The pelvis protects the reproductive organs and is located in your lower abdomen (where the abdomen meets your legs). Pelvic pain may extend to the lower abdomen making it difficult to diagnose and differentiate from the abdominal pain. 

The article details different pelvic pain causes, symptoms, and its management. Some common causes include abnormalities of the organs, infections, and pain in the pelvic bones.

Management of the pelvic pain depends on the cause. If you face a long-standing pelvic pain, it is best to consult your physician. They will help find the cause and manage it accordingly.

Overview

Pelvic pain is pain felt below your belly button and between your hips. It is of two main types, acute and chronic pain. Acute pelvic pain is the pain lasting for less than three months. On other hand, chronic pelvic pain is pain that lasts for more than six months or longer.

There are many reasons for this type of pain. It may be due to an underlying condition or can be a disorder on its own. If a disease condition causes your problem, treating it may be sufficient to get rid of your pain.

However, it might be difficult to find a cause in some cases. In such cases, the primary aim of the treatment is to alleviate pain and other symptoms.

Reason for Pelvic Pain

Usually, the pelvic pain is an indicator of a problem with any of the reproductive organs in a woman, such as fallopian tubes, ovaries, vagina, and cervix.

However, it can be present in either sex and may stem from other causes. Pelvic pain may be due to infection, the problem in non-reproductive organs, or pain in the pelvis bone.

Symptoms

Some common symptoms and type of pain are:

• Intermittent pain or pain that comes and goes
• Severe and steady pain
• Cramping or sharp pains
• Dull aching
• Heaviness or pressure deep within your pelvis

You may also have:

• Pain while passing stools or urinating
• Pain during intercourse
• Pain if you sit for an extended period of time

The pain or discomfort may intensify after standing for long and improves when you rest or lie down. The intensity of pain may be different for every woman and can be mild, severe, or annoying.

Causes

Some common causes are:

Pelvic Inflammatory Disease

It is an infection of the female reproductive organs and is mainly caused by a sexually transmitted disease such as gonorrhea or chlamydia.

Women may have no symptoms when the infection occurs. If left untreated, the pelvic inflammatory disease may cause severe complications such as severe and long-standing pain in the abdomen or pelvis.

Some other symptoms are fever, heavy vaginal odor and discharge, bleeding during intercourse, and pain or difficulty during urination. Other complications include scarring of the reproductive organs, infertility, ectopic pregnancy, and abscesses.

Endometriosis

It is caused by the growth of the uterine tissue outside the uterus and can occur at any time during your reproductive years. The tissue grows and sheds in response to your cycle, just like it would within the uterus.

Endometriosis may result in pain of varying degree and is most severe during menses. The pain may also be experienced during bowel or bladder movements. The pain originates in the pelvis and may extend to the abdomen.

While it is rare, endometriosis may also affect the diaphragm and lungs. Along with pelvic pain, it may also cause other symptoms such as nausea, infertility or sub-fertility, heavy periods, and bloating.

Management of pain involves OTC painkillers and surgical procedures, such as laparoscopy. If endometriosis affects your fertility, options such as in vitro fertilization can help.

Ovulation

Many women may get a temporary, sharp pain during ovulation. This kind of pain lasts only a few hours and improves with OTC pain medicines.

Menstruation

Pelvic pain can also occur during or before menses and is experienced as cramps in the lower abdomen or pelvis. However, pain severity may be different during each menstrual cycle.

Pelvic pain before menses is known as premenstrual syndrome. But if the pain is so severe that it interferes with your daily activities, it is known as dysphoric disorder (PMDD). Some other symptoms of PMS and PMDD are irritability, anxiety, mood swings, joint pain, bloating, insomnia, tender breasts, and headache. Majority of the time, these symptoms resolve after the onset of menses. 

On the other hand, pain during menses is known as dysmenorrhea. The pain is felt like cramps in the abdomen or a nagging pain in the lower back and thighs.

Other symptoms include headache, vomiting, nausea, and light headedness. If you have severe pelvic pain during or before menses, OTC medicines may help. You can also discuss the same with your doctor.

Ovarian Torsion

It is a condition where your ovary twists on its spindle. Ovarian torsion may result in an immediate, excruciating, sharp pain along with nausea and vomiting. The pain may also occur as intermittent cramping during the initial days.

Ovarian torsion needs emergency treatment, which is a surgery. So, if you face anything like this, seek medical care immediately.

Ovarian cyst

In most of the cases, ovarian cysts do not cause any symptoms. If the cysts are large, they may cause sharp or dull pain on either side of the abdomen or pelvis. The pain may be associated with heaviness or bloating.

If the cyst ruptures, it results in sudden and sharp pain. 

Although ovarian cysts resolve on their own, persistent symptoms need medical care. Your doctor may advise its removal if it is large, to avoid its rupture.

Uterine Fibroids 

They are benign growths in your uterus. Symptoms differ according to the size and location and some women may not have any symptoms at all. Larger fibroids may result in a feeling of heaviness, pressure, or dull pain in the lower abdomen or pelvis.

Other symptoms of fibroids include heavy periods, leg pain, back pain, bleeding during intercourse, problems with urination, and constipation. They may also cause infertility.

If fibroids outgrow their blood supply, they start to die and result in sharp and severe pain.

Seek emergency medical care if you have sharp pelvic pain, trouble voiding your bladder, long-term pelvic pain, and heavy bleeding between periods.

