Pelvic pain is pain or discomfort felt in the lower part of the abdomen or pelvis. It can affect women of all ages and can vary significantly from person to person.
For some women, pelvic pain may be a temporary symptom associated with their menstrual cycle. For others, it can be persistent, recurring or severe enough to affect everyday life, relationships, work and sleep.
There are many possible causes of pelvic pain. Some are relatively straightforward to diagnose and treat, while others may require more detailed investigation. Gynaecological conditions such as endometriosis, fibroids and ovarian cysts are possible causes, but pelvic pain can also originate from the bladder, bowel, pelvic floor muscles or an infection.
At Gynae Solution, Mr Jafaru Abu will take the time to understand your symptoms and how they are affecting you. The aim is to establish the underlying cause wherever possible and develop an appropriate treatment plan based on your individual circumstances.
What Is Pelvic Pain?
Pelvic pain refers to pain experienced in the area below your tummy button and between your hips.
It can feel very different depending on its cause.
You may experience:
- A dull or heavy ache
- Cramping or throbbing
- Sharp or stabbing pain
- Burning or shooting pain
- A feeling of pressure or heaviness
- Pain that comes and goes
- Constant pain
- Pain that is worse during your period
- Pain during or after sexual intercourse
- Pain when passing urine
- Pain when opening your bowels
- Pain that spreads into your lower back, hips or thighs
Pelvic pain can be acute, meaning it develops suddenly, or chronic, meaning it persists or recurs over a longer period. NICE defines chronic pelvic pain as pain lasting for six months or longer.
Understanding when your pain occurs, what makes it worse and whether it follows a pattern can be extremely helpful when trying to identify the underlying cause.
Symptoms Associated With Pelvic Pain
Pelvic pain may be your only symptom, but it can also occur alongside other changes.
Depending on the underlying cause, you may experience:
- Painful periods
- Heavy or irregular periods
- Bleeding between periods
- Bleeding after sexual intercourse
- Pain during or after sex
- Abdominal bloating
- A feeling of pressure in the pelvis
- Vaginal discharge
- Pain when passing urine
- Needing to urinate more frequently
- Difficulty emptying your bladder
- Constipation or diarrhoea
- Pain when opening your bowels
- Lower back pain
- Fatigue
- Difficulty becoming pregnant
Keeping a record of when your pain occurs can be particularly useful. For example, does it happen before or during your period, around ovulation, during sex, when going to the toilet or at particular times of the day?
A symptom or pain diary can help your specialist identify patterns and may be particularly useful when investigating conditions such as endometriosis.
What Causes Pelvic Pain?
There are many potential causes of pelvic pain. It is important not to assume that the pain is caused by a particular gynaecological condition without appropriate assessment.
Period Pain
Period pain is extremely common and is caused by contractions of the womb during menstruation.
For some women, however, period pain can be severe and significantly affect their quality of life. Severe or worsening period pain can sometimes be associated with conditions such as endometriosis, adenomyosis or fibroids.
Endometriosis
Endometriosis occurs when tissue similar to the lining of the womb grows elsewhere in the body, commonly around the ovaries, fallopian tubes and other areas within the pelvis.
It can cause:
- Pelvic pain
- Severe period pain
- Pain during or after sex
- Pain when opening your bowels
- Pain when passing urine
- Fatigue
- Difficulty becoming pregnant
Symptoms can be cyclical, but they do not always occur only during your period.
Adenomyosis
Adenomyosis occurs when tissue similar to the lining of the womb grows into the muscular wall of the womb.
It can cause painful and heavy periods, pelvic pain and a feeling of pressure or heaviness in the pelvis.
Fibroids
Fibroids are non-cancerous growths that develop in or around the womb.
Depending on their size and location, they can cause:
- Pelvic pressure
- Lower abdominal pain
- Heavy periods
- Painful periods
- Backache
- Pressure on the bladder or bowel
Ovarian Cysts
Ovarian cysts are fluid-filled sacs that develop on or within an ovary.
Many cause no symptoms and disappear naturally, but a larger cyst can sometimes cause pelvic pain or pressure.
Pain may be sudden and severe if a cyst ruptures or causes the ovary to twist.
Pelvic Inflammatory Disease
Pelvic inflammatory disease (PID) is an infection affecting the female reproductive organs, including the womb, fallopian tubes and ovaries.
It can cause pelvic or lower abdominal pain and may also be associated with unusual vaginal discharge, painful sex, bleeding between periods or after sex, and fever.
Early diagnosis and treatment are important because untreated PID can lead to complications.
Pelvic Floor Problems
The muscles forming the pelvic floor support the bladder, bowel and reproductive organs.
Problems affecting these muscles can contribute to pelvic pain, pressure or discomfort, particularly when sitting, exercising or having sex.
Bladder and Bowel Conditions
Not all pelvic pain originates from the reproductive organs.
