Pelvic pain is pain that occurs in the lower abdomen and pelvis and is a common issue for women. It can range from minor and short lasting through to debilitating pain affecting a woman’s work and her relationships.
Pelvic pain can be acute or chronic. Acute pelvic pain occurs suddenly and stays only for a short period of time. Chronic pelvic pain lasts for more than six months and does not show any improvement with treatment.
Symptoms
Pelvic pain may be dull or sharp; persistent or intermittent; mild to severe and can refer to your lower back or thighs. The type and intensity of the pain can vary across your monthly cycle.
The common symptoms of pelvic pain are:
- Pain and cramps during menstruation
- Pain during urination, bowel movements, and intercourse
- Pain referred to the hip and groin region
- Altered bowel habits (constipation or diarrhoea)
Causes
There are numerous causes for pelvic pain. Many have a gynaecological cause, however there are many other reasons.
The common gynaecological causes of acute pelvic pain are:
- Pelvic inflammatory disease (infection of the reproductive organs)
- Congestion or abscess (collection of pus) in the pelvic region
- Urinary tract infection
- Miscarriage or threatened miscarriage
- Ectopic pregnancy (pregnancy that occurs outside the uterus)
- Twisted or ruptured ovarian cyst
The common gynaecological causes of chronic pelvic pain are:
- Chronic pelvic inflammatory disease
- Endometriosis (abnormal growth of uterus lining)
- Interstitial cystitis (inflammation of urinary bladder)
- Pelvic floor disorders (spasm or tension in the pelvic floor muscles)
- Uterine fibroids (non-cancerous uterine growths)
Other causes of pelvic pain need to be considered
- Appendicitis
- Musculoskeletal and nerve issues
- Irritable bowel syndrome
- Inflammatory bowel conditions
- Coeliac disease
- Kidney infections
- Hernias
- Psychological factors such as stress, depression or a history of physical abuse can also present with physical symptoms including pelvic pain
Diagnosis
Your doctor will ask you questions about your pain symptoms, timing of your symptoms along with a thorough medical history. An abdominal and pelvic examination will also be completed. For additional information, you may be sent for blood and urine tests, a pregnancy test, and quite likely a transvaginal ultrasound.
Treatment
Treatment for pelvic pain depends on the cause of pain, intensity and frequency of the pain. Conservative management of pelvic pain includes rest and participating in regular physical therapy and exercise. Medication can be used to relieve pain (pain killers), muscle spasm/contraction (muscle relaxants) and to treat infection (antibiotics). There may be a role for hormonal medications for pain relief related to your menstrual cycle or to control the symptoms of endometriosis.
Surgery is performed urgently for patients with acute pelvic pathologies (for example ectopic pregnancy or a large ovarian cyst) and also to investigate chronic pelvic pain suggestive of endometriosis.
Surgical treatments for chronic pain may include pelvic floor repair, hysterectomy, excision of endometriosis, adhesiolysis (removal of internal adhesions) and sometimes a combination of these. In some cases, we will recommend medical plus surgical management in the setting of a multidisciplinary care plan involving physiotherapists, dietitians and psychologists.
In summary
Pelvic pain is a common problem and has many potential causes. The role of a specialist Gynaecologist is to investigate and treat or manage gynaecological conditions causing pain. Sometimes this is a simple process, but frequently pain syndromes are complex and require the input from other specialists and allied health professionals.
Evolve Women’s Health utilises a network of experts to help women with pelvic pain – your GP can refer you directly to our clinic.
