Pelvic Pain

What Is Pelvic Pain?

The pain felt below the umbilicus and above the thigh is known as pelvic pain. It can be caused by a number of things, which ranges from being harmless to a medical emergency. There are a lot of organs in the pelvic region like bowel, bladder, ovaries, uterus, appendix, etc., so the pain can be due to problems is any of these organs. When you have pelvic pain, it is crucial to differentiate when it is normal and when to seek help.

The pain can begin suddenly or be cyclic or dull or sharp or be accompanied with itching and burning around the genitals and thighs. In women, it feels different from the usual menstrual cramps. The pain can worsen with movement, on lifting things, straining, and stress. Chronic pelvic pain that is pain present on most days for six months should not be ignored, and finding the cause is essential.

What are the causes of Pelvic Pain?

1. The possible causes of pelvic pain in both men and women are:

• Appendicitis - The inflammation of the appendix is called appendicitis. The pain starts near the belly button and moves toward the right side of the lower abdomen. It is a medical emergency as the inflamed appendix can rupture and cause infection.

• Irritable bowel syndrome (IBS) - A group of diseases affecting the large intestine is called IBS. Here, the patient has abdominal cramps, constipation or diarrhea, bloating, gas, and mucus in stools. The pain usually subsides after a bowel movement.

• Sexually transmitted diseases (STD) - STDs like gonorrhea and chlamydia cause dull pain in the abdomen. The other symptoms include discharge from the vagina and penis, pain during sex, pain on urination, and pain or bleeding from the rectum.

• Bladder disorder or Urinary tract infection (UTI) - Bacterial infection of the urinary tract, which includes the urethra, bladder, ureters, and kidneys is called UTI. It usually causes pain in the middle of the pelvis and around the pubic bone. The other symptoms are persistent urge to urinate, pain or burning on urination, bloody or cloudy urine, and fever.

• Kidney stones or kidney infection - A kidney stone and infection can cause pain that starts at the side and back and radiates to the lower belly and groin. Blood in urine, frequent urge to urinate, burning on peeing, nausea, vomiting, and fever are other associated symptoms.

• Interstitial cystitis (IC) - Also called painful bladder syndrome, which is a condition that causes bladder pressure and chronic pelvic pain. The pain in women is felt between the anus and vagina. In men, it is felt between the scrotum and anus.

• Scar tissue formation after any surgery - Scar tissue form after any open surgery of the pelvic region like c-section. This scar tissue grows between organs like bladder, bowel, ureter, and ovaries and causes pelvic pain.

• Nerve compression - Pressure and entrapment of the pudendal nerve, which is the nerve that supplies genitals, anus, and urethra, causes an electric shock-like pain between the genitals and the perineum. This pain worsens on sitting.

• Hernia - A hernia is caused when a tissue or organ pushes through a weak spot in your abdomen. The pain increases with coughing, laughing, and bending. In men, it also causes swelling around the testicles.

• Fractured pelvic bone - The pelvic bone can break during an accident. It causes pain in the hip, groin, and lower back, and the pain increases on walking and moving the legs.

• Nonrelaxing pelvic floor dysfunction - Here, the pelvic floor muscles are too tight. The spasm in the levator ani muscle causes constant dull pain in the rectum.

• Iliac crest pain syndrome - It occurs when the iliolumbar ligament, which is a ligament that connects the vertebrae to the pelvic bone, tears. It causes pain in the lower back that can spread to the hip and groin.

• Psychogenic pain - Pain that is caused by psychological factors like depression and anxiety is called psychogenic pain.

2. The possible causes of pelvic pain in women alone are:

• Ectopic pregnancy - Ectopic pregnancy is when a fertilized egg gets attached anywhere outside the uterus. The pain experienced here is sharp, stabbing, and one-sided.

• Pregnancy - Early stages of pregnancy can cause abdominal cramps and discomfort.

• Miscarriage - Loss of a baby before the 20th week of the pregnancy is called a miscarriage. Severe cramps and pain in the stomach with spotting or bleeding are the signs of a miscarriage.

• Mittelschmerz (painful ovulation) - Pain felt by a woman during ovulation is called mittelschmerz. The pain can be sharp or dull, one-sided, and can last for a few minutes to hours.

• Premenstrual syndrome (PMS) and menstrual cramps - It is the abdominal pain and discomfort felt before and during the menstrual period. The other symptoms that you might have are sore breasts, bloating, mood changes, diarrhea, nausea, etc.

