Pelvic pain, also known as lower abdominal pain, in women is any pain that occurs in the area below your belly button. Pain may be sudden and severe or mild and persistent. It is important to see your GP to investigate what may be causing your pelvic pain. Although in some cases your doctor may not be able to identify a cause, they may still be able to advise you on how best to manage your pelvic pain.
There are many different reasons that you may have pelvic pain, such as an infection in your pelvis or pain coming from the bones, joints, muscles, blood vessels, nerves or organs in your pelvis.
Organs in your pelvis include your bowel and bladder. In women, who are more likely to experience pelvic pain than men, the womb, ovaries, fallopian tubes, cervix (the neck of the womb) and vagina also sit in the pelvis. A problem affecting one or several of these reproductive organs is often the cause of lower abdominal pain in women. Your GP may therefore refer you to a doctor specialising in the female reproductive system (a gynaecologist) to investigate your pelvic pain.
Pelvic pain can be acute or chronic (long-term). In either case, you should see your GP so your pain can be investigated and treated.
Acute pelvic pain comes on suddenly and unexpectedly.
Around one in six women have chronic pelvic pain, which is pelvic pain that lasts for at least six months. It may be continuous or come and go, and is more severe and longer-lasting than your usual period pain.
If you are not pregnant, there are several common causes of acute pelvic pain, which can be grouped into those affecting your reproductive organs and those affecting your non-reproductive organs.
Causes affecting reproductive organs
Causes affecting non-reproductive organs
Less common acute pelvic pain causes include endometriosis, where tissue similar to the lining of your womb (endometrium) starts to grow elsewhere. During your periods when the tissue breaks down, it can’t be released from your vagina and consequently causes pain and may form scar tissue which can reduce your fertility. You may also experience some vaginal bleeding, which is darker than your period bleeding
Pelvic abscesses can also acute pelvic pain in women. These pus-filled structures develop between your womb and vagina, and need urgent medical treatment.
A type of ovarian cyst called a corpus luteum cyst can cause acute pelvic pain too if it ruptures. Pain is severe and on one side of your pelvis. If you experience this pelvic pain in early pregnancy ie the first 12 weeks of pregnancy, you should contact your midwife or your doctor.
Acute pelvic pain in pregnancy
Acute pelvic pain in pregnancy usually needs urgent medical treatment.
An ectopic pregnancy can cause acute pelvic pain. An ectopic pregnancy occurs when the embryo implants and starts growing outside of your womb. Symptoms include sharp pelvic pain or cramps often on one side of your abdomen, bleeding from your vagina, dizziness and nausea. You will need urgent treatment as an ectopic pregnancy can be life-threatening.
A miscarriage ie loss of a pregnancy in the first 23 weeks can cause acute pelvic pain and/or cramps and bleeding from your vagina. You may also pass tissue that looks like a large blood clot from your vagina.
Placental abruption ie when the placenta starts to detach from the wall of your womb, also causes acute pelvic pain. If it occurs before week 24 of your pregnancy this is called a miscarriage; after week 24 of your pregnancy, emergency treatment is needed to deliver your baby.
Premature labour ie labour before week 37 of your pregnancy can cause pelvic pain, period-like pains, regular contractions, tightening across your abdomen, fluid leaking from your vagina and backache that is not usual for you. Call your midwife immediately if you experience these symptoms
The three most common causes of chronic pelvic pain in women are chronic pelvic inflammatory disease, endometriosis and irritable bowel syndrome (IBS).
Chronic pelvic inflammatory disease is a bacterial infection of your reproductive organs that most commonly occurs after becoming infected with chlamydia or gonorrhoea. It needs urgent treatment with antibiotics. Symptoms include, fever, pain during sex or urination, pelvic pain and unusual vaginal discharge.
Endometriosis occurs when tissue similar to the lining of your womb (endometrium) starts to grow elsewhere.
IBS is a common condition affecting your bowel, which can cause pelvic pain, stomach cramps, bloating, and recurring diarrhoea and constipation. The causes aren’t clear but it can be treated with dietary changes, reducing stress levels and taking certain medications.
Less common causes of chronic pelvic pain in women can be grouped into those affecting your reproductive organs and those affecting your non-reproductive organs.