Gynecologic Cancers

Cancer can affect the endometrium, uterus, ovaries, and cervix. Some common symptoms include a dull, aching pain in the abdomen and pelvis. It may also cause unusual vaginal discharge and pain during intercourse.

Getting regular physical examination and checkups can help spot cancers early when they are easier to manage.

Pelvic pain in pregnancy

Usually, pelvic pain during pregnancy is common and should not be worried about. As your body grows, the ligaments and bones stretch, resulting in discomfort or pain. 

However, if the pain bothers you or makes you nervous, it is better to discuss it with your doctor. This is especially true if the pain is associated with vaginal bleeding or lasts for an extended period of time.

Some common causes of pain during pregnancy are:

• Braxton-Hicks contractions: This type of pain is also referred to as false labor and mainly occurs during the third trimester. They may be caused due to the baby’s movements, physical exertion, and dehydration. While Braxton-Hicks contractions are comfortable, they are not intense. They also do not increase in intensity or come at regular intervals. 
• Miscarriage: It is a condition where the pregnancy is lost before 20 weeks of gestation. Miscarriage is often associated with abdominal cramps, tissue or fluid flow from the vagina, bright red spotting, vaginal bleeding, or pain in the abdomen, pelvis, or lower back. If you have some of these symptoms, it is best to consult your doctor immediately.
• Premature labor: When labor happens before 37 weeks of pregnancy, it is known as early labor. Some common symptoms include sharp and timed contractions, fatigue, lower back pain, abnormal vaginal discharge, cramps in the stomach without diarrhea. Other symptoms include passing of mucus plug and fever. Premature labor is a medical emergency. 
• Placental abruption: The placenta provides nutrition and oxygen to the growing baby. In rare cases, the placenta detaches from the uterine wall, resulting in placental abruption. Some common symptoms include vaginal bleeding and pain and tenderness in the back or abdomen. While placental abruption is common in the third trimester, it can occur anytime after 20 weeks of gestation.
• Ectopic pregnancy: It is a condition where the fertilized egg implants in the fallopian tube or other parts of the reproductive tract instead of the uterus. Chances of abortion are high and may cause rupture of the fallopian tube, resulting in internal bleeding. Some common symptoms are intense, sharp pain and vaginal bleeding. The pain may initiate in the pelvis or abdomen and may extend to the neck or shoulder. It may resolve with medicines or need surgery to manage it.

Other Causes

Some other causes include:

• Appendicitis
• Diverticulitis
• Pelvic floor muscle spasm
• Kidney stones
• Enlarged spleen
• Chronic constipation
• Hernias
• Ulcerative colitis

Diagnosis

To find the cause of your problem, your doctor will take your history, including the type and location of pain and other associated symptoms. They may also advise a pap smear if you did not have it in the last three years.

Your doctor may also conduct a physical check to look for tender spots in the pelvis and abdomen.

Some tests that can help your doctor to find of the cause are:

• Pelvic ultrasound
• Blood and urine test
• Pelvic MRI
• CT scan
• Colonoscopy
• Pelvic laparoscopy
• Cystoscopy

What You Can Do

Pelvic pain may resolve with OTC painkillers. But you need to check with your doctor before taking any medicine, especially if you are pregnant. 

You can also try the following:

• Place a hot water bottle on the abdomen
• Take a warm bath
• Elevate your legs
• Try yoga and meditation
• Herbs such as willow bark

Treatment

Your doctor will find out the underlying cause of your pelvic pain and treat it accordingly. Some treatment options include:

• Hormonal treatment or birth control pills for problems associated with your periods
• Medicines to manage infection or irritable bowel syndrome
• Surgery to remove a cyst, growth, or tumor

A long-standing pain is a condition in itself. Whether the underlying cause is determined or not, your doctor will help you manage it. You may also get relief from combination treatment such as:

• Nonsteroidal anti-inflammatory drugs such as naproxen and ibuprofen
• Anticonvulsants or tricyclic antidepressants
• Biofeedback or cognitive-behavioral therapy
• Counseling
• Painkillers
• Physical therapy

You may need to try various treatment options to know what works the best for you. Besides, taking an active part in your treatment makes you hopeful.

Living With

Pelvic pain can be irritating and frustrating, especially when it is long-lasting. Sometimes it may be difficult to know how long the pain will last and the best suitable treatment for you. As the severity and cause are different, its management is also different.

In general:

• When the cause is found, treating it will help resolve your pelvic pain.
• If it is difficult to spot a cause, the doctor may advise some tests and recommend certain treatments to see what works for you.
• Symptoms as a result of hormonal fluctuations resolve without treatment once hormonal imbalance settles or menopause occurs

It is also important to understand that certain factors increase your risk for chronic pelvic pain, including:

• Pelvic inflammatory disease history
• History of surgery or radiation of the pelvis or abdomen
• History of sexual or physical abuse
• Substance use disorder
• Depression
• Abnormality in the structure of female genital organs
• Childbirth and pregnancy that puts pressure on the pelvis and back, such as a difficult delivery, large baby, or a vacuum or forceps delivery.

Final Thoughts

Pelvic pain is a prevalent condition with a wide range of causes. It can be acute or long-standing in nature. Pelvic pain usually responds to OTC painkillers and home remedies.

However, it may be due to a severe underlying condition, requiring emergency medical care. So, it is always a good idea to consult your doctor if you have pelvic pain, especially if it occurs regularly. They will help find out the cause and treat them.

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