Pelvic Pain

What is Pelvic Pain?

Pelvic pain is any discomfort or pain felt in the lower abdomen, pelvis, or groyne area. It can vary in intensity and duration and may be chronic or acute. Various factors, including medical conditions, injuries, or functional disorders, can cause pelvic pain.


Impact of Pelvic Pain on Anatomy and Health

Some potential impacts of pelvic pain include:

  • Reproductive system: Pelvic pain can be associated with gynaecological conditions such as endometriosis, ovarian cysts, uterine fibroids, pelvic inflammatory disease (PID), or menstrual disorders. These conditions can affect the reproductive organs, leading to pain and potential complications related to fertility and menstruation.
  • Urinary system: Pelvic pain can also result from urinary tract infections, bladder disorders, kidney stones, or interstitial cystitis. These conditions may affect the bladder, ureters, or kidneys, causing pain and urinary symptoms like frequency, urgency, or discomfort during urination.
  • Gastrointestinal system: Digestive disorders, such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), or gastrointestinal infections, can cause pelvic pain. These conditions can affect the intestines, causing pain, bloating, changes in bowel habits, or other gastrointestinal symptoms.
  • Musculoskeletal system: Pelvic pain can arise from muscle or joint dysfunction in the pelvic area. Conditions like pelvic floor or sacroiliac joint dysfunction can lead to chronic pain and discomfort in the pelvis and lower back.
  • Nervous system: Nerve-related conditions, such as pelvic neuralgia or pelvic floor muscle spasms, can result in pelvic pain. These conditions can cause chronic pain, tingling, or numbness in the pelvis.


Pelvic pain can interfere with daily activities, sleep, sexual function, and overall quality of life. It may lead to emotional distress, anxiety, and depression, particularly if the pain becomes chronic and challenging to manage.


Who is Most at Risk for Pelvic Pain?

Several factors can increase an individual's susceptibility. These include:

  • Gender: Pelvic pain is more commonly reported among females due to the higher prevalence of gynaecological conditions that can cause pelvic pain.
  • Reproductive age: Pelvic pain is frequently experienced during reproductive years, particularly due to conditions like endometriosis, ovarian cysts, or menstrual disorders.
  • History of pelvic surgeries or trauma: Previous pelvic surgeries, such as hysterectomy or caesarean section, or pelvic injuries may increase the risk of developing pelvic pain.
  • Infections: Certain infections, such as pelvic inflammatory disease (PID) or sexually transmitted infections (STIs), can cause pelvic pain.
  • Chronic conditions: Individuals with pre-existing chronic conditions like IBS, IBD, or fibromyalgia may have a higher likelihood of experiencing pelvic pain.
  • Psychological factors: Emotional stress, anxiety, or a history of psychological trauma can contribute to the experience and perception of pelvic pain.


Causes of Pelvic Pain

Pelvic pain can have various causes, often requiring a thorough medical evaluation to determine the underlying condition. Some common causes of pelvic pain include:

  • Gynaecological conditions: Pelvic pain can be attributed to conditions affecting the female reproductive system, such as:
  • Endometriosis
  • Ovarian cyst
  • Uterine fibroids
  • Pelvic inflammatory disease (PID)
  • Adenomyosis
  • Pelvic organ prolapse
  • Urinary conditions: Pelvic pain can be associated with disorders of the urinary system, including:
  • Urinary tract infections (UTIs)
  • Interstitial cystitis (bladder pain syndrome)
  • Kidney stones
  • Digestive disorders: Conditions affecting the gastrointestinal system can also contribute to pelvic pain, such as:
  • Irritable bowel syndrome (IBS)
  • Inflammatory bowel disease (IBD
  • Gastrointestinal infections
  • Musculoskeletal issues: Pelvic pain can arise from dysfunction or conditions affecting the muscles, joints, or bones in the pelvic region, including:
  • Pelvic floor dysfunction
  • Sacroiliac joint dysfunction
  • Nerve-related conditions: Certain conditions that affect the nerves in the pelvic region can result in pelvic pain, such as:
  • Pelvic neuralgia
  • Pudendal neuralgia


Symptoms of Pelvic Pain

The symptoms of pelvic pain can vary depending on the underlying cause. Common symptoms include:

  • Dull, aching, or sharp pain in the lower abdomen, pelvis, or groyne area.
  • Pain during sexual intercourse (dyspareunia).
  • Painful or difficult urination.
  • Changes in bowel movements, including constipation or diarrhoea.
  • Menstrual irregularities or heavy periods.
  • Pelvic pressure or a feeling of fullness.
  • Bloating or abdominal swelling.
  • Fatigue and emotional distress.


