Pelvic pain: symptoms, diagnosis and treatment

Pelvic pain is pain in the lower part of the tummy, between the belly button and the groin. Sometimes it is simply period cramps, ovulation or a digestive upset, such as a food intolerance. However, pelvic pain can also be a sign of a more serious problem, so it is worth understanding the possible causes and knowing when to see a doctor.

Where does pelvic pain come from?

The pelvis contains the womb, ovaries and fallopian tubes, but also the bowel, the bladder and the lower ureters, all surrounded by muscles, connective tissue and bone. Pelvic pain can start in any of these. It is usually considered separately from pain in the vagina, vulva or perineum. Pain can be acute, coming on suddenly, or chronic; pelvic pain that lasts for 3 to 6 months or more is called chronic.

Gynaecological causes of pelvic pain

• Period pain and cramps: the most common symptom of all menstrual disorders. Cramps usually start just before a period, as the womb contracts to shed its lining, and can feel like a spasm or a jabbing pain.
• Painful ovulation: pain on one side of the pelvis in the middle of your cycle. When an egg is released, a little fluid also escapes from the ovary and can irritate the lining of the pelvis.
• Endometriosis: tissue similar to the womb lining growing outside the womb.
• Ovarian cysts: fluid-filled sacs that can cause bloating, pressure or pain on one side.
• Fibroids: non-cancerous growths of muscle and fibrous tissue in the womb, the most common benign gynaecological tumour.
• Pelvic inflammatory disease: an infection that spreads from the vagina or cervix into the womb and can damage nearby tissue.
• Pelvic adhesions: scar tissue joining organs that should not be connected, often after infection, endometriosis or surgery. Adhesions can cause chronic pelvic pain.
• Ectopic pregnancy: a pregnancy growing outside the womb, which can cause sharp, one-sided pain with bleeding, nausea or dizziness. This is an emergency.

Other causes of pelvic pain

• Cystitis and urinary tract infections: bacteria entering the urethra and bladder, causing pain and stinging.
• Interstitial cystitis: long-term bladder inflammation with no known cause, which can cause frequent, painful urination and pain during sex.
• Sexually transmitted infections: such as chlamydia or gonorrhoea, which may also cause bleeding between periods or a change in discharge.
• Irritable bowel syndrome: a gut disorder causing pain, bloating, constipation or diarrhoea.
• Appendicitis and urinary stones, which can both cause severe pain.
• Tumours: rarely, a cancer of the reproductive, urinary or digestive system can cause pelvic pain.

When should you see a doctor about pelvic pain?

Not every twinge needs medical care. However, see a doctor if you think an infection may be causing your pain, if you have unexpected vaginal bleeding with severe pain, or if a known condition suddenly changes. Seek help quickly if pelvic pain comes with a fever, nausea or vomiting, or if you could be pregnant.

A gynaecologist will take a careful history, examine you and usually arrange an ultrasound scan (see gynaecological ultrasounds). Sometimes a laparoscopy, a keyhole look inside the pelvis, is needed to find the cause. Once it is clear, a treatment plan can be agreed.

NICE explains how endometriosis-related pelvic pain should be assessed, and the Royal College of Obstetricians and Gynaecologists has patient information on long-term pelvic pain. Our pelvic pain page has more detail. Routine check-ups also help to keep your gynaecological health on track. To book a consultation with Mr Jafaru Abu, please get in touch.