Pelvic pain: Causes and treatment

Pelvic pain is a common issue among women. You may suddenly feel pain in the pelvic area, which may or may not go away. Sometimes, it may last a few months. In some cases, it is accompanied by back or thigh pain, nausea, and abnormal vaginal discharge. You may be among several women who experience pain in this region while menstruating. However, this is not the only cause of pelvic pain in women. It may have to do with an infection or pregnancy or a disease, including cancer. You don’t have to always worry about the pain, but if it is chronic, you will need medical attention.

What is pelvic pain?

“It is discomfort or pain that occurs in the lower abdomen or pelvic region, which is the area below the belly button and above the thighs,” explains obstetrician and gynaecologist Dr Chetna Jain. It can arise from a wide range of causes and can affect both men and women. But this kind of pain is more common in women than men, according to the UK National Health Service.

Types of pelvic pain

Here are two types of pelvic pain:

• Acute pelvic pain: Sudden and severe pain, often caused by conditions like ovarian cysts, pelvic inflammatory disease, or ectopic pregnancy.
• Chronic pelvic pain: Lasts for six months or longer and may be constant or intermittent. It is often linked to conditions like endometriosis, or chronic bladder or bowel issues.

What are the causes of pelvic pain in women?

1. Menstrual cramps

The pain is caused by the contraction of the uterus during period. “It is common and usually felt as cramping in the lower abdomen before or during a period, and often resolves after a few days,” says the expert. During a February 2024 study published in the Journal Of Personalized Medicine, the effects of the menstrual cycle on women’s pelvic symptoms were analysed. As many as 41.3 percent of the participants experienced pelvic pain while they were down.

2. Endometriosis

In the case of endometriosis, the tissue, which is similar to the lining of the uterus, grows outside the uterus. “This tissue responds to the menstrual cycle, and causes inflammation, pain in the pelvic area, and sometimes even infertility,” shares the expert.

3. Pelvic inflammatory disease

It is infection of the reproductive organs, often due to sexually transmitted infections like chlamydia or gonorrhea. Pelvic Inflammatory Disease can lead to severe pelvic pain, fever, and abnormal discharge. Chronic pelvic pain is seen in about one-third of women with Pelvic Inflammatory Disease, according to research published in StatPearls in 2023.

4. Ovarian cysts

They are fluid-filled sacs that get developed on the ovaries, which are located on each side of the uterus. “Some cysts are harmless, but if they rupture or become twisted (ovarian torsion), they can cause sharp, and localised pain,” says the expert.

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5. Uterine fibroids

These are common noncancerous growths in the uterus that often appear during a woman’s reproductive stage. “Uterine fibroids can cause pain in the pelvic area as well as pressure, and heavy bleeding, especially if they are big in size,” says Dr Jain.

6. Urinary tract infections

These are bacterial infections in the urinary system, such as the bladder or kidneys. “Urinary Tract Infections or UTIs often lead to pelvic discomfort, along with symptoms like painful urination, increased urgency, and fever,” says the expert.

7. Interstitial cystitis

It is a chronic bladder condition that causes bladder pressure, and pain. Sometimes, it leads to pelvic pain too. It tends to affect the way you pee. You may feel the need to frequently urinate and experience pain, and discomfort when your bladder gets full.

8. Irritable bowel syndrome (IBS)

It is a functional gastrointestinal disorder affecting the large intestine. IBS can cause abdominal cramping, bloating, diarrhea, constipation, and pelvic pain. During a 2014 study published in the Journal of Clinical Gastroenterology, 40 percent of women had pain in the pelvic area and IBS.

9. Constipation

When you have constipation, you have difficulty passing stools, and it is often accompanied by bloating and discomfort. “Chronic constipation can cause pelvic pain as the colon stretches and applies pressure to nearby organs,” says the expert.

10. Ectopic pregnancy

It is pregnancy where the fertilised egg implants outside the uterus, usually in the fallopian tube. Ectopic pregnancy can cause severe, sharp pelvic pain and is considered a medical emergency. It is a considerable cause of maternal morbidity, according to research published in the Journal of Family Planning And Reproductive Health Care in 2012.