Conditions affecting the bladder or bowel, including urinary tract infections, irritable bowel syndrome and constipation, can cause pain in the pelvic region.
This is why a thorough assessment is important when the cause of pelvic pain is unclear.
Pregnancy-Related Conditions
Pelvic pain can occur during pregnancy for a number of reasons.
Some causes are relatively common, while sudden or severe pain during pregnancy can require urgent assessment.
If you are pregnant or think you may be pregnant and experience pelvic pain, you should seek appropriate medical advice.
Less Common Causes
Less commonly, pelvic pain can be associated with more serious conditions, including certain gynaecological cancers.
This does not mean that pelvic pain usually indicates cancer. There are many much more common causes. However, persistent or unexplained symptoms should be assessed rather than ignored.
When Should I See a Doctor?
You should arrange an appointment with your GP or a gynaecologist if your pelvic pain:
- Keeps coming back
- Does not go away
- Is becoming more severe
- Is affecting your everyday activities
- Is interfering with your sleep or relationships
- Is associated with painful periods
- Occurs during or after sex
- Is accompanied by abnormal bleeding
- Is accompanied by unusual vaginal discharge
- Occurs alongside changes in your bladder or bowel habits
- Is accompanied by unexplained weight loss or persistent bloating
Persistent pelvic pain is not something you simply have to learn to live with. Finding the cause can open up treatment options and help improve your quality of life.
When Is Pelvic Pain an Emergency?
Severe or rapidly worsening pelvic pain requires urgent medical assessment.
Seek urgent medical advice if you have pelvic pain accompanied by symptoms such as:
- Severe or rapidly worsening pain
- Fainting, dizziness or feeling lightheaded
- Heavy vaginal bleeding
- A high temperature or feeling very unwell
- Vomiting
- Difficulty passing urine or opening your bowels
- Blood in your urine or stools
- Pain when you may be pregnant
Sudden severe pain, particularly when accompanied by fainting, heavy bleeding or other concerning symptoms, may require emergency assessment.
How Is Pelvic Pain Diagnosed?
Because pelvic pain can have so many different causes, there is no single test that can diagnose it.
The first step is a detailed consultation with your specialist.
Mr Abu will ask about:
- Where the pain is located
- When it started
- Whether it is constant or intermittent
- How severe it is
- What the pain feels like
- Whether it is connected to your menstrual cycle
- Whether it occurs during or after sex
- Whether you experience pain when opening your bowels
- Whether you have bladder symptoms
- Any abnormal vaginal bleeding
- Any unusual vaginal discharge
- Previous pregnancies and births
- Your medical and surgical history
- Previous gynaecological conditions
- Your fertility plans
The timing and pattern of your symptoms can provide important clues.
Pelvic Examination
Depending on your symptoms, a pelvic examination may be recommended.
This allows Mr Abu to assess for:
- Tenderness
- Pelvic masses
- Changes to the cervix
- Abnormal vaginal discharge
- Changes affecting the vagina or vulva
- Signs that may suggest endometriosis or another pelvic condition
NICE recommends abdominal and pelvic examination when endometriosis is suspected, although a normal examination does not necessarily rule it out.
Ultrasound Scan
An ultrasound scan is commonly used when investigating pelvic pain.
A transvaginal ultrasound can provide detailed images of the womb, ovaries and surrounding pelvic structures.
It may help identify conditions such as:
- Ovarian cysts
- Fibroids
- Adenomyosis
- Pelvic masses
- Some features associated with endometriosis
An abdominal ultrasound may also be appropriate depending on your symptoms.
Blood and Urine Tests
Depending on your symptoms, blood or urine tests may be recommended.
These can help investigate possible infection, inflammation, anaemia or urinary problems.
STI Testing
If there is a possibility that an infection could be contributing to your symptoms, testing for sexually transmitted infections may be recommended.
This can be particularly important where pelvic pain occurs alongside unusual discharge, bleeding or pain during sex.
Further Imaging
If an ultrasound does not provide enough information, additional imaging such as an MRI scan may sometimes be recommended.
MRI can provide more detailed images of the pelvic organs and can be particularly useful when investigating certain conditions such as deep endometriosis or adenomyosis.
Laparoscopy
In some circumstances, laparoscopy may be considered.
This is a minimally invasive surgical procedure in which a small camera is inserted through a small incision in the abdomen.
It allows the surgeon to examine the pelvic organs directly and, where appropriate, treat certain conditions during the same procedure.
Not every woman with pelvic pain will require laparoscopy. The decision will depend on your symptoms, examination and other investigation results.
How Is Pelvic Pain Treated?
Treatment depends on the cause.
The aim is not simply to manage the pain but, wherever possible, to identify and treat the underlying condition.
Pain Relief
Depending on your individual circumstances, pain-relieving medication may be recommended.
