What causes pelvic pain?

Pelvic pain occurs in the lower abdomen or pelvic area and can vary in intensity, from mild discomfort to severe, debilitating pain. It may also be acute, with a sudden and intense onset, or chronic, persisting for months or even years.

This article will cover the primary causes, diagnosis, and treatment options available for pelvic pain.

What conditions can cause pelvic pain?

Pelvic pain may result from a variety of medical conditions, some of which are benign while others may signal more serious health issues.

Gynaecological causes

In women, pelvic pain is particularly associated with gynaecological conditions:

• Endometriosis: This is a condition where tissue similar to the uterine lining grows outside the uterus, leading to inflammation, scar tissue, and pain, especially during menstruation.
• Ovarian cysts: These fluid-filled sacs on the ovaries can cause pain when they grow large, rupture, or twist. Symptoms may vary from slight discomfort to intense pain.
• Uterine fibroids: These benign growths in or around the uterus can cause pressure and pain in the pelvic region, especially when they grow large or press on surrounding organs.

Urological and gastrointestinal causes

Pelvic pain may also arise from issues with the urinary or digestive systems, such as:

• Urinary tract infections (UTIs): Bacterial infections in the bladder or kidneys can lead to abdominal discomfort and pelvic pain, often accompanied by a burning sensation during urination.
• Interstitial cystitis: This chronic condition, also known as bladder pain syndrome, causes pelvic pain alongside a frequent need to urinate.
• Irritable bowel syndrome (IBS): This is a digestive disorder that can cause abdominal cramping, bloating, and pain that may spread to the pelvic region.

Musculoskeletal causes

Muscle and ligament problems can contribute to pelvic pain, especially after injuries, surgeries, or childbirth. Common causes include:

• Pelvic floor dysfunction: Muscle imbalances or spasms in the pelvic floor can lead to pain in the pelvic area.
• Hernias: Inguinal hernias can create sharp or persistent pain in the lower abdomen and pelvic region, especially when pressure is applied.

Pelvic pain can occasionally indicate emergency conditions. Sudden, severe pain could suggest appendicitis, ectopic pregnancy, or even a twisted ovarian cyst. In these cases, immediate medical evaluation is required.

How is the cause of pelvic pain diagnosed?

A specialist, such as gynaecologist, will start by taking a detailed medical history of your symptoms. Additionally, they may ask questions about any accompanying symptoms like abnormal bleeding, discharge, urinary frequency, or digestive issues.

A physical examination will then follow, including a pelvic exam, to check for signs of infection, unusual growths, or tenderness.

Depending on the initial findings, diagnostic tests may also be recommended, such as:

• Imaging tests: Ultrasound, MRI, or CT scans can detect structural issues, such as ovarian cysts and fibroids.
• Laparoscopy: In some cases, a laparoscopy may be recommended to allow direct visualisation of the pelvic organs, helping identify conditions like endometriosis.
• Laboratory tests: Blood and urine tests can detect infection or inflammation that may explain pelvic pain. In some cases, specific tests for bacteria may also be conducted.

What treatment options are available for pelvic pain?

The treatment for pelvic pain depends on its underlying condition. Once a diagnosis is confirmed, a management plan will be established to address both the cause of the pain and its symptoms.

Medication

For many conditions, medication is often the first line of treatment:

• Pain relievers: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are frequently prescribed to alleviate mild to moderate pain.
• Hormonal treatments: Endometriosis and fibroids often respond to hormone-based treatments, including oral contraceptives, gonadotropin-releasing hormone (GnRH) agonists, or progesterone therapy.
• Antibiotics: For infections such as UTIs, antibiotics can eliminate the infection and alleviate associated pain.

Surgical interventions

In more complex cases, especially when conditions don’t respond to medications, surgery may be required:

• Laparoscopic surgery: A laparoscopy can also be used to remove endometrial tissue, excise ovarian cysts, or treat other structural abnormalities causing pain.
• Hysterectomy or myomectomy: In severe cases of chronic pelvic pain caused by uterine fibroids, a hysterectomy (removal of the uterus) or a myomectomy (fibroid-specific surgery) might be considered as a last resort.