• Pelvic inflammatory disease (PID) - Bacterial infection of the female reproductive organs is called PID. The pain is in the center of the lower abdomen, and it can be tender to touch.

• Pelvic congestion syndrome(PCS) - It is the condition that results from the formation of varicose veins in the pelvic region. The pain is dull, and it increases on standing up, in evenings, before menstruation, and during sex.

• Ovarian torsion - When the ovary and fallopian tubes entangle with the surrounding tissue it is called ovarian torsion. It causes severe and sudden pain in the lower abdomen.

• Ovarian cyst rupture - Cysts, which are fluid-filled sacs, present in the ovaries twist or rupture causing pain in the lower abdomen. The pain can be sharp or dull.

• Uterine fibroids - Growths in the wall of the uterus is called uterine fibroids. They are commonly seen in reproductive age women. Larger fibroids can cause pressure and pain in the pelvis.

• Endometriosis - Growth of the uterine tissue outside the uterus is called endometriosis. It causes severe pain before and during periods, heavy bleeding, fatigue, and nausea.

• Pelvic organ prolapse - The muscles that support the bladder, uterus, and rectum become weak with age and childbirth. This causes these organs to fall into the vagina. It produces a feeling of pressure and heaviness in the pelvis.

• Vulvodynia - It is a pain or discomfort felt around the vulva (opening of the vagina). It causes pain, burning, and irritation on sitting or during sex.

• Cervical or ovarian or uterine cancer - Cancer of the reproductive organs can also cause pelvic pain.

3. The possible causes of pelvic pain in men alone are:

• Bacterial prostatitis - Inflammation of the prostate gland due to bacterial infection is called bacterial prostatitis. Apart from pelvic pain, frequent urination, fever, chills, nausea, and fatigue are also its symptoms.

• Chronic pelvic pain syndrome - Pelvic pain that lasts for more than 3 months with no obvious cause is called chronic pelvic pain syndrome. The patient usually has pain in the penis, testicles, lower abdomen, and near the perineum.

• Urethral stricture - Narrowing or blockage of the urethra is called urethral stricture. This blockage can be caused due to swelling, injury, or infection of the urethra. It causes pain during urination.

• Benign prostatic hyperplasia (BPH) - It is the enlargement of the prostate gland. As the size of the prostate gland grows, it puts pressure on the urethra and causes pain.

• Post-vasectomy pain syndrome - Vasectomy is the surgery that cuts the vas deferens so the sperm cannot get into the semen. Some people experience pain in the testicles for up to 3 months after this surgery.

What Are the Symptoms Related to Pelvic Pain?

Some symptoms occur along with pelvic pain, they are -

1. Menstrual cramps and pain.

2. Vaginal discharge.

3. Painful urination or burning on peeing.

4. Constipation or diarrhea.

5. Gas.

6. Blood in stools.

7. Pain during sex.

8. Fever.

9. Chills.

10. Pain in the hip and groin.

How Is Pelvic Pain Diagnosed?

When you visit the doctor for pelvic pain, the doctor will ask you questions like when the pain started, what are the factors triggering it, what gives you relief, how long have you had this pain, is the pain dull or sharp or aching, etc. The doctor might also ask about your sex life and family history, to rule out sexually transmitted infection and hereditary cancers.

Then the doctor will perform a pelvic examination, where he or she checks any abnormalities like masses or tenderness in the pelvic region. After this, depending on the history and physical examination, the doctor might ask you to perform all or a few of the following tests.

• Blood test.

• Urine test.

• Pregnancy test.

• Vaginal and semen culture.

• X-rays.

• Diagnostic laparoscopy.

• Hysteroscopy.

• Stool test.

• Colonoscopy or sigmoidoscopy.

• Ultrasound.

• CT scan.

What are the Treatments for Pelvic Pain?

The treatment for pelvic pain depends on the cause, the severity of pain, and the frequency of pain. Depending on the cause, it can be treated with medicines like antibiotics and painkillers, surgery, or other therapeutic measures. For example, antibiotics are given for pelvic inflammatory disease and surgery is indicated in cases of ectopic pregnancy, cervical or uterine cancer, appendicitis, and ovarian torsion. In some chronic cases, physiotherapy and psychological counseling are also needed.

When to Consult a Doctor?

Mild and temporary pain in the pelvic region is usually nothing to worry about, but if the pain gets severe and becomes continuous, then it is best to consult your doctor. You should also seek immediate medical help if pelvic pain is accompanied with blood in urine or stool, difficulty urinating, fever, chills, constipation or diarrhea, and vaginal spotting.