Pelvic pain
Pelvic pain occurs in the lower abdomen and pelvis. The pain can originate from organs close by, such as any of the reproductive organs, the digestive or urinary systems, or from the surrounding muscles and ligaments.
It predominantly affects women, and may be acute, lasting a short time, such as in period cramps or a urinary tract infection, or persisting as a chronic condition. Chronic pelvic pain is defined as intermittent or continuous pelvic pain that lasts for longer than 6 months and affects around 1 in 6 women.
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What causes pelvic pain?
For women, any conditions related to the reproductive organs can cause pelvic pain, including period pains either before or during menstruation, pelvic inflammatory disease, endometriosis, adenomyosis or fibroids, ovarian cysts or cancer, and pregnancy-related issues such as ectopic pregnancy or miscarriage.
Men may suffer chronic pelvic pain for issues related to the prostate, such as prostatitis.
Both men and women can suffer conditions in the urinary tract, such as infections or kidney stones, or those arising from the bowel, such as appendicitis, inflammatory bowel disease, constipation, or colon cancer.
When should I see a doctor?
If there is any chance you may be pregnant, you should be on alert that sudden and severe pelvic pain may be caused by an ectopic pregnancy. This is a medical emergency and needs urgent attention.
If your pelvic pain is accompanied by any symptoms of infection, then you should seek medical attention by speaking to your doctor.
Pelvic pain may point to cancer, and you should make an urgent appointment with your doctor if you have additional concerns, including weight loss, poor appetite, night sweats, bloating, persistent vaginal bleeding with no obvious cause, or you have a family member who has had cancer.
Pelvic pain that becomes chronic or affects your day-to-day life should be discussed with your doctor in a routine appointment.
How is pelvic pain managed?
To identify the cause of pelvic pain, your doctor will first take a detailed history to identify where the pain may be coming from. This may include asking you about your sexual history, urinary symptoms, and menstrual history, if applicable.
The doctor will then likely perform an examination of the pelvis and abdomen. Blood tests may be ordered looking for infections or hormonal dysfunction. They may suggest a sexually transmitted infection (STI) screen to look for chlamydia and gonorrhea.
More detailed investigations like ultrasounds may be needed, and depending on the results, you may be offered a trial of treatment. You may be referred to a specialist team, such as the gynecology team, for further investigations.
How is pelvic pain treated?
Regular exercise, physiotherapy, and changes in diet can help manage pelvic pain for some.
Others may need medications to reduce the severity of the symptoms. Simple painkillers, muscle relaxants, and occasionally antidepressants may be helpful. Hormonal treatments can be helpful for women with endometriosis, period pains, or fibroids. In severe cases, surgery may be required to reduce the fibroids, endometriosis, or adhesions. Surgery is not always successful, so it is usually a last resort.
Antibiotics are used to treat STIs. In the absence of a positive test, but with strong suspicion of chronic prostatitis in men or pelvic inflammatory disease in women, antibiotics are used to treat a presumed and persistent STI infection.
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