Pelvic Pain

Pelvic pain is a common complaint among women and can be caused by a number of pelvic conditions. Its nature and intensity may fluctuate, and its cause is often obscure. In some cases, no disease is evident.

What is Pelvic Pain?

Pelvic pain can be categorized as either acute, meaning the pain is sudden and severe, or chronic, lasting over a period of months or longer. Pelvic pain may originate in genital or extragenital organs in and around the pelvis, or it may be psychological, which can make pain feel worse or actually cause a sensation of pain when no physical problem is present.

The following are examples of the different types of pelvic pain most commonly described by women and their possible cause or origin. Always consult your physician for a diagnosis.

• localized pain: may be due to an inflammation
• colicky pain: may be caused by spasm in a soft organ, such as the intestine, ureter or appendix
• sudden onset of pain: may be caused by a temporary deficiency of blood supply due to an obstruction in the circulation of blood
• slowly-developing pain: may be due to inflammation of the appendix or an intestinal obstruction
• pain involving the entire abdomen: may suggest an accumulation of blood, pus or intestinal contents
• pain aggravated by movement or during examination: may be a result of irritation in the lining of the abdominal cavity

Who is at risk for Pelvic Pain?

The pelvis is a complex region that houses many important structures including the bladder, urethra, uterus, ovaries, vagina, bowel and a complex muscular support structure. Dysfunction in any of these areas may contribute to pain in the pelvis. In women, common nerves innervate these regions and inflammation or irritation of one structure can flare other surrounding structures. Although pelvic pain is common in women, it is also found frequently in men. Men and women both share supportive pelvic floor muscles and spasm or inflammation of these muscles are a frequent cause of pelvic pain and urinary and bowel dysfunction.

What can cause Pelvic Pain?

Pelvic pain may have multiple causes, including:

• inflammation or direct irritation of nerves caused by acute or chronic trauma, fibrosis, pressure or intraperitoneal inflammation
• muscular contractions or cramps of both smooth and skeletal muscles
• psychogenic factors, which can cause or aggravate pain

Some of the more common sources of acute pelvic pain, or pain that occurs very suddenly, may include:

• ectopic pregnancy: a pregnancy that occurs outside the uterus
• pelvic inflammatory disease: an infection of the reproductive organs
• twisted or ruptured ovarian cyst
• miscarriage or threatened miscarriage
• urinary tract infection
• appendicitis
• ruptured fallopian tube

Some of the conditions that can lead to chronic pelvic pain, pain that may last for several months or longer, may include:

• menstrual cramps
• endometriosis
• uterine fibroids: abnormal growths on or in the uterine wall
• adhesions: scar tissue between the internal organs in the pelvic cavity
• endometrial polyps: protrusions attached by a small stem in the uterine cavity
• cancers of the reproductive tract

This long-term and often unrelenting pain may cause a woman's defenses to break down, resulting in emotional and behavioral changes. This occurrence is often termed "chronic pelvic pain syndrome."

How is Pelvic Pain diagnosed?

Diagnostic procedures and tests will be performed in order to determine the cause of the pelvic pain. In addition, your physician may ask you questions regarding the pain such as:

• When and where does the pain occur?
• How long does the pain last?
• Is the pain related to your menstrual cycle, urination and/or sexual activity?
• What does the pain feel like (i.e., sharp, dull, etc.)?
• Under what circumstances did the pain begin?
• How suddenly did the pain begin?

Additional information about the timing of the pain and the presence of other symptoms related to activities such as eating, sleeping, sexual activity and movement can also help the physician in determining a diagnosis.

In addition to a complete medical history and physical and pelvic examination, diagnostic procedures for pelvic pain may include:

• blood tests
• pregnancy test
• urinalysis
• culture of cells from the cervix
• ultrasound : a diagnostic imaging technique which uses high-frequency sound waves to create an image of the internal organs
• computed tomography (CT): a non-invasive procedure that takes cross-sectional images of the internal organs to detect any abnormalities that may not show up on an ordinary X-ray
• magnetic resonance imaging (MRI): a non-invasive procedure that produces a two-dimensional view of an internal organ or structure
• laparoscopy : a minor surgical procedure in which a laparoscope, a thin tube with a lens and a light, is inserted into an incision in the abdominal wall to determine the locations, extent and size of the endometrial growths
• X-ray: electromagnetic energy used to produce images of bones and internal organs onto film

How can Pelvic Pain be treated?

Treatment for pelvic pain can range from behavioral therapies, medication or surgery. Based on your diagnosis, your doctor may recommend one of the following treatments for pelvic pain:

• antibiotic medications
• anti-inflammatory and/or pain medications
• relaxation exercises
• oral contraceptives (ovulation inhibitors)
• leading-edge outpatient procedures
• pudendal neuromodulation
• surgery
• physical therapy

Specific treatment for pelvic pain will also be determined based on:

• your overall health and medical history
• extent of condition
• cause of the condition
• your tolerance for specific medications, procedures or therapies
• expectations for the course of the condition
• your opinion or preference

If a physical cause for your pelvic pain cannot be found, it may be diagnosed as a psychological defense or coping mechanism for some type of trauma. In some cases, psychotherapy is recommended. In other cases, physicians may recommend a multi-disciplinary treatment utilizing a number of different approaches including nutritional modifications, environmental changes, physical therapy and pain management.