Types of Pelvic Pain

  • Acute Pelvic Pain: Acute pelvic pain refers to sudden, severe pain that typically lasts for a short duration. It often requires immediate medical attention and can be caused by conditions such as ovarian torsion, ectopic pregnancy, appendicitis, or urinary tract infections.
  • Chronic Pelvic Pain: Chronic pelvic pain is characterised by persistent or recurrent pain in the pelvic region that lasts for at least six months. It can have multiple causes, including endometriosis, pelvic inflammatory disease (PID), irritable bowel syndrome (IBS), interstitial cystitis, or musculoskeletal issues.
  • Cyclical Pelvic Pain: Cyclical pelvic pain occurs in a pattern related to the menstrual cycle. It is commonly associated with endometriosis, adenomyosis, or ovarian cysts. The pain typically worsens before or during menstruation and may improve afterwards.
  • Non-cyclical Pelvic Pain: Non-cyclical pelvic pain does not follow a predictable pattern related to the menstrual cycle. It can be constant or intermittent and is often associated with pelvic adhesions, chronic pelvic inflammatory disease, or musculoskeletal issues.


Diagnosis of Pelvic Pain

Diagnosing pelvic pain involves a comprehensive evaluation that typically includes the following:

  • Medical History: The gynaecologist will review your medical history, including details about the pain, its characteristics, duration, triggers, and any associated symptoms. They may also ask about your menstrual cycle, sexual history, previous surgeries, and relevant medical conditions.
  • Physical Examination: A physical examination may assess the pelvic area for any abnormalities, tenderness, or signs of inflammation. The gynaecologist may perform a pelvic exam to evaluate the reproductive organs and check for signs of infection, masses, or other abnormalities.
  • Imaging Tests: Various imaging techniques can help visualise the pelvic area and identify potential causes of pain. These may include ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), or X-rays.
  • Laboratory Tests: Blood tests, urine tests, or cultures may be performed to check for signs of infection, inflammation, hormonal imbalances, or other underlying conditions.
  • Specialised Tests: Additional specialised tests may be necessary depending on the suspected cause of pelvic pain. For example, laparoscopy (a minimally invasive surgical procedure) can be used to diagnose conditions like endometriosis.
  • Consultations: In some cases, referral to specialists such as gynaecologists, urologists, gastroenterologists, or pain management specialists may be required for further evaluation and targeted treatment.


Treatment of Pelvic Pain 

The treatment of pelvic pain depends on the underlying cause and may involve a combination of approaches. Treatment aims to alleviate pain, manage associated symptoms, and improve the individual's quality of life. Here are some common treatment options for pelvic pain:

  • Medications: Pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may help alleviate mild to moderate pelvic pain. Hormonal medications, such as birth control pills or hormonal IUDs, can be prescribed to manage pain associated with menstrual disorders or conditions like endometriosis. In certain cases, antidepressants or anticonvulsant medications may be prescribed to help manage chronic pain.
  • Physical Therapy: Pelvic floor physical therapy is often recommended for pelvic pain, particularly related to musculoskeletal issues or pelvic floor dysfunction. Physical therapists can provide exercises, manual therapy, and techniques to improve muscle strength, flexibility, and pelvic function.
  • Hormonal Treatments: For conditions like endometriosis or uterine fibroids, hormonal therapies such as gonadotropin-releasing hormone (GnRH) agonists, progestins, or oral contraceptives may be prescribed to regulate hormonal imbalances and reduce pain.
  • Antibiotics: If pelvic pain is caused by an infection, such as pelvic inflammatory disease (PID) or urinary tract infections (UTIs), antibiotics are typically prescribed to eliminate the infection and alleviate associated symptoms.
  • Minimally Invasive Procedures: In some cases, minimally invasive procedures may be recommended for diagnostic purposes or to treat specific causes of pelvic pain. Examples include laparoscopy for endometriosis or adhesions, cyst aspiration or removal for ovarian cysts, or nerve blocks for nerve-related pelvic pain.
  • Complementary and Alternative Therapies: Some individuals find relief from pelvic pain through complementary therapies such as acupuncture, yoga, relaxation techniques, or transcutaneous electrical nerve stimulation (TENS).
  • Counselling and Psychological Support: Pelvic pain can be physically and emotionally challenging. Counselling or therapy can help individuals cope with the emotional impact of chronic pain and develop strategies to manage stress, anxiety, and depression.


What if Pelvic Pain is Untreated?

Untreated or poorly managed pelvic pain can lead to chronic pain, physical disability, emotional distress, and reduced quality of life. Additionally, untreated pelvic pain may result in complications associated with the underlying condition. For example, untreated infections can spread, causing more severe infections or damaging reproductive organs. 


Delaying treatment for conditions like endometriosis or pelvic inflammatory disease (PID) can lead to fertility issues or the formation of scar tissue that can further contribute to pain and complications.


If you are experiencing pelvic pain, seeking medical attention and discussing your symptoms with a gynaecologist is important. Early diagnosis and appropriate treatment can help alleviate pain, manage underlying conditions, and prevent potential complications.

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