Many women experience pelvic pain at some point in their lives. Identifying the cause can be a lengthy process, as multiple factors can contribute to the pain, and pinpointing its exact source can be challenging. Women experiencing pelvic pain should consult a doctor, especially if the pain disrupts daily life or worsens over time.

Types of Pelvic Pain

Pelvic pain can vary in sensation and timing. It can be intermittent or constant, and may occur only at specific times, such as before or after eating, during urination, during sex, or during menstrual periods. Some women experience pelvic pain almost daily, which may indicate a worsening condition. Over time, coping with chronic pain can become more difficult, impacting work, movement, sexual relations, sleep, and family duties. Prolonged pain can also affect mental and physical health.

Chronic pelvic pain, lasting more than six months and not improving with treatment, requires thorough evaluation by a doctor. The nature of the pain—whether intermittent or constant, sharp or dull, localized or widespread—helps in diagnosing the cause.

Causes of Pelvic Pain

Pelvic pain can be acute or chronic. Acute pain develops over a short period and often has a single cause, such as infection, ovarian cysts, or ectopic pregnancy. Chronic pain may be due to multiple factors, including reproductive, gastrointestinal, urologic, muscular, or psychological issues.

Acute Pelvic Pain

1. Infection: Infections in reproductive organs, urinary tract, bowel, or appendix can cause pelvic pain. Pelvic inflammatory disease (PID) involves infection of the uterus, fallopian tubes, and ovaries, presenting with fever and pelvic pain.
2. Ovarian Cysts: Cysts can cause dull aches, heaviness, or sharp pain, especially if they leak fluid or bleed. Large or persistent cysts may require surgical removal.
3. Ectopic Pregnancy: This occurs when a pregnancy grows outside the uterus, typically in a fallopian tube, and requires urgent medical attention.

Chronic Pelvic Pain

1. Dysmenorrhea: Severe menstrual pain caused by prostaglandins leading to uterine cramps.
2. Ovulation Pain: Known as mittelschmerz, this pain occurs mid-cycle and can range from mild to severe.
3. Endometriosis and Adenomyosis: Conditions involving uterine tissue growing outside or into the uterine muscle wall, respectively, causing severe menstrual cramps and other symptoms.
4. Fibroids: Benign growths in or on the uterus, causing heavier periods and pelvic pain.

Other causes include gastrointestinal issues (like diverticulitis or irritable bowel syndrome), urologic problems (such as bladder infections or stones), muscular and skeletal issues (like lower back pain or fibromyalgia), and psychological factors (such as depression).

Diagnosis

Due to the varied causes of pelvic pain, a detailed medical history and physical examination are essential. Doctors may also recommend tests such as ultrasound, cystoscopy, laparoscopy, colonoscopy, CT scans, MRI, IVP, or barium enemas to diagnose the underlying cause.

Treatment

Treatment depends on the identified cause. Infections are treated with antibiotics, while NSAIDs can help with dysmenorrhea. Hormonal treatments, like birth control pills, can manage symptoms of conditions like endometriosis and fibroids. Antidepressants may be used for chronic pain.

Surgical options range from minor procedures to major surgeries, depending on the problem. Other treatments include heat therapy, muscle relaxants, nerve blocks, physical therapy, trigger point injections, nutrition therapy, acupuncture, and mental exercises. Counseling and relaxation techniques can also be beneficial.