Pelvic pain, which is a condition more common in women than men, is typically felt in the lower abdomen and pelvis. Pain that is associated with a gynaecological condition generally occurs around the time of or is aggravated by the menses or sexual intercourse. However, many patients complain of pelvic pain which might be associated with intestinal complaints like constipation or Irritable Bowel Syndrome.
Pelvic pain may be acute or chronic, it may be dull or sharp with a slow or rapid onset, depending on the cause. Patients experiencing symptoms for six months or more have what is termed chronic pelvic pain. If you are experiencing pelvic pain which is causing you concern or affecting your work, quality of life and sexual function, you should make an appointment to see a gynecologist.
What Causes Pelvic Pain?
There are many causes of pelvic pain, some of which are much more serious than others. some of which are listed below.
Acute pelvic pain is pain that manifests itself suddenly and for the first time. If you are experiencing this type of pelvic pain, it is important to seek immediate medical attention.
Menstrual pain illustration. Symptoms of pms pain.
In women who are not pregnant, there are several common causes of acute pelvic pain, which include:
- Gynaecological problems
- Ovulation: ovulation means releasing an egg from your ovary. Some women develop a sharp pain when an egg is released. This ovulation pain is called “Mittelschmerz” (middle pain – because it occurs mid-cycle). The pain may be on a different side each month, depending on which ovary releases the egg. This pain only lasts a few hours but some women find it is severe.
- Period pains (dysmenorrhoea): most women have some pain during their periods. The pain is often mild but, in about 1 in 10 women, the pain is severe enough to affect day-to-day activities. The pain can be so severe that they are unable to go to school or work. Doctors may call period pain ‘dysmenorrhoea’.
- Pelvic inflammatory disease (PID): PID is an infection of your womb. Germs (bacteria) that cause the infection usually travel into your womb from your vagina or cervix. Most cases are caused by the sexually transmitted bacteria, chlamydia or gonorrhoea. Symptoms of PID include pain in your lower abdomen or pelvis, high temperature (fever), abnormal vaginal bleeding and a vaginal discharge.
- Rupture or torsion of ovarian cyst: an ovarian cyst is a fluid-filled sac which develops in an ovary. Most ovarian cysts are non-cancerous (benign) and cause no symptoms. Some cause problems such as pain and irregular bleeding. Pain may happen when they burst (rupture) or twist (called torsion). No treatment may be needed for certain types of ovarian cysts which tend to go away on their own. Read more about ovarian cysts.
- Fibroid degeneration: fibroids are non-cancerous growths which can occur in your womb. They are common and usually cause no symptoms. However, they can sometimes cause heavy periods, abdominal swelling and urinary problems. Rarely, the fibroid outgrows its blood supply leading to degeneration, which can be very painful.
- Endometriosis: this is a condition found in women between the ages of 13 and 50. It is most commonly diagnosed in women in their thirties. It can be found in 1 in 5 women who are having problems conceiving. Typically, pain occurs or worsens around the time of your period and after sexual activity.
Appendicitis: appendicitis is a common condition resulting from inflammation of your appendix. Typical symptoms include abdominal pain, vomiting that gradually get worse over 6-24 hours and loss of appetite. An operation to remove the inflamed appendix is usually done before it bursts (ruptures).
Irritable bowel syndrome (IBS): IBS is a common gut disorder. The cause is not known. Symptoms can be quite variable and include abdominal pain, bloating, and sometimes bouts of diarrhoea and/or constipation. Symptoms tend to come and go. There is no cure for IBS but symptoms can often be eased with treatment.
Cystitis: is a common female condition,which is an infection of the bladder. Symptoms include increased frequency of and burning upon urination. A short course of antibiotics along with increased fluid intake resolve this problem in most cases.
Interstitial Cystitis: if you have symptoms of cystitis but there are no signs of infection when your urine is tested, you may have Interstitial cystitis. This is a poorly understood condition where the walls of the bladder are inflamed. It is a cause of long-term pain. It is also called ‘painful bladder syndrome’.
