What causes pelvic pain?

The pelvis is the lowest part of the stomach area just above the vagina.

The pain experienced in that area can be sudden and last for a short time or it can last a long time and happen repeatedly for six months or more.

The pain can come from the:

• Reproductive system, which includes the organs and tissues involved in pregnancy and childbirth;
• Urinary system, which refers to the bladder, urethra, ureter and kidneys that remove waste from the body through urine; or the
• Digestive system, which takes in, digests and absorbs nutrients from food and drink.
• It can also refer to symptoms that come from muscles and connective tissue called ligaments in the pelvis.

Depending on its source, the pain can have different characteristics. It may be dull or sharp, constant or sporadic or it may be mild to severe.

The pain can spread to the lower back, buttocks or thighs. You might notice it only at certain times like when you use the bathroom or during sex.

Sudden and severe pelvic pain may be an emergency and you need to get medical care right away. Be sure to get pelvic pain checked by your doctor or other healthcare professional if it’s new, disrupts your daily life or gets worse over time.

Causes

Pelvic pain may be caused by many types of diseases and other health conditions. Occasionally, the pain can be due to more than one condition.

It can start in the digestive, reproductive or urinary systems. Some pelvic pain can also come from certain muscles or ligaments, for example, by pulling a muscle in the hip or the pelvic floor.

Pelvic pain might also be caused by irritation of nerves in the pelvis.

Female reproductive system

Conditions that may cause pain in the reproductive system include:

• Adenomyosis
• Endometriosis
• Ovarian cancer
• Ovarian cysts
• Pelvic inflammatory disease (PID)
• Uterine fibroids
• Vulvodynia
• Dysmenorrhoea or period pain.

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Pregnancy complications

Pelvic pain is an emergency if you are pregnant. It may be due to:

• Ectopic pregnancy
• Intrauterine foetal death
• Miscarriage
• Preterm labour
•  Placental abruption.

Non-reproductive causes

Health conditions not related to reproduction that may cause pelvic pain, even in men, include:

• Appendicitis
• Colon cancer
• Constipation
• Crohn’s disease
• Diverticulitis
• Intestinal obstruction
• Irritable bowel syndrome
• Ulcerative colitis
• Interstitial cystitis
• Kidney infection
• Kidney stones
• Urinary tract infection
• Fibromyalgia
• Inguinal hernia
• Pelvic floor muscle spasms.

Diagnosis

The possible causes of pelvic pain are wide and varied and you need to be thoroughly examined before taking pain medication as some causes can be life-threatening.

Your doctor will first take a full history of your symptoms. The following will then happen:

• Pelvic exam. The doctor will feel your pelvis to accurately locate the pain and will ask you to confirm as they examine around your pelvis. They will also feel for unusual growths or tense pelvic floor muscles.

• Sonar or ultrasound. The doctor will first want to exclude pregnancy to ensure the pain is not one of its complications. This test uses sound waves to make pictures of tissues, organs and other parts inside the body. It can help find growths or cysts in the ovaries, uterus or fallopian tubes.

• Laboratory tests. These will include bedside tests like urine dipstick and pregnancy tests. Then blood tests to test for infections.

• Laparoscopy. The need for this test will be determined by the tests conducted. It is a surgical procedure where a small cut is made in the stomach area.
  
  A thin tube with a small camera is placed through the cut. The camera lets the surgeon look at your pelvic organs and check for unusual tissues or infections. This procedure can help to find and treat problems such as endometriosis and chronic pelvic inflammatory disease.

Treatment

The aim of treatment is to make sure the cause is treated and to relieve the pain because it can cause anxiety.

With chronic pelvic pain, the goal of treatment is to ease your symptoms and improve your quality of life. Depending on the cause, you may need more than one treatment.

Medications

• Antibiotics. If an illness caused by bacteria is the source of your pain, you may need antibiotics.

• Pain relievers. Medicines that you can buy over the counter may ease some of your pain. These include painamol, aspirin and ibuprofen. When indicated, more stronger pain medication may be prescribed especially if pain is chronic.

• Hormone treatments. Some women find that the days they have pelvic pain may overlap with a phase of their period. When this is the case, birth control pills or other hormonal medicines may help relieve pelvic pain.

• Antidepressants. Some types of medicines that treat depression can also be helpful for chronic pain. Your doctor will guide you on the use of these.

•  Muscle relaxants. These might help relax muscles linked with chronic pelvic pain.

Surgery

Your doctor might suggest surgery including:

• Laparoscopy. This can treat or remove the tissue outside the uterus that causes pain.
• Evacuation of uterus. If you have had a miscarriage or foetal death.
• Hysterectomy. In rare cases, your uterus may need to be removed, called a hysterectomy.

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