Pelvic Pain

Pelvic pain, a pain in the lower abdomen, is more common among women. But the pain may be seen in men too. The pain may be persistent or periodic. It may be sudden and severe, or just mild and gradual.

It may be a chronic pain or acute. Pelvic pain that is persistent for more than six months, either continuous or periodic, is known as chronic pelvic pain. Acute pelvic pain has a sudden onset.

In some cases, the pain may radiate to the back, thighs or buttocks. In some cases, the pain is felt only during certain activity like urination.

Pelvic pain can be caused by several factors. Pelvic pain may be caused by an infection or due to pain in internal organs like colon or bladder. In women, the pain may be due to a problem in any of the reproductive organs in the pelvic area like the uterus, vagina, fallopian tubes, or cervix.

Acute pelvic pain may be caused by appendicitis, pelvic inflammatory disease, ovarian cyst, urinary tract infection, or peritonitis. Chronic pelvic pain may be caused by endometriosis, irritable bowel syndrome (IBS), adenomyosis, or interstitial cystitis.

Pelvic pain may be accompanied by a number of other symptoms, some of which may indicate a problem, includes: 

• Severe menstrual pain or cramps
• Vaginal bleeding
• Pain during urination
• Fever
• Chills
• Pain in groin area
• Pain during sexual activity
• Constipation
• Diarrhea
• Bloating
• Pain in the hip
• Blood in stools

Other symptoms of pelvic pain may vary from women to women. When the pain is severe it may interfere with normal activities.

Medical history, physical examination, and tests and imaging are used in the diagnosis of the condition. Pelvic examination is the most common diagnostic test used in women to confirm the diagnosis.

Other physicians and specialists may also be involved in identifying the cause of the pain. Imaging techniques like ultrasound scanning, laparoscopy, cystoscopy, and colonoscopy are used in diagnosis.

Chronic pelvic pain is relieved by simple treatment methods. This includes physical therapy, medications, lifestyle modifications and surgery. The treatment may also depend on the intensity and periodicity of pain.

If one is sure of the cause of pelvic pain, over the counter painkillers like ibuprofen may be of help in alleviating the symptom. But if the pain is severe or if not sure of the cause of the pain, seeing the doctor is advisable.

Pregnancy-related problems:

Miscarriage – loss of pregnancy within 24 weeks of gestation is referred to as a miscarriage. Some may occur before 13 weeks into pregnancy. Miscarriage results in abnormal vaginal bleeding and pelvic cramps.

Premature labor – labor that starts before the completion of normal 37 weeks of pregnancy is referred to as premature labor. This leads to strong, continuous pain in the lower abdomen. In some cases, the water may break leading to a gushing of fluid from the vaginal opening.

Ectopic pregnancy – pregnancy in which the fetus develops outside the uterus is known as ectopic pregnancy. Pain in the pelvis is one of the common symptoms of ectopic pregnancy. Sharp pain may develop suddenly or worsen gradually over a period of time.

Abruption of placenta – detachment of the placenta from the wall of the uterus is known as placental abruption. This is an emergency situation and needs immediate medical attention. As the placenta separates before time, the developing fetus may not receive enough nutrition and oxygen. Placental abruption is also accompanied by pelvic pain.

Rupture of corpus luteum cyst – Corpus luteum may sometimes become swollen and burst, resulting in a sharp pain in one side of the pelvis.

Gynecological problems: 

Dysmenorrhea – pain during the menstrual period is normal in most women. But in some cases, the pain may be intense and unbearable, affecting the day to day activities of the person. This pain is referred to as dysmenorrhea and is one of the most common causes of pelvic pain.

Ovulation – this pain occurs during the middle of the menstrual cycle and is often referred to as ‘middle pain’. The pain may be felt on a different side each month, depending on the ovary from which ovum is released during ovulation. The intensity of pain is less, but for some, it may become intense.

Pelvic inflammatory disease (PID) – infection of the uterus is referred to as PID. Pain in the pelvis and abnormal vaginal bleeding are common symptoms of this condition.

Rupture of ovarian cyst – Ovarian cysts are benign fluid-filled sacs that develop in the ovary. Some of these cysts may cause pain and abnormal vaginal bleeding. Pain is usually associated with the rupture of a cyst.

