Pelvic Pain

What is pelvic pain?

Pelvic pain is a common complaint among women. Its nature and intensity may fluctuate, and its cause is often obscure. In some cases, no disease is evident. 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.

What causes 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 (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 which 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."

What are the different types of pelvic pain?

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


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 feels 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.

Diagnostic tests for pelvic pain:

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. Using the laparoscope to see into the pelvic area, the physician can 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.

Treatment for pelvic pain:

Specific treatment for pelvic pain will be determined by your physician 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

Treatment may include:

- Antibiotic medications
- Anti-inflammatory and/or pain medications
- Relaxation exercises
- Oral contraceptives (ovulation inhibitors)
- Surgery
- Physical therapy

If a physical cause cannot be found, pelvic pain 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.