Patient Education

Pelvic Pain

The term “pelvic pain” is a very broad description of a problem that almost all women experience at least once in their lives. Pelvic pain can be a result of many different conditions, and can range from being mild menstrual cramps to severe, chronic pain resulting from an illness. This means that finding the cause of your pelvic pain may take a while, since there are many different problems that need to be ruled out. Almost all women experience varying degrees of pelvic pain from various causes and handle it in different ways, but it is important to go to your healthcare provider if the pain is consistent, if it has worsened exponentially, or if it is disrupting your life. This page should help answer some common questions about pelvic pain and what can be done about it. 

WHAT CAN CAUSE PELVIC PAIN?

There are  an unlimited amount of problems that can cause pelvic pain of varying degrees. However, there are several common offenders that are categorized by the amount of pain that they create: 

  • Acute Pain: Acute (sharp) pain oftentimes starts suddenly or over a short period of time, anywhere from a few minutes to a few days. Usually, acute pain is a warning that something within your body has gone wrong, and usually has one root cause. Acute pain needs to be looked over and treated properly before anything worse can happen.
    • Infection: Acute pelvic pain can be caused by an inflammation or an infection, which does not necessarily have to stem from the reproductive organs. The pain source may be found in the bowel, appendix, or the bladder.
      • Pelvic Inflammatory Disease (PID): PID is a broad term that applies to inflammation of the reproductive organs, and are usually due to STDs. Untreated STDs may also cause serious problems. Symptoms of PID include fever and a pain (mild to severe ache) in the lower stomach). 
      • Vaginal Infection (vaginitis): Vaginitis is caused by bacteria, hormonal changes, or allergies. It can sometimes cause pain, especially after sex. 
    • Ovarian Cysts: Sometimes a cyst (sac of fluid like a blister) can grow on an ovary, usually resulting from hormonal level changes. The cysts are often felt as a dull ache, or a heaviness, and can cause pain during intercourse. They can also cause sharp pain if they burst or leak. Usually, cysts will go away by themselves, but rarely, surgery is needed when a large, severe cyst becomes twisted and causes sharp, constant pain. 
    • Ectopic Pregnancy: Ectopic pregnancies occur in the fallopian tubes rather than the uterus, most commonly on women who have preexisting damage to their tubes. Spotting and bleeding may occur after the missed period coupled with severe pain. Ectopic pregnancies are very serious and need to be removed immediately, as they can cause the fallopian tube to burst, which would cause severe internal bleeding. 
  • Chronic Pain: Chronic pain can either be constant, or can come and go. Oftentimes, constant chronic pain is caused by more than one problem, whereas intermittent chronic pain has one cause. Sometimes, illnesses can cause intermittent pain which then becomes constant.
    • Dysmenorrhea: Dysmenorrhea is a condition where a woman experiences extreme pain and cramps during her period. It is a chronic intermittent pain that can be caused by the hormone prostaglandin which can cause spasms or cramping of the uterus. Endometriosis/Adenomyosis: 
    • Endometriosis occurs when endometrial tissue that makes up the uterine lining grows outside of the uterus, which causes severe pain and bleeding during periods and sex. Adenomyosis occurs when the tissue of the endometrium becomes buried and grafted into the uterine muscle wall. This also causes menstrual cramps, as well as pressure and bloating before menstruation. 
    • Ovulation Pain: This type of pelvic pain can occur when a woman’s ovary produces an egg during the middle of the month. This can cause either mild or severe pain every month during the middle of a woman’s cycle, but is not always intense. 
  • Other Causes of Pain:
    • Adhesions: Adhesions (scar tissue) can result when the body is healing from an injury. Sometimes, adhesions can cause the binding of organs together, which can be very painful, and can attach to the uterus, bowels, tubes, or ovaries. 
    • Fibroids: Fibroids are growths that can develop on the uterus for uncertain causes, although estrogen has been linked. They usually do not cause symptoms, but have the potential to cause heavier periods and pain or pressure. 
    • Miscellaneous: There are many, many other causes of pelvic pain than listed. Other causes may be kidney/bladder stones, appendicitis, muscle spasms, irritable bowel syndrome, or diverticulus. 

HOW WILL MY HEALTHCARE PROVIDER BE ABLE TO DIAGNOSE THE CAUSE OF MY PELVIC PAIN?

Your practioner may have you use many different tests and methods to discover the source of your pelvic pain, because there are so many various problems to rule out. It will help your healthcare provider if you document your pain- exactly where it is, how long it lasts, the severity, and any other details. If your health care provider  determines that your problem is not gynecological, he or she may refer you to other specialists who may continue your evaluation. 

Precautions have many different tools that can be used to look inside you and find the root of your problem. Devices such as ultrasound, computed tomography (Cat Scan), magnetic resonance imaging (MRI), intravenous pyelography (IVP), and barium enemas all are ways that allow your doctor to get direct looks inside of your body without surgeries. 

HOW CAN MY PELVIC PAIN BE TREATED?

The way your health care provider will choose to treat your pain depends upon the causes. Infections like a UTI and vaginitis can be treated with an antibiotic. Severe PID may require hospitalization. For dysmenorrhea, anti-inflammatory medications like ibuprofen can greatly lessen the pain of menstrual cramps by blocking prostaglandins that cause the uterus to contract. For problems that concern hormones, combination oral contraceptives can be prescribed to help regulate the levels and relieve pain from cramps as well. Other hormones can shrink certain growths like fibroids and endometriosis. When other medications don’t work, sometimes practioners will prescribe antidepressants to break the cycle of depression that may be caused by the pelvic pain. Pain relievers are rarely used.  

If all other methods don't help relieve your pelvic pain, surgery may become necessary. Laparoscopies and hysteroscopies may be performed to allow your doctor get a better look inside your pelvis to determine if there are any abnormal growths. If there are serious problems, a hysterectomy is needed, which removes the uterus entirely. Your doctor will talk to you about what option is best for your health. 

IN CONCLUSION

Pelvic pain, especially when chronic, has the possibility to cause frustration and many other emotions because of how involved the search for the cause is. However, it is important to be patient, because once your problem is discovered, you will be able to get relief once it is treated. If you are having pelvic pain, is important to talk to your healthcare provider.