Fibroids – fibroids usually remain asymptomatic. But in some cases, shrinkage or degeneration of the fibroids may result in pelvic pain.

Endometriosis – when present it is one of the common cause of pelvic pain, particularly during periods. It may also cause pain during intercourse.

Bowel problems: 

Irritable bowel syndrome (IBS) – It is a common disorder that causes pelvic pain and bloating.

Cystitis – urine infection of the bladder is referred to as cystitis. In some cases, the walls of urinary bladder develop inflammation leading to chronic pelvic pain.

Appendicitis – inflammation of appendix also result in pelvic pain.

Adhesions – Adhesions refer to the sticking of tissues together. This usually happens after a surgery when the tissues are sticky. Adhesions are common in bowel after surgery and result in pelvic pain.

A strangulated hernia – pushing or bulging of a part of the abdomen under the skin is referred to as a hernia. The bulge occurs through the gap in the ligament or muscle. A strangulated hernia results when a large portion of abdomen pushes through the gap and becomes squeezed. This can lead to severe pain in the abdominal region.

Muscle and bone problems:

Problems in the bones of pelvis and hip joint can cause severe pain in the pelvic region. In most of the cases it is easy to detect the origin of pain in the region, but in some cases, it may be difficult to pinpoint the origin of pain.

Medical history and clinical manifestations are the first steps in determining the cause of pelvic pain. This is usually followed by a thorough physical examination, based on which further tests and investigations are recommended.

Some of the common tests used in the diagnosis of the cause of pelvic pain include: 

• Blood and urine tests
• Examination of uterus called hysteroscopy
• CT scan of abdomen and pelvis
• Ultrasound scan
• Lower endoscopy
• Cystoscopy
• Stool test
• Laparoscopy to check for the structures in pelvis
• Pregnancy test, particularly in females of reproductive age
• Vaginal and penile cultures to identify sexually transmitted diseases
• Pelvic x-rays
• Pelvic MRI

Pelvic examination is a common test used to detect the cause of pain in the pelvic region. Pelvic examination is a type of physical examination in which the reproductive organs are checked for abnormalities.

Pelvic examination helps to assess the gynecologic health of a person and to diagnose any diseases. It includes and external visual exam and an internal visual exam. Bimanual exam and Pap test are suggested in some cases.

Pelvic laparoscopy is a method in which a laparoscope is inserted through a small incision in the skin to visualize the organs in the pelvic region. Cystoscopy is a diagnostic method in which a small camera is inserted into the body to visualize the bladder. Colonoscopy, on the other hand, is used to visualize the parts of the bowel, particularly the colon.

In some cases, the actual cause of the pain is easily detected. But in some cases the cause remains unknown and in such cases, understanding the triggers of pain is very important. Treatment of pelvic pain depends on the underlying cause. It may also depend on the intensity and periodicity of pain.

Some of the common treatment measures used include:

• Medications – pain relievers, muscle relaxants, and antidepressants are the medications commonly used in alleviating pelvic pain. Pain relievers can be either taken orally or injected.
• Hormones – hormonal treatment is suggested for pain caused by endometriosis and pain associated with periods. They can be taken orally, as injections, or be placed in the uterus.
• Physical therapy – physical therapy is often suggested for pain caused by muscle and connective tissue problems. This includes massage, relaxation of pelvic muscles, stretching, and strengthening.
• Surgery – surgery is recommended for bowel adhesions, fibroids, and endometriosis.
• Lifestyle modifications – regular exercise, improved posture, and a healthy diet are all very important in alleviating pelvic pain.
• Counseling – also known as talk therapy, counseling is useful in treating pelvic pain. In most of the cases, it is combined with medications for better results.
• Nutritional therapy – this is a new method in which vitamin B1 and magnesium are given to alleviate pain.

Women with chronic pain may benefit from learning to cope with pain. Many alternative therapies like acupuncture, homeopathy, acupressure, nerve stimulation therapy and exercises are also used in the treatment of pelvic pain. Biofeedback, a method in which measures are taken to control body functions like blood pressure and heartbeat also is used in some cases.