Pelvic pain is discomfort in the area below the abdomen and between the hip bones. This pain can be acute, with a sudden and severe onset, or chronic, persisting for six months or longer. Chronic pain may be constant or intermittent. Because the pelvic region houses organs from different body systems, determining the source of the pain can be complex, making a thorough evaluation necessary.
Gynecological Origins of Pelvic Pain
Many cases of pelvic pain in women originate from the reproductive organs. One common cause is endometriosis, a condition where tissue similar to the uterine lining grows elsewhere in the pelvic cavity. This misplaced tissue responds to the menstrual cycle, thickening and bleeding, which can lead to inflammation, scar tissue, and chronic pain that often worsens during menstruation. The pain is frequently described as a persistent, deep ache in the pelvis or lower back.
Uterine fibroids, noncancerous growths of muscle and fibrous tissue, can also be a source of discomfort. While many fibroids cause no symptoms, larger ones can exert pressure on surrounding structures like the bladder or rectum. This pressure can result in a feeling of fullness in the lower abdomen, frequent urination, constipation, and pain in the lower back or during intercourse. In some instances, a fibroid may outgrow its blood supply and begin to degenerate, causing acute, localized stabbing pain.
Ovarian cysts, fluid-filled sacs that form on or within an ovary, are another frequent cause of pelvic pain. Most of these cysts are harmless and resolve on their own, but some can cause a dull ache or a feeling of pressure. The pain can become sudden and severe if a cyst twists or ruptures, releasing fluid into the pelvic cavity. This event can also be accompanied by symptoms like spotting, bloating, and dizziness.
Pelvic Inflammatory Disease (PID) is an infection of the uterus, fallopian tubes, or ovaries, often stemming from sexually transmitted bacteria. The pain associated with PID can range from mild to severe lower abdominal tenderness. It is often accompanied by fever, unusual vaginal discharge, and pain during urination or sex. Left untreated, PID can lead to scarring of the pelvic organs, which may result in chronic pain.
An urgent gynecological cause of pelvic pain is an ectopic pregnancy. This occurs when a fertilized egg implants outside of the uterus, most commonly in a fallopian tube. As the pregnancy grows in a location that cannot expand, it can cause sharp, one-sided pelvic pain, vaginal bleeding, and dizziness. An ectopic pregnancy is a medical emergency because the fallopian tube can rupture, leading to life-threatening internal bleeding.
Non-Gynecological Origins in the Abdomen and Pelvis
Pain felt in the pelvis does not always originate from the reproductive system and can be referred from other organ systems. Gastrointestinal conditions are a frequent source of such pain. Irritable Bowel Syndrome (IBS) can cause cramping and discomfort in the lower abdomen that may be perceived as pelvic pain. Appendicitis, the inflammation of the appendix, causes sharp pain in the lower right abdomen, while diverticulitis can lead to steady, severe pain in the lower abdomen.
The urinary system is another common source of pelvic discomfort. Urinary tract infections (UTIs) can cause a sensation of pressure in the lower pelvis, along with frequent and painful urination. A more chronic condition, bladder pain syndrome or interstitial cystitis, involves long-term pain and pressure in the bladder area, often with urinary urgency. Kidney stones, as they travel from the kidney down through the ureter, can cause intense, sharp pain that may radiate into the pelvic region.
Musculoskeletal problems can also manifest as pelvic pain. Pelvic floor muscle dysfunction, where the muscles that support the pelvic organs are tight or weak, can lead to a persistent, deep ache in the pelvis. Inguinal or femoral hernias occur when tissue pushes through a weak spot in the abdominal muscles, which can cause a bulge and pain in the groin or pelvic area. Pain can also originate from issues in the hip joints or the lower back and radiate downwards.
The Diagnostic Evaluation Process
To determine the cause of pelvic pain, a healthcare provider initiates a diagnostic evaluation, beginning with a detailed patient history. The patient will be asked to describe the pain’s specific location, intensity, and duration. It is also important to note whether the pain is constant or intermittent, and if it has any relationship to the menstrual cycle, urination, or bowel movements. This information helps the provider narrow down potential sources.
Following the patient history, a physical examination is performed. This includes an abdominal exam, where the provider will gently press on different areas of the abdomen to check for tenderness or masses. A pelvic exam may also be conducted to assess the health of the reproductive organs. These examinations help identify physical abnormalities that could be contributing to the pain.
Laboratory tests are often a next step in the diagnostic process. Blood tests can be used to check for signs of infection or to rule out pregnancy. A urine sample will be collected to test for a urinary tract infection or the presence of blood, which could indicate kidney stones. If a sexually transmitted infection is suspected as the cause of PID, screenings will be conducted.
When more information is needed, imaging studies are employed to visualize the internal structures of the pelvis and abdomen. An ultrasound is frequently the first imaging technique used, as it provides a clear view of the uterus, ovaries, and bladder, and can identify issues like fibroids or ovarian cysts. For a more detailed look at other organs or complex cases, a CT scan or MRI may be ordered to provide cross-sectional images of the bones, organs, and other soft tissues.
When to Seek Medical Attention
It is important to know when pelvic pain requires immediate medical care versus when it is appropriate to schedule a doctor’s appointment. Certain symptoms are considered red flags and warrant a trip to the emergency room.
- The sudden onset of severe and debilitating pain
- A high fever
- Persistent nausea and vomiting
- Heavy vaginal bleeding or pelvic pain that occurs during a known pregnancy
For pelvic pain that is less severe but still concerning, scheduling an appointment with a healthcare provider is the best course of action. Medical attention should be sought for pain that is persistent, does not resolve on its own, or recurs regularly. If the pain begins to interfere with daily activities, such as work or sleep, it is a clear sign that a medical evaluation is needed to determine the cause.