause
the surfaces of organs and structures inside the abdomen to bind to each other.
Fibroid tumors (a non-cancerous, benign growth from the muscle of the uterus)
often have no symptoms; however when symptoms do appear they can include pelvic
pain or pressure, as well as menstrual abnormalities.
Diagnosis and Treatment of Pelvic Pain
Due to the large number of possible causes of pelvic pain, diagnosis begins by
process of elimination. Your physician may order several types of tests to
diagnose the problem. It may seem tedious and time-consuming; however, this
approach is the best way for your provider to determine the cause of your pelvic
pain. Some of the tests that your physician may order include ultrasound
imaging, computed tomography (CT), magnetic resonance imaging (MRI), intravenous
pyelography (IVP), and barium enema. However these tests cannot detect
endometriosis or adhesions and laparoscopy may be necessary to diagnose the
cause of your pelvic pain.
What type of treatment you receive depends on the diagnosis. Treatments can vary
from medications for urinary tract infections (UTI) or vaginal infections to
pharmacologic treatment in the hospital for serious infections such as PID. If a
sexually transmitted disease is diagnosed, your partner will also need to be
treated to prevent reinfection.
Menstrual cramps can often be relieved with drugs that reduce inflammation, such
as ibuprofen which blocks the production of prostaglandins that cause the uterus
to contract. Sometimes the diagnosis will require the use of hormonal therapies
including oral contraceptives and other types of hormones. Antidepressants are
helpful for some women because they help break the cycle of pain and depression
that often occurs in women with chronic pelvic pain.
Surgery may be the answer for certain types of pelvic pain. What type of surgery
depends on the diagnosis. Surgery such as laparoscopy can be done on an
outpatient basis, while other surgeries such as hysterectomy require a stay in
the hospital. Your healthcare provider will discuss your options based on your
diagnosis, as well as the risks and benefits of these procedures and the chance
of them working. Hysterectomy is not always the best treatment, especially in
the case of chronic pelvic pain.
Other treatments include heat therapy, muscle relaxants, nerve blocks, and
relaxation exercises. If digestive or urinary conditions are diagnosed specific
treatments for these conditions will be used.
Determining the cause of pelvic pain can be a frustrating situation for many
women, but try not to give up. Even when one specific cause for chronic pelvic
pain is not found your healthcare provider has treatments that can help.
Maintaining an open working relationship with you physician is the best way to
find the treatment that works best for you.