Pelvic Pain

What causes pelvic pain?

Pelvic pain can have many causes, such as:

• Inflammation or irritation of nerves caused by injury, fibrosis, pressure, or peritonitis
• Muscle cramps
• A pregnancy that happens outside the uterus (ectopic pregnancy)
• Pelvic inflammatory disease (PID), 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 may include:

• Menstrual cramps
• Endometriosis
• Uterine fibroids (growths on or in the uterine wall)
• Scar tissue between the organs in the pelvic cavity
• Endometrial polyps
• Cancers of the reproductive tract
• Other problems in the digestive, urinary, or nervous systems
• Myofascial pain

What are the symptoms of pelvic pain?

These are examples of the different types of pelvic pain most commonly described, and their possible cause or origin. Always talk with your healthcare provider for a diagnosis.

Type of pain	Possible cause
Local pain	May be from an inflammation
Cramping	May be caused by a spasm in the intestine, ureter, or appendix
Sudden start of pain	May be caused by a short-term lack of blood supply because of a problem with blood flow
Slowly developing pain	May be from inflammation of the appendix or blockage in the intestines
Pain of the entire abdomen (belly)	May be a buildup of blood, pus, or stool in the bowels
Pain made worse by movement or during exam	May be from irritation in the lining of the abdomen

How is pelvic pain diagnosed?

Tests will be done to find the cause of the pelvic pain. Your healthcare provider may ask you questions about the pain, such as:

• When and where does the pain happen?
• How long does the pain last?
• Is the pain related to your menstrual cycle, urination, or sexual activity?
• What does the pain feel like? For example, is it sharp or dull?
• What was happening when the pain started?
• How suddenly did the pain start?

Tell your healthcare provider all you can about the timing of the pain and other symptoms related to eating, sleeping, sexual activity, and movement. This can help with a diagnosis.

The healthcare provider will give you a physical and pelvic exam. You may have tests, such as:

• Blood tests
• Pregnancy test
• Urinalysis
• Culture of cells from the cervix

You may also have tests, such as:

• Ultrasound. This test uses high-frequency sound waves to create an image of organs.
• CT scan. This is an imaging test that uses X-rays and a computer to make detailed images of the body. A CT scan shows details of the bones, muscles, fat, and organs, and any abnormalities that may not show up on an ordinary X-ray.
• MRI. A noninvasive procedure that shows a 2-D 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. Using the laparoscope to see into the pelvic area, the healthcare provider can determine the locations, extent, and size of any endometrial growths.
• X-ray. A small amount of radiation is used to show images of bones and internal organs onto film.
• Colonoscopy. In this test, the healthcare provider can view the entire length of the large intestine. It can often help find growths, inflamed tissue, ulcers, and bleeding. It is done by putting a long, flexible, lighted tube (colonoscope) in the rectum and up into the colon. The colonoscope lets the healthcare provider see the lining of the colon, remove tissue to test, and treat some problems that are found.
• Sigmoidoscopy. This test lets the healthcare provider examine the inside of a part of the large intestine. It can find the causes of diarrhea, abdominal pain, constipation, abnormal growths, and bleeding. A short, flexible, lighted tube (sigmoidoscope) is put into the rectum. The scope blows air into the intestine to inflate it and make viewing the inside easier.

How is pelvic pain treated?

Treatment may include:

• Antibiotics
• Anti-inflammatory medicines
• Pain medicines
• Muscle relaxants
• Relaxation exercises
• Birth control pills
• Surgery
• Physical therapy
• Trigger point injections
• Botox
• Neuromodulators

If a physical cause can’t be found, your healthcare provider may refer you for counseling. This can help you cope with chronic pain. In other cases, you may benefit from:

• Nutrition changes
• Environmental changes
• Physical therapy
• Pain management

Key points about pelvic pain

• Pelvic pain is a common problem in women. Its cause is often unclear.
• Pain can be acute or chronic.
• Treatment will depend on the cause, as found by the physical exam and tests.
• Treatment may include medicines, surgery, physical therapy, or pain management.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new directions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your healthcare provider if you have questions.

Medical Reviewer: Irina Burd MD PhD

Medical Reviewer: Donna Freeborn PhD CNM FNP

Medical Reviewer: Heather M Trevino BSN RNC

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