11. Pelvic organ prolapse

In the case of pelvic organ prolapse, weakening of the pelvic floor muscles leads to the descent of pelvic organs such as the bladder, uterus, or rectum. “Prolapse can cause discomfort, pain, and a sensation of fullness or pressure in the pelvic region,” says the expert.

12. Musculoskeletal pain

It is the pain in muscles, ligaments, or bones in the pelvic area. “Injuries, overuse, or strain of the pelvic muscles or ligaments can result in pain and discomfort. The pain can be especially felt during certain movements or physical activities,” says the expert.

13. Chronic pelvic pain syndrome

It is the persistent pelvic pain without a clear medical cause or reason behind it. “Often linked to pelvic floor dysfunction, stress, or nerve issues, the Chronic Pelvic Pain Syndrome can result in long-term discomfort and pain,” says Dr Jain. The pain can last for six months or even longer.

14. Pudendal neuralgia

It is the irritation or damage to the pelvic nerves. It is a medical condition that leads to pain, and discomfort in the pelvis area. Sometimes, you feel numbness in the pelvis region. It happens due to damage, inflammation, or injury of the pudendal nerve.

15. Endometrial hyperplasia

It is the overgrowth of the endometrial lining inside the uterus. “Endometrial hyperplasia can cause heavy periods, and abnormal bleeding along with pelvic discomfort. Sometimes, it can lead to more severe conditions like cancer,” says Dr Jain.

16. Sexually transmitted infections

Sexually transmitted infections like chlamydia, gonorrhea, or herpes can affect the reproductive organs. Chlamydia, caused by chlamydia trachomatis bacteria, can lead to chronic pelvic pain, according to research published in The Journal of Infectious Diseases in 2010. STIs can also cause abnormal discharge, itching, and a burning sensation during urination.

17. Cancer

Cancers like ovarian, cervical, and uterine when malignant tumors get formed in the reproductive organs. “Pelvic pain associated with cancer is often persistent and can worsen over time, accompanied by other symptoms like bloating, weight loss, and changes in bowel or urinary habits,” says the expert. While studying the symptoms of early-stage high risk ovarian cancer, researchers found that pelvic pain was the most common sign seen in women. About 70 percent of them experienced it, as per research published in the Obstetrics And Gynecology journal in 2023.

What are the symptoms of pelvic pain?

Pain in the pelvic area can manifest in various ways, so look out for these signs:

• Localised pain: A dull or sharp pain in the lower abdomen or pelvic region, which may also be felt in the lower back or thighs.
• Pain during or after sex: Pain during penetration, deep thrusting, or after sex, which can be a sharp or aching pain.
• Painful urination or bowel movements: A burning or stinging sensation during urination or bowel movements, often accompanied by the urge to urinate or pass stools more frequently.
• Abnormal vaginal discharge: Unusual vaginal discharge (which may be thick, green, yellow, or foul-smelling) or abnormal bleeding (spotting, heavy periods, or bleeding between periods).
• Nausea: Feeling nauseous or actually vomiting along with pelvic pain.
• Bloating or fullness: A sensation of fullness or bloating in the lower abdomen, which may cause discomfort or difficulty with movement.
• Back or thigh pain: Radiating pain that travels from the pelvic area to the lower back, buttocks, or thighs.

How to treat pelvic pain?

Treatment depends on the underlying cause of the pelvic pain in women, but some of the options are:

• Medications: Pain relievers, antibiotics for infections, or hormone therapy may be given for conditions like endometriosis.
• Physical therapy: Pelvic floor exercises or therapy can help to relax tense muscles or strengthen weak ones.
• Surgery: For conditions like fibroids, cysts, or endometriosis, surgery may be necessary.
• Lifestyle changes: Stress management, or weight loss can help alleviate some types of pelvic pain.
• Heat therapy: Applying heat pads or warm baths can help to relieve cramps and muscle tension.

Pelvic pain in women is quite common. But if it is persistent or severe, reach out to a doctor to determine the cause and figure out the best treatment for you.