Pelvic Pain: Types, Causes, Symptoms, Treatment

Pelvic pain mostly occurs in the lower abdominal area. The pain may be constant, or it may come and go. If the pain is severe enough, it may affect the performance of daily activities.

Females may experience a dull pain during periods. Other times the pain can also happen during sex. Pelvic pain indicates that there may be a problem with one of the organs in the pelvic area such as the ovaries, uterus, fallopian tubes, cervix, or vagina. Pelvic pain could also indicate an underling infection or problem with the lower intestines, urinary tract, rectum, muscle or bone. In males, the cause for pelvic pain is often problems with the prostate gland.

• Acute Pelvic Pain: Acute pelvic pain suddenly starts over a short period of time and can be anywhere from a few minutes to a few days. Acute pain is often an indication or a warning of something being wrong that needs immediate attention. Acute pelvic pain can indicate a problem with bowel, bladder, bowel, or appendix can produce pain in the pelvic region. There might be other causes as well like pelvic inflammatory disease, vaginal infections, vaginitis, and sexually transmitted diseases.
• Chronic Pelvic Pain: Chronic pelvic pain can be constant or can be intermittent. Intermittent pain usually has a singular specific cause whereas constant pain may be the product of more than one problem. Most common example of chronic pelvic pain is dysmenorrhea or menstrual cramps. Adenomyosis, endometriosis, and ovulation pain are few other causes of chronic pelvic pain.

Given below are few examples of the different types of pelvic pain commonly described by women with the possible cause and origin.

• Localized Pain: Inflammation is the likely cause.
• Colicky Pain: May be the result of spasming of soft organ such as the intestine, appendix or ureter.
• Sudden Onset of Pain: May be the result of temporary deficiency of blood supply most probably because of an obstruction in the blood circulation.
• Slowly-developing Pain: Inflammation of appendix or an intestinal obstruction may be the culprit.
• Pain Involving the Entire Abdomen: This may suggest accumulation of pus, blood, or intestinal contents.
• Pain Aggravated by Movement or During Examination: Irritation in the lining of the abdominal cavity may be the likely cause.

Chronic pelvic pain is quite common, mostly affecting the females. Approximately 1 in 7 women are affected. A study of reproductive-aged women in primary care practices demonstrated prevalence rate of pelvic pain to be 39%. About 10% of the referrals made to gynecologists are for pelvic pain.

The hypothesis of limbic-associated pelvic pain is designed to account for many of the features seen in these patients, but as such the pathophysiology underlying the development of chronic pain is unknown.

• Inflammation along with direct irritation of nerves which may be as a result of fibrosis, trauma, pressure, and/or inflammation of intraperitoneal areas.
• Muscle contractions as well as cramps of both skeletal and smooth muscle.
• Psychogenic factors tend to aggravate pain.

• Ectopic pregnancy.
• Pelvic inflammatory disease.
• Ruptured fallopian tube.
• Twisted ovarian cyst.
• Ovarian cyst rupture.

• Miscarriage/threat of miscarriage.
• Appendicitis.
• Urinary tract infections.

• Endometriosis.
• Menstrual cramps.
• Uterine fibroids.
• Endometrial polyps.
• Adhesions between internal organs in pelvic cavity.
• Reproductive tract cancers.

This unrelenting long-term pain may often cause breakdown of defense of a female resulting in behavioral and emotional distress. Chronic pelvic pain syndrome is term used to describe such condition.

Prostatitis is a common cause in males for pelvic pains, which is generalized pain and discomfort around the pelvis region; however, the pain may also be present in and around the testes, penis, anal area or lower back. The pain or discomfort may be constant or may be intermittent. Pelvic pain associated with prostatitis may be more severe with ejaculation or urination.

Pelvic pain in females relates to pain affecting the lower abdominal area and pelvis. Chronic female pelvic pain is often defined as pelvic pain that may have persisted for at least six months.

• Pain that ranges from dull to sharp.
• Pain that ranges from mild to severe.
• Severe cramping during periods.
• Pain during sex.
• Pain while urinating or having a bowel movement.

• Blood in the urine or stool.
• Heavy or irregular vaginal bleeding.
• Vaginal bleeding after intercourse.
• Depression symptoms also are commonly linked to chronic pain.

Prostatitis is the common cause of pelvic pain in males. The pain or discomfort may be constant or may be intermittent. Pain may be more severe with ejaculation or urination.

Treatment for pelvic pain is dependent on root cause that needs to be diagnosed before beginning any treatment. Treatment is based on:

• Medical history and overall health.
• Degree of condition.
• Cause of condition.
• Tolerance to specific drugs or therapy.
• Expectations for course of condition.

• Antibiotic medication.
• Anti-inflammatory medications.
• Relaxation techniques.
• Oral contraceptive.
• Physical therapy (PT).

In the absence of physical cause, pelvic pain can be associated to psychological coping mechanism from trauma. Psychotherapy is recommended for some of the cases. A multidisciplinary treatment is recommended in few other cases utilizing a various approaches including nutritional modification, physical therapy (PT), environmental changes, etc.

A complete medical history, physical and pelvic examination is the first step towards the investigation.

• Blood tests.
• Urinalysis.
• Pregnancy test.
• Culture of cells from the cervix.
• Ultrasound.
• Magnetic resonance imaging (MRI).
• Computed tomography (CT).
• X-ray.
• Laparoscopy.
• High vaginal swab for bacteria and endocervical swab.
• FBC.