Pain in the pelvic region, often described as a sharp ache near the ovaries, that flares up during or immediately after a bowel movement is a common, yet frequently alarming, symptom. This specific pain pattern, known medically as dyschezia, signals an underlying physical issue being aggravated by the mechanical process of defecation. Understanding why this happens requires looking at the close anatomical relationship between the organs housed within the limited space of the pelvis.
The Anatomical Connection: Why Bowel Movements Trigger Pain
The ovaries, uterus, rectum, and the final section of the large intestine, the sigmoid colon, are packed closely together within the pelvis. The sigmoid colon, the S-shaped segment connecting to the rectum, sits directly behind the uterus and ovaries. This tight arrangement means that inflammation, swelling, or scarring on one organ can easily affect its neighbors.
During a bowel movement, the sigmoid colon and rectum distend and contract to pass stool, and this physical expansion puts pressure on nearby tissues. This includes the ovaries and the ligaments that support the uterus. If these adjacent structures are sensitive, inflamed, or tethered by scar tissue, the natural process of defecation triggers a painful response.
Primary Gynecological Causes of Pain
Conditions originating in the reproductive system often cause this pain due to their proximity to the lower bowel. These typically involve inflammation or abnormal tissue growth agitated by the mechanical action of defecation.
Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, including on the ovaries, uterosacral ligaments, and the bowel surface. These lesions cause inflammation and scarring (adhesions) that tether organs together. When this tissue adheres to the rectosigmoid colon, the movement of stool stretches the inflamed areas, leading to severe, deep pelvic pain during a bowel movement. This dyschezia is often most pronounced during the menstrual cycle when the ectopic tissue is active.
Bowel involvement in deep infiltrating endometriosis is common, occurring on the rectosigmoid colon in up to 90% of cases where the bowel is affected. The painful stretching and compression of these lesions by passing stool can be debilitating. The chronic inflammatory response also sensitizes surrounding nerves, making the area hypersensitive to minor pressure changes, which contributes significantly to the intensity of the pain felt during defecation.
Ovarian cysts, which are fluid-filled sacs on the ovaries, can also cause pain during bowel movements. A large cyst can physically press against the adjacent sigmoid colon or rectum. As the bowel fills and distends, it pushes against the cyst, causing an ache that intensifies as stool passes.
A more abrupt and severe cause is the rupture of an ovarian cyst or ovarian torsion (twisting of the ovary). Both events cause sudden, sharp pain aggravated by any movement, including muscle contractions during a bowel movement. A ruptured cyst releases irritating fluid into the pelvic cavity, while torsion cuts off the blood supply. In either case, the lower abdomen becomes highly sensitive, and pressure changes from defecation cause intense pain.
Non-Gynecological and Gastrointestinal Contributors
Pain perceived in the ovary area during a bowel movement does not always originate from the reproductive system; it can often be referred pain from the digestive tract or muscular structures. A significant contributor is Irritable Bowel Syndrome (IBS), a disorder of the large intestine characterized by cramping, bloating, and changes in bowel habits.
The abnormal muscle contractions, or spasms, in the colon associated with IBS can be intensely painful. Because the colon is close to the ovaries, the pain from a severe intestinal spasm can be misinterpreted as originating from the reproductive organs. This is often amplified by visceral hypersensitivity, where gut nerves are overly sensitive to normal internal sensations like gas and stretching. Moving stool can thus trigger severe discomfort in the lower abdomen that feels distinctly like ovarian pain.
Pelvic floor dysfunction also contributes to this discomfort. The pelvic floor is a group of muscles that support the organs in the pelvis and are essential for proper bowel and bladder function. When these muscles are chronically tight or unable to relax properly, they can spasm. This muscle tension causes deep, localized pelvic pain that is easily mistaken for ovarian pain, especially when the muscles are strained during defecation.
Other gastrointestinal issues cause this pain by creating excessive pressure in the lower bowel. Chronic constipation leads to a buildup of hard stool in the rectum, physically exerting force on surrounding structures. Conditions like diverticulitis, the inflammation of small pouches in the colon wall, cause localized inflammation irritated by the passage of stool. In these cases, the pain is a direct mechanical or inflammatory response from the bowel, but it is felt in the nearby ovarian area due to shared nerve pathways.
Medical Evaluation and Next Steps
Addressing pelvic pain associated with bowel movements begins with a detailed medical history and a physical examination. The physician will ask about the timing, nature, and intensity of the pain, noting if it is worse during menstruation or with specific foods. A pelvic examination helps identify tenderness, masses, or nodules.
Diagnostic imaging is often the next step to visualize the pelvic and lower abdominal organs. A transvaginal ultrasound is a common tool used to check the ovaries and uterus for masses, such as ovarian cysts or fibroids. For a more detailed assessment, especially when deep infiltrating endometriosis is suspected, magnetic resonance imaging (MRI) may be used to map the extent of lesions or adhesions on the bowel or surrounding structures. If imaging is inconclusive, a minimally invasive surgical procedure called laparoscopy may be performed to directly examine the pelvic organs.
If the pain is sudden and severe, accompanied by fever, vomiting, heavy vaginal bleeding, or signs of shock (like dizziness and rapid heart rate), immediate medical attention is necessary. These symptoms could indicate a medical emergency, such as a ruptured ovarian cyst or ovarian torsion, which requires prompt treatment. For chronic or recurring pain, scheduling a non-urgent appointment with a healthcare provider is the appropriate next step to establish a diagnosis and create an effective management plan.