"Pelvic pain" describes pain that occurs mostly or only in the region below a woman's belly button. This region includes the lower stomach, lower back, bottom, and genital area. Pelvic pain is chronic if it lasts for more than 6 months and affects a woman's quality of life. This condition is a common reason why women seek medical care
About 15% of women of childbearing age in the U.S. report having pelvic pain that lasts at least 6 months. Among them, about 15% of employed women have pain that is severe enough to cause them to miss work
Symptoms of Pelvic Pain
The symptoms of pelvic pain vary from woman to woman. Pelvic pain can be severe enough that it interferes with normal activities, such as going to work, exercising, or having sex.
Women describe pelvic pain in many ways. Pelvic pain can be steady, or it can come and go. It can be a sharp and stabbing pain felt in a specific spot, or a dull pain that is spread out. Some women have pain that occurs only during their menstrual periods. Some women feel pain when they need to use the bathroom, and some feel pain when lifting something heavy. Some women have pain in the vulva (the external genitals), which is called vulvodynia, during sex or when inserting a tampon.
Causes of Pelvic Pain
Researchers do not know the exact causes of pelvic pain. Often, pelvic pain signals that there may be a problem with one of the organs in the pelvic area. This organ could be a reproductive organ, such as the uterus (also called the womb), or other organs like the intestine or the bladder. Pain also can be a symptom of an infection.
The extent of a woman's pelvic pain is not always the same as the extent of the related condition. For example, if a woman has a physical abnormality that is associated with the pain, the size of the abnormality may be small, but she may still experience a lot of pain.
The following health problems can cause or contribute to pelvic pain:
- Adhesions. Adhesions are bands of tissue that form between internal tissues and organs and keep them from shifting easily as the body moves.3 They can form as a result of surgery or infections, such as pelvic inflammatory disease.
- Endometriosis. This condition occurs when tissues that normally grow inside the uterus grow somewhere else in the pelvis, such as on the outside of the uterus, ovaries, or fallopian tubes. The two most common symptoms of endometriosis are pain and infertility.
- Interstitial cystitis/painful bladder syndrome. This syndrome causes bladder pain and a need to urinate often and right away. This pain may be a burning or sharp pain in the bladder or at the opening where urine leaves the body.
- Irritable bowel syndrome.This syndrome is a digestive problem that can cause pain, bloating, constipation, or diarrhea. Researchers have yet to find a specific cause for irritable bowel syndrome but stress or certain foods can trigger symptoms in some people.
- Pelvic floor disorders. These disorders occur when the muscles and connective tissues that hold all the pelvic organs in place weaken or are injured. Sometimes the condition is caused by spasms or an increase in pelvic floor muscles tone. Pelvic floor disorders can cause discomfort and pain as well as functional problems, such as trouble with bladder control.
- Uterine fibroids. Uterine fibroids are noncancerous tumors made of muscle cells and other tissues that grow within and around the wall of the uterus. Symptoms can include heavy or painful periods, pain during sex, and lower back pain.
- Vulvodynia. This condition involves pain or discomfort of the vulva (the parts of the female sex organs that are on the outside of the body). This condition can cause burning, stinging, itching, or rawness of the vulva.
A woman may have more than one cause of pelvic pain at the same time. In some cases, a person with one chronic pain condition has an increased risk for other types of chronic pain.
Studies have found a good deal of overlap among pain conditions. For instance, a woman may have endometriosis, irritable bowel syndrome (IBS), and depression at the same time—each of which contributes to the overall pain she feels. Having more than one pain condition can complicate diagnosis and treatment. To be effective, treatment needs to address all the conditions that are contributing to a woman's pain.
Diagnosis of Pelvic Pain
To find out the cause of a woman's pain, her health care provider will:
- Ask questions about the woman's pain and health history. How a woman describes her pain can help her health care provider figure out the pain type and what might be causing it.
- Perform a physical exam. The health care provider will examine the abdomen and pelvis, and check the woman's organs, muscles, and tissues in the pelvic region for tenderness or abnormalities that suggest a pain disorder.
The information the doctor gathers from the questions and physical exam will help the doctor decide whether additional tests or procedures are needed to help diagnose the cause of the pelvic pain. These tests or procedures may include:
- Lab tests, such as blood work or a urine test
- Pelvic ultrasound, a procedure that uses sound waves to look at organs and structures inside the pelvic region
- Pelvic laparoscopy, a minor surgery in which the doctor inserts a viewing instrument called a laparoscope through a small cut in the skin below the belly button to look inside the pelvis
- Pelvic MRI, (magnetic resonance imaging) scan, an imaging test that uses powerful magnets and radio waves to create pictures of the pelvis
- Cystoscopy, looking into the bladder by inserting a viewing instrument
- Colonoscopy, looking into the bowel by inserting a viewing instrument
Finding the cause of pelvic pain can be challenging and can take time. Some women must check with more than one doctor or with a specialist to get help for their pain. Sometimes, the cause of the pain is not found. But failure to locate the cause does not mean that the pain a woman feels is not real or that it cannot be treated. Understanding what triggers the pain also can be helpful.
Treatment of Pelvic Pain
Treatment depends on the cause of pelvic pain, how intense the pain is, and how often the pain occurs. No one treatment approach has been shown to be better than another in all cases.
Some treatment options include:
- Medicines.Many types of medicine are used to treat pelvic pain. These include pain relievers that are swallowed or injected, muscle relaxants, and antidepressants.
- Hormonal treatment. Hormones can help pain related to endometriosis and menstruation. These include hormones that are swallowed, injected, or placed in the uterus, such as birth control pills, gonadotropin-releasing hormone injections, or progestin-releasing intrauterine devices. This is not the same as hormone therapy that is sometimes used to treat the symptoms of menopause.
- Lifestyle changes. Some women's pain is helped by changes in diet, improved posture, and regular physical activity.
- 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.
- Surgery. Some women may need surgery to remove adhesions, fibroids, and/or endometriosis. In some cases, the surgery might also reduce or relieve pelvic pain. Some women may have surgery to cut or destroy nerves to interrupt pain signals,1 but such pain surgeries often are not successful. Depending on the cause of the pain, a woman's health care provider might recommend a hysterectomy, surgery to remove a woman's uterus, to help relieve or reduce pelvic pain.
- Counseling. Counseling or "talk therapy" may help treat pain. In fact, talk therapy, when combined with medical treatment, appears to work better for improving some symptoms than does medical treatment alone.
Finding a treatment that works can take time. Some women want to try alternative therapies to relieve their pain. Learning healthy ways to cope with pain is an important aspect of any treatment approach.
How can I describe my pain to my doctor?
The better you can describe your pain, the easier it may be for your doctor to find the cause of the pain and treat your pain. Information that is helpful to your doctor includes:
- How long you have had your pain
- Where you feel the pain
- Whether your pain is in one spot or spread out
- How the pain feels and how severe it is
- Whether pain is constant or comes and goes
- What activities make pain worse or improve it
- How your pain limits what you can do
- How often the pain occurs and how long it lasts
- Anything that triggers the pain
Keeping a pain diary or record of your pain is a good way to track your pain triggers as well as symptoms over time. Be as specific as possible. Some words that can help you describe the way your pain feels include:
- Hot or burning
- Punishing or cruel
- Tiring or exhausting
Pelvic Pain and Pregnancy
Some pelvic conditions that are associated with pain also are associated with difficulty getting pregnant. These include:
- Endometriosis. Up to 30% to 50% of women with endometriosis are not able to get pregnant, making this condition one of the top three causes of female infertility.
- Pelvic adhesions. Adhesions that form on the ovaries, fallopian tubes, or uterus can make it difficult or impossible to get pregnant.
- Uterine fibroids. Most women with fibroids do not have problems with fertility and can get pregnant. If a woman's fibroid is located in the uterine cavity, she may face an increased risk of early pregnancy loss. Some women with fibroids may not be able to get pregnant naturally, but advances in treatments for infertility may help some of them get pregnant.
Some treatments for pelvic pain also can affect a woman's ability to get pregnant. For example, hormonal birth control commonly is used to treat endometriosis. Hysterectomy, which is surgery to remove a woman's uterus, may be an option for women who are not helped by other treatments, but it makes pregnancy impossible. However, a woman may still be able to become a mother through other means, such as a surrogate carrier.
Reference: National Institutes of Child Health and Human Development