Understanding pelvic pain
Pelvic pain is felt in the lower abdomen and pelvic areas, and is described as chronic if it occurs over a period of six months. Chronic pelvic pain affects roughly one in six women and can affect your ability to perform everyday activities.
Pelvic pain can be dull or sharp, depending on its source, and can be constant or intermittent. The pain can sometimes radiate to surrounding areas such as thighs, buttocks and lower back, and may only be noticeable at certain time like when urinating or sex.
Causes of pelvic pain
Chronic pelvic pain can be caused by a combination of social, physical or psychological factors, and is not always just a single condition. Possible causes can include:
- Interstitial cystitis
- Pelvic organ prolapse
- A traumatic experience
- Irritable bowel syndrome (IBS)
- Pelvic inflammatory disease
- Musculoskeletal pain
- Depression and stress
What is endometriosis?
Endometriosis is caused by the endometrial lining being found outside of the uterus, for example attached to internal organs like the outside of the bladder, intestine or kidneys. Every menstrual cycle these endometrial cells become inflamed and bleed as if they were inside the uterus. This causes immense pain in many women, however some women with endometrial lining found outside of the uterus inexplicably do not have this pain. Endometriosis can be linked to inflammation of the fallopian tubes, ovaries and pelvic peritoneum, and is a cause of infertility. The cause of endometriosis is not known.
Also known as painful bladder syndrome, interstitial cystitis (IC) causes frequent urination and bladder pain. Interstitial cystitis is chronic with no known cause, and a mixed response to treatments. IC can go into remission for periods of time before reappearing, or it may disappear for good.
Women with red hair and fair skin have an increased chance of developing interstitial cystitis, as do those who suffer from chronic pain disorders like fibromyalgia or irritable bowel.
Pelvic organ prolapse
Pelvic organ prolapse (POP) is a condition in which one or more organs in the pelvic area are no longer supported properly supported by connective tissue and other pelvic structures. This can cause the unsupported organs to slip out of place.
Pregnancy and giving birth are the most common causes of a pelvic organ prolapse, but it can happen to young women who have never been pregnant. Weak pelvic floor muscles, connective tissue disorders, poor posture and a lack of oestrogen can contribute to causing a pelvic organ prolapse.
There are a handful of different injuries that can cause pelvic pain such as
- Saddle injuries – these involve your vulva or pubic/pelvic bones impacting with a hard surface, which can cause bruising or damage
- Penetrative injury – occurs from something penetrating the vagina and causing damage that may need medical treatment, including accidents and sexual assault
- Non-penetrative injury – damage can be caused by a fracture or other injury
- Multiple trauma injury – a combination of any of the injuries mentioned above
- Urethral injury – an injury that affects the urethra or urethral meatus
- Insufflation injury – damage caused by blowing air or other substances inside the vagina, which becomes an issue when bubbles get trapped in tissue
Irritable bowel syndrome (IBS)
If you have IBS, the contraction in your bowels are stronger than normal, which can result in food moving fast and causing diarrhoea, bloating and gas. Conversely, it moves too slowly and causes constipation. This can cause cramping and chronic pain in the abdomen and pelvic area.
Pelvic adhesions are common in those who have had extensive and untreated endometriosis, Caesareans (C-sections), other open surgeries, or infections. Scar tissue can grow between any organs, attaching one to the other, and cause significant pelvic pain.
Pelvic inflammatory disease
Pelvic inflammatory disease (PID) is a condition in which a sexually transmitted infection (STI) or other infection in left unnoticed or untreated. This can cause inflammation and scarring, and sometimes lead to severe pain and infertility. The main diseases that cause PID are chlamydia and gonorrhoea, and other infections that are not STIs.
It is very common for musculoskeletal problems to cause pelvic pain, but it is often overlooked. Tissues can be stretched, torn or cut during surgery, muscles can weaken or tighten, and posture and movement can put strain on the pelvis. Chronic pain can be caused by muscle spasms.
Depression and stress
The trigger points in the pelvic floor that register sore and painful muscles may be susceptible to the hormones and physiological changes brought on by stress. There can be a strong relationship between stress and depression levels and chronic pelvic pain in some people.
Your doctor’s visit for pelvic pain
At your appointment, you will have an opportunity to discuss the pain you are experiencing, and discuss any concerns you have. It is important to accurately describe your pain and symptoms to ensure your diagnosis is accurate. You should tell your doctor about:
- The pattern of pain
- Anything that makes your pain better or worse (movement or positions)
- Any medication you have tried
- Any other problems that can be linked to your pain (periods, sex, psychological symptoms)
It can be beneficial to keep a pain diary to note down whenever you experience pain, the severity, how long it lasts and if there is any obvious cause. Aspects of your everyday life such as sleep patterns, appetite and general wellbeing can also exacerbate your symptoms, so it’s important to keep an accurate record to assist with diagnosis and successful treatment.
Treatments for pelvic pain
If your pain is due to a particular identifiable cause, you will be offered a specific treatment for the condition:
- Irritable bowel syndrome (IBS) – a change of diet and medication can help
- Infections – can be treated with antibiotics
- Pain related to your menstrual cycle, including endometriosis – you may be offered hormone treatments and in some cases more advanced treatments to remove tissue
- Adhesions – may be treated with surgery, other non-invasive therapies or a change in diet
If you are suffering pelvic pain, the first step is to contact your doctor.