The most appropriate medication will depend on your symptoms, medical history and any other medicines you take.
Hormonal Treatment
If your pelvic pain is related to your menstrual cycle or a condition such as endometriosis, hormonal treatments may be considered.
These can include different forms of hormonal contraception or other hormone-based treatments.
Treatment for Infection
If pelvic pain is caused by an infection such as PID, antibiotics may be required.
Early treatment is important to reduce the risk of complications.
Treatment for Endometriosis
Treatment for endometriosis may include pain relief, hormonal treatment or surgery, depending on the severity of symptoms, the extent of the disease and whether fertility is a priority.
Treatment for Fibroids
If fibroids are responsible for your pain, treatment may involve medication, minimally invasive procedures or surgery depending on their size, location and symptoms.
Treatment for Ovarian Cysts
Many ovarian cysts do not require treatment and can simply be monitored.
If a cyst is large, persistent, symptomatic or has concerning characteristics, surgery may be recommended.
Physiotherapy and Pelvic Floor Treatment
Some women benefit from physiotherapy, particularly where pelvic floor muscle problems are contributing to pain.
Treatment may include exercises, muscle relaxation techniques and strategies to improve pelvic floor function.
The NHS recognises physiotherapy, including pelvic floor exercises, as one of the treatment approaches that may be used for pelvic pain depending on its cause.
Surgery
If an underlying condition cannot be adequately treated with conservative measures, surgery may be considered.
The type of surgery will depend entirely on the cause of the pelvic pain.
Where possible, minimally invasive or keyhole approaches may be used.
Pelvic Pain and Fertility
Some causes of pelvic pain can also affect fertility.
Endometriosis, for example, can be associated with difficulty becoming pregnant. Other conditions affecting the ovaries, fallopian tubes or womb can also influence fertility.
If you are trying to conceive or may want to have children in the future, this should form part of the discussion when deciding on investigations and treatment.
The aim is to treat your symptoms while taking your reproductive plans into account.
Recovery and Aftercare
Recovery will depend on the underlying cause and the treatment you receive.
If your symptoms are managed with medication, you may need follow-up appointments to assess whether your pain is improving.
If you undergo a procedure or surgery, your recovery time will depend on the type of treatment.
Following keyhole surgery, for example, you may experience some abdominal discomfort, bloating or tiredness while you recover.
You will receive advice about:
- Managing discomfort
- Caring for any wounds
- Returning to exercise
- Returning to work
- Sexual activity
- When to seek medical advice
- Any follow-up appointments required
If your pelvic pain is associated with a chronic condition, ongoing management may be required rather than a single course of treatment.
Risks and Benefits of Treatment
The benefits and risks of treatment depend on the underlying cause and the treatment being considered.
Identifying the cause of pelvic pain can provide reassurance and allow targeted treatment rather than simply managing symptoms without knowing why they are occurring.
Potential benefits may include:
- Reducing or controlling pain
- Improving periods
- Improving sexual comfort
- Improving bladder or bowel symptoms
- Improving quality of life
- Treating an underlying condition
- Protecting fertility where possible
Some treatments have potential risks or side effects.
Medication may cause side effects, while procedures and surgery can carry risks including bleeding, infection, damage to surrounding organs, complications from anaesthesia and, in some cases, an impact on fertility.
Mr Abu will discuss the potential benefits, risks and alternatives before recommending treatment, allowing you to make an informed decision about your care.
Living With Pelvic Pain
Persistent pelvic pain can have an impact that extends far beyond the physical symptoms.
It can affect your:
- Work
- Sleep
- Exercise
- Relationships
- Sex life
- Emotional wellbeing
- Ability to carry out everyday activities
You should not feel that you simply have to put up with ongoing pelvic pain.
Keeping a pain and symptom diary can be useful when preparing for an appointment. Recording when the pain occurs, its severity, your menstrual cycle and any associated bowel, bladder or sexual symptoms can help your specialist identify patterns. NICE specifically recommends symptom diaries as a useful tool for discussions when endometriosis is suspected.
Specialist Care for Pelvic Pain
Pelvic pain can be difficult to live with, particularly when you have been experiencing symptoms for some time without a clear explanation.
There are many possible causes, and sometimes identifying the underlying condition requires a combination of careful history-taking, examination, imaging and other investigations.
At Gynae Solution, Mr Jafaru Abu will listen to your symptoms and concerns rather than simply treating the pain in isolation. The aim is to understand what may be causing your symptoms and identify the most appropriate treatment for you.
Whether your pelvic pain is related to endometriosis, fibroids, ovarian cysts, adenomyosis, an infection or another condition, your treatment will be tailored to your individual circumstances.
If you are experiencing persistent, recurring or unexplained pelvic pain, contact Gynae Solution to arrange a consultation with Mr Jafaru Abu.
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