Adhesions: adhesions may occur after surgery. As your body tries to heal after surgery, the tissues become sticky and some tissues may stick together. The most commonly affected organ is the bowel. This may result in long term pain.
Strangulated hernia: a hernia occurs where there is a weakness in the wall of the abdomen that at times allows parts of the intestines to push through. In most cases this may just result in a visible or palpable lump, but occasionally the intestines are squeezed between the defect in the muscle wall causing pain and possibly damage to the intestines requiring surgery.
Pelvic pain which has lasted for six months or more is known as chronic and affects around 1 in 6 women. This type of pain may be sporadic or constant in nature. Some women complain of constant pain which may be worsened by certain factors like eating spicy foods, sexual activity or even physical activity. Most women seek help when these symptoms start to have negative effects on their lives.
If you are experiencing chronic pelvic pain, you should take time out of your busy schedule to take care of your health and have a consultation with a qualified gynaecologist. There are several common causes of this type of pelvic pain, some of which are the same as acute pelvic pain and have been mentioned above:
- Endometriosis
- Pelvic Inflammatory Disease
- Irritable Bowel Syndrome – which is a long-term condition affecting many people. Symptoms include bloating, abdominal (stomach) cramps, constipation and diarrhoea.
- Inflammatory Bowel Disease – which includes two chronic conditions; Crohn’s Disease and Ulcerative Colitis.
- A hernia – which means an internal body part has pushed through into the muscle or tissue wall surrounding it
- Recurrent ovarian cysts
- Recurrent Urinary Tract Infections (UTIs) (Cystitis)
- Pain due to dysfunction of the lower back and pelvic bones
- Fibroids– may cause chronic pain due to degeneration or pressure, if they become large.
- Uterine prolapse – occurs when the womb has slipped partially or fully into the vagina resulting in a persistent dragging sensation.
- Adenomyosis – a type of endometriosis which penetrates into the muscle of the womb leading to painful heavy periods.
- Chronic Interstitial Cystitis – which is a long-term condition where the bladder is inflamed.
Most causes of pelvic pain, like bladder infections or sexually transmitted diseases are easily treated. However, if left untreated or improperly treated or ignored, they may lead to serious consequences like chronic pelvic pain. In some instances, the cause may be an undiagnosed ectopic pregnancy which left untreated, could rupture and lead to death.
Should you see your “family doctor” and a clear diagnosis is not made, help from a gynaecologist may shed light on the problem and bring resolution to the problem. Keeping a record of your pain symptoms, inclusive of when they occur relative to your periods, aggravating and relieving factors, along with any previous investigations or treatments used, would be helpful at your initial gynaecological assessment. This would save time and money as both tests and treatments which yielded no positive results need not be repeated.
Investigation And Clinical Diagnosis
During your initial consultation you will be asked some questions about your symptoms, medical history and likely have a gynaecological exam performed. Based on what is found, further investigations may be advised.
As urinary infections are a very common cause of pelvic pain, a urine sample may be sent for testing. Vaginal or cervical swabs may be required to test for infections such as gonorrhoea and a pregnancy test done if you have missed your period. Based on your history an ultrasound might be performed to rule out ectopic pregnancies, ovarian cysts or fibroids.
Laparoscopy is commonly undertaken by gynaecologists when pain persists and a cause has not been found. In this procedure, a small telescope is put through a small cut in your belly button. This allows the doctor to see inside your pelvis. A see and treat technique is generally employed, that is, if adhesions or cysts are seen at laparoscopy they can be treated at the same time.
Alternatively, if the cause is likely due to intestinal problems, doctors who specialise in the bowel may use flexible telescopes to look inside your bowel. This is called a colonoscopy and it is routinely recommended for all patients over 50 as a screening tool for colon cancer.