Pelvic pain
What is pelvic pain?
Pelvic pain is pain experienced in the lower abdomen or pelvis. It is a common symptom and can affect people of all ages. The pain may be mild or severe, occur only during certain times of the menstrual cycle, or be present more persistently.
Pelvic pain is not a diagnosis in itself, but rather a symptom that may have many different causes. Identifying the underlying cause is an important step in determining the most appropriate treatment.
What causes pelvic pain?
Pelvic pain can arise from the reproductive organs, urinary tract, bowel, muscles, joints or nerves within the pelvis.
Some of the more common causes include:
Menstrual pain
Period pain (dysmenorrhoea) is one of the most common causes of pelvic pain. During menstruation, the uterus contracts to shed its lining, resulting in cramping that can range from mild discomfort to severe pain.
Urinary tract infection (UTI)
Urinary tract infections occur when bacteria enter the urinary system and cause inflammation.
In addition to pelvic discomfort, symptoms may include:
- pain or burning when passing urine
- frequent urination
- urgency to urinate.
Constipation
Constipation can place pressure on the pelvic organs and surrounding muscles, resulting in lower abdominal or pelvic discomfort.
Endometriosis
Endometriosis occurs when tissue similar to the lining of the uterus grows outside the uterus. It commonly causes pelvic pain that is worse during menstruation but may also cause pain during ovulation, sexual intercourse or bowel motions.
Pelvic inflammatory disease (PID)
Pelvic inflammatory disease is an infection affecting the female reproductive organs, most commonly caused by sexually transmitted bacteria.
Symptoms may include:
- pelvic pain
- abnormal vaginal discharge
- fever
- pain during sexual intercourse.
There are many other possible causes of pelvic pain, which is why a thorough assessment is often required.
What symptoms can occur?
Pelvic pain affects everyone differently.
Depending on the underlying cause, symptoms may include:
- pain in the lower abdomen or pelvis
- pain during menstruation
- pain during sexual intercourse
- pain when passing urine
- pain when opening the bowels
- bloating
- changes in bladder or bowel habits
- abnormal vaginal discharge
- fever.
The timing, severity and pattern of your pain often provide important clues to the underlying cause.
How is pelvic pain diagnosed?
Your doctor will begin by asking detailed questions about your symptoms, including:
- when the pain started
- where the pain is located
- whether it occurs during particular stages of your menstrual cycle
- what makes it better or worse
- whether there are associated bowel, bladder or gynaecological symptoms.
A physical examination may also be recommended, including a pelvic examination where appropriate.
Further investigations depend on your symptoms and may include:
- urine tests
- blood tests
- pelvic ultrasound
- magnetic resonance imaging (MRI) in selected situations.
These investigations help identify, or exclude, conditions that may require treatment.
Treatment for pelvic pain
Treatment depends entirely on the underlying cause of the pain.
Menstrual pain
Simple pain relief, including non-steroidal anti-inflammatory medications (NSAIDs), is often effective for menstrual cramps.
Urinary tract infection
Urinary tract infections are usually treated with antibiotics.
Constipation
Increasing dietary fibre, maintaining adequate hydration and addressing bowel habits may relieve constipation-related pelvic pain.
Endometriosis and pelvic inflammatory disease
More complex conditions such as endometriosis or pelvic inflammatory disease often require specialist assessment.
Treatment may include:
- hormonal medication
- antibiotics
- surgery
- other condition-specific treatments.
Your doctor will recommend the most appropriate management based on the underlying diagnosis.
When should I seek medical advice?
You should seek medical assessment if pelvic pain:
- is severe
- persists or recurs
- interferes with your daily activities
- is associated with fever
- occurs with abnormal vaginal bleeding or discharge
- develops during pregnancy
- is accompanied by difficulty passing urine or opening your bowels.
Early assessment helps identify conditions that may require prompt treatment.
What can I expect?
Most causes of pelvic pain can be investigated and managed effectively once the underlying diagnosis has been established.
Sometimes the cause is straightforward and easily treated. In other situations, further investigations or referral to a gynaecologist or another specialist may be required.
The most appropriate treatment depends on the condition responsible for your symptoms.
What to remember
Pelvic pain is common, but it should not be dismissed as something you simply have to live with.
Because there are many possible causes, an accurate diagnosis is the first step towards effective treatment. If pelvic pain is affecting your quality of life or is becoming more frequent or severe, it is important to discuss your symptoms with your GP or specialist.
Further information
For additional evidence-based information about pelvic pain, visit Jean Hailes for Women’s Health.
https://www.jeanhailes.org.au/news/pelvic-pain-know-the-differences-and-when-to-seek-help
This article is intended for educational purposes only and should not replace personalised medical advice, diagnosis or treatment. Every article is written by a qualified specialist clinician and independently reviewed by a second specialist clinician to help ensure clinical accuracy and reflect current evidence-based practice.