Causes affecting reproductive organs
This is a type of endometriosis where the tissue lining the womb grows into the muscular wall of the womb. Symptoms include painful, heavy periods.
Fibroids are non-cancerous growths in or around your womb. They may cause heavy or painful periods if they deteriorate or become twisted. Around one in five women aged 30-50 years has fibroids. Other symptoms include difficulty getting pregnant, lower back pain, painful sex, pelvic pain and pressure in your abdomen.
Prolapse of the womb
This occurs when your womb slips down into your vagina causing a dragging pain or discomfort. This is more common in post-menopausal women and women who have had multiple vaginal births but it is not usually a serious problem.
Recurring ovarian cysts
Ovarian cysts are fluid-filled sacs that develop on or in your ovaries. They are usually harmless and go away on their own (functional ovarian cysts) but cause pelvic pain if they burst or become twisted.
Causes affecting non-reproductive organs
Chronic interstitial cystitis
This is also known as painful bladder syndrome. The causes are unclear but the result is long-term inflammation of your bladder. Symptoms include severe pelvic pain, sudden strong urges to urinate, urinating more frequently and waking up often at night to urinate.
Frequent urinary tract infections (UTIs)
Symptoms of UTIs include pelvic pain, pain or a burning feeling when you urinate and urinating more frequently.
A hernia is where part of the tissue inside your body pushes through the muscle or tissue holding it in. Inguinal hernias are most common and occur when part of your bowel pushes through your abdominal muscle, which can cause severe pain, especially if the blood supply to the bowel is cut off (strangulated hernia).
Inflammatory bowel disease (IBD)
IBD includes two similar but different conditions that affect your gut, Crohn's disease and ulcerative colitis.
Kidney stones are deposits of salt and minerals that vary in size, from as small as a grain of sand to as large as a golf ball. Small kidney stones may pass out of your urine on their own but larger kidney stones may need treatment.
Lower back pain
There are many causes of lower back pain including muscle damage, pinched nerves and spinal abnormalities, which can all cause pain to spread to your pelvis.
Other less common causes of chronic pelvic pain affecting non-reproductive organs include:
Pelvic pain symptoms vary considerably depending on the underlying cause eg you may experience a sharp, stabbing pain in your pelvic area or feel a dull pressure in your lower abdomen. Depending on which organ or structure is involved you may have pelvic bone pain or pelvic muscle pain.
You may find that your pelvic pain is worse after a bowel movement or that it is worse during your period eg if you have menstrual pain or menstrual cramps. Other symptoms associated with pelvic pain include:
Pelvic pain can also occur alongside or lead to hip and/or groin pain.
If you have pelvic pain, whether it is acute or chronic, it’s important to see your doctor. They will ask you questions about your symptoms and medical history, as well as conduct a physical examination. If you are a woman of reproductive age, your doctor may suggest taking a pregnancy test.
Further tests for the diagnosis of pelvic pain, which your doctor may recommend, include scans of your abdomen and pelvis, such as:
Your doctor may recommend a more invasive test using special, thin telescope-like tubes that have a camera on the end (scopes) so they can see directly inside your body. These tests include:
Other tests to help diagnose your pelvic pain include:
Pelvic pain treatments vary depending on the underlying cause, as well as the frequency and intensity of your pain.
Treatments include medications, such as painkillers and antibiotics. If you are certain that your pelvic pain is caused by your period you can try taking the painkillers paracetamol and/or ibuprofen.
However, in some cases, you may need surgery or another medical intervention, especially if the pain is caused by damage to or disease of an organ or tissue.
Physiotherapy can help treat some causes of pelvic pain. A physiotherapist can put together a specific programme tailored to your symptoms.
If you have chronic pelvic pain, treatment may not just be limited to physical interventions. You may want to consider seeing a counsellor, psychologist or psychiatrist to help you cope with the stress of managing chronic pain.
If you don’t know what’s causing your pelvic pain or your pain is severe, see your doctor. You may need medical treatment and in some cases, this may be needed urgently.
How do you know if pelvic pain is serious?
If you don’t know what’s causing your pelvic pain or if your pelvic pain is caused by your periods but is