Pelvic pain is a common problem among women. Its nature and intensity may fluctuate, and its cause is often unclear. Pelvic pain can be a sign that there might be a problem with one of the reproductive organs in a woman’s pelvic area. The type of pain varies, and it may be sudden and severe (acute pelvic pain) or last 6 months or longer (chronic pelvic pain).  Pelvic pain may originate in genital or other organs in and around the pelvis, or it may be psychological

Causes

  • inflammation or direct irritation of nerves caused by injury, fibrosis, pressure, or intraperitoneal inflammation
  • Contractions or cramps of  smooth muscles
  • Musculoskeletal problems such as fibromyalgia, pelvic floor muscle tension, inflammation of the pubic joint (pubic symphysis) or hernia 
  • Pelvic congestion syndrome,  enlarged, varicose-type veins around uterus and ovaries may result in pelvic pain
  • Some of the more common sources of acute pelvic pain, or pain that happens very suddenly, may include:
  • Ectopic pregnancy (a pregnancy that happens outside the uterus)
  • Pelvic inflammatory disease (also called PID, an infection of the reproductive organs)
  • Twisted or ruptured ovarian cyst
  • Miscarriage or threatened miscarriage
  • Urinary tract infection
  • Appendicitis
  • Ruptured fallopian tube

 Some of the conditions that can lead to chronic pelvic pain may include:

  • Menstrual cramps
  • Endometriosis
  • Uterine fibroids (abnormal growths on or in the uterine wall)
  • Scar tissue between the internal organs in the pelvic cavity
  • Endometrial polyps
  • Cancers of the reproductive tract
  • Psychological factors  Depression, chronic stress or a history of sexual or physical abuse may increase your risk of chronic pelvic pain.
  • Other causes may be related to problems in the digestive, urinary, or nervous systems.

Symptoms of pelvic pain

Pelvic pain varies. It may affect a small area around the pelvis or the whole area.

Types of pelvic pain include:

  • a sharp, stabbing or burning pain that happens suddenly
  • a pain that comes on slowly but does not go away
  • a dull or heavy ache, or feeling of pressure
  • a twisted or knotted feeling
  • a cramping or throbbing pain, which may come and go

Pain only when you’re doing something, like exercising, having sex, or peeing

  • Menstrual cramps
  • Menstrual pain
  • Vaginal bleeding, spotting, or discharge
  • Bloating or gas
  • Blood seen with a bowel movement
  • Constipation, diarrhea
  • Fever or chills
  • Pain in the hip area
  • Pain in the groin area

When to consult a doctor

  • pelvic pain does not go away
  • you have been feeling bloated for a while (about 3 weeks)
  • you’re losing weight without trying to
  • there’s blood in your pee or poo, or an unusual discharge or bleeding from your vagina
  • you have constipation or diarrhea that does not go away

Diagnosis

Pelvic exam: This can reveal signs of infection, abnormal growths or tense pelvic floor muscles.  Doctor checks for areas of tenderness.

Blood tests:  doctor may order labs to check for infections, such as chlamydia or gonorrhea. Doctor may also order bloodwork to check blood cell counts. 

Urinalysis: To check for a urinary tract infection.

Ultrasound: This test uses high-frequency sound waves to produce precise images of structures within the body. This procedure is especially useful for detecting masses or cysts in the ovaries, uterus or fallopian tubes.

Computed tomography (CT scan):  A CT scan shows details of the bones, muscles, fat, and organs, and any abnormalities that may not show up on an ordinary X-ray.

Magnetic resonance imaging (MRI): A noninvasive procedure that produces a two-dimensional view of an internal organ or structure.

Colonoscopy: In this test, the healthcare provider can view the entire length of the large intestine, and can often help identify abnormal growths, inflamed tissue, ulcers, and bleeding

Sigmoidoscopy: A diagnostic procedure that allows the healthcare provider to examine the inside of a portion of the large intestine. It is helpful in identifying the causes of diarrhea, abdominal pain, constipation, abnormal growths, and bleeding

Laparoscopy: A minor surgical procedure in which a laparoscope is using to see inside of the pelvic area, the healthcare provider can determine the locations, extent, and size of any endometrial growths.

Treatment

Medications

    • Pain relievers  Over-the-counter pain remedies, such as aspirin, ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others), may provide partial relief from the pelvic pain.
    • Hormone treatments – Some women find that the days when they have pelvic pain may coincide with a particular phase of their menstrual cycle and the hormonal changes that control ovulation and menstruation. When this is the case, birth control pills or other hormonal medications may help relieve pelvic pain.
  • Antibiotics – If an infection is the source of  pain, doctor may prescribe antibiotics.
  • Antidepressants – Some types of antidepressants can be helpful for chronic pain. Tricyclic antidepressants, such as amitriptyline, nortriptyline (Pamelor) and others, seem to have pain-relieving as well as antidepressant effects. They may help improve chronic pelvic pain even in women who don’t have depression.

Other therapies

    • Physical therapy: Some types of pain, such as muscle and connective tissue pain, respond well to physical therapy. This type of therapy might involve massage, stretching, strengthening, or learning to relax or control pelvic muscles.
    • Neurostimulation (spinal cord stimulation): This treatment involves implanting a device that blocks nerve pathways so that the pain signal can’t reach the brain. It may be helpful, depending on the cause of the pelvic pain.
    • Trigger point injections: If the doctor finds specific points where you feel pain, you may benefit from having a numbing medicine injected into those painful spots
    • Psychotherapy: If the pain could be intertwined with depression, sexual abuse, a personality disorder, a troubled marriage or a family crisis, then it will be helpful to talk with a psychologist or psychiatrist. There are different types of psychotherapy, such as cognitive behavioral therapy and biofeedback. 
  • Lifestyle changes: Some women’s pain is helped by changes in diet, improved posture, and regular physical activity.

Surgery

  • laparoscopic surgery. If you have endometriosis, doctors can remove the adhesions or endometrial tissue using laparoscopic surgery
  • Hysterectomy. In rare complicated cases, your doctors may recommend removal of your uterus (hysterectomy), fallopian tubes (salpingectomy) or ovaries (oophorectomy).

References

https://www.mayoclinic.org/                  (MYOCLINIC)

https://www.hopkinsmedicine.org/     (JOHN HOPKINS MEDICINE)

https://www.nhs.uk/     (NHS)

https://www.nichd.nih.gov/                     (NIH)