A woman's pelvis contains the uterus, fallopian tubes, ovaries, vagina, bladder, and rectum. Pelvic pain refers to any pain or discomfort in this area of the body.
Pelvic pain is a common symptom in women. It is frequently, but not always, related to the reproductive system. Other causes of pelvic pain are related to the intestines or urinary tract. Psychological factors can make the pain seem worse, or sometimes even cause a sensation of pain where no physical problem exists.
Pelvic pain can range from mild discomfort or cramping, to severe, intense pain. This pain may be acute, when it occurs suddenly, or chronic, when the pain lasts for a long period of time.
When a woman has pelvic pain, the healthcare professional will need more information. Questions may be asked about the pain, including: When did the pain start?How long has the pain existed? When does it stop? How often does it occur?What type of pain is it? Dull, sharp, steady, or crampy?Where is the pain located?When was the last menstrual period? Was it a normal period?Is there any vaginal bleeding or drainage?Does any activity, position or medication decrease the pain or make the pain worse?Are there any other symptoms, such as fever, fatigue, malaise, nausea, vomiting, change in bowel movements, or trouble urinating?Is the woman sexually active? What form of birth control, if any, does she use?What medications, drugs, or herbs does the person take, if any?Is there a history of any other medical problems or surgery?
Further questions may be asked, depending on the woman's age and other related medical history.
Pelvic pain in females has many causes including: pelvic adhesions, which are fibrous bands holding parts together that are usually separateendometriosis, a disorder in which patches of endometrial tissue (normally found only in the lining of the uterus) grow outside the uterus particularly on other pelvic organsperitonitis, an inflammation usually caused by an infection of the lining of the abdomenurinary tract infection hernia, or a bulging of internal organs or tissues through an abnormal opening in the muscle wallmenstrual crampingMittelschmerz, which is pain in the middle of the menstrual cycle caused by ovulationectopic pregnancy, a pregnancy in which the fetus develops outside of the uterustwisted ovarymiscarriage ovarian cysts uterine fibroid, a non-cancerous growth that occurs in the wall of the uteruscolon cancer or ovarian cancer diverticulosis, a saclike protrusion of any part of the digestive tract, usually in the large intestineirritable bowel syndrome gastroenteritis, a general term for a group of conditions caused by infection in the digestive tractkidney stones abscess, or an accumulation of pus usually caused by a bacterial infectionpelvic inflammatory disease (PID), an infection of the uterus, fallopian tubes, and adjacent pelvic structures. PID is commonly caused by a sexually transmitted infection that has not been treated quickly and effectively.appendicitis, or inflammation of the appendixmusculoskeletal disorders, such as a misalignment or shifting of the pelvic bonespsychological factors, such as stress
Other causes are also possible. In some cases, the cause is never found.
Prevention of pelvic pain may or may not be possible, depending on the cause. Some ways to decrease the risk of pelvic pain include: using condoms to decrease the risk of sexually transmitted infections and secondary pelvic inflammatory disease (PID)seeking early treatment for infections of the genital tract, such as PIDoral birth control pills, which may reduce the risk of pelvic pain associated with painful ovulation and mensesdrinking plenty of fluids every day and avoiding dehydration to prevent kidney stones
Many of the causes of pelvic pain cannot be prevented.
Diagnosis of pelvic pain begins with a history and physical exam. The healthcare provider may order tests, including: a urinalysis and a urine culture to rule out any kidney or bladder disorders, such as an infection or kidney stones blood tests, which may include a complete blood count or CBC, to check for infectiona pregnancy test a pelvic exam to help determine which organs are affected and whether an infection is presentother types of imaging tests, such as ultrasound, CT scans, or MRI scans
Long-term effects are related to the cause of the pelvic pain. For example, irritable bowel syndrome may make a person uncomfortable and even depressed, but poses no serious long-term health risks. A small kidney stone may pass by itself and have no long-term effects. A large kidney stone may require surgery to remove. Cancer may lead to death if treatment is unsuccessful. A woman with an ectopic pregnancy may need medical therapy or surgery, and in some cases, may have to have the fallopian tube removed.
Pelvic pain itself is not contagious and poses no risk to others. If the pain is chronic and severe it may interfere with sexual as well as other relationships. If the pain is caused by a sexually transmitted infection, that infection is contagious.
Specific treatment for pelvic pain depends on the cause of the pain. Treatment may include: advice about appropriate diet and exercise antibioticsnonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (i.e., Advil, Motrin) or naproxen (i.e., Aleve, Anaprox, Naprosyn)pain medication birth contol pills to stop pain caused by ovulationsurgeryrelaxation exercisesphysical therapy
Side effects to treatment will depend on the treatment used. There may be stomach upset, diarrhea, or allergic reaction to antibiotics. There may be stomach upset, ulcers and bleeding, or allergic reaction to NSAIDs. NSAIDs may also affect the liver and kidneys. Treatments that require surgery pose a risk of bleeding, infection, and allergic reaction to anesthesia.
What happens after treatment depends on the success of the treatment and the cause of the pain. For example, those who pass a kidney stone on their own or have it removed may not need any further treatment. Those with cancer may need long-term treatment for the cancer and may die if treatment is unsuccessful.
Any new or worsening symptoms should be reported to the healthcare professional.
Harrison's Principles of Internal Medicine, 1998, Fauci et al.
The Merck Manual of Medical Information, 1997
Professional Guide to Diseases: 6th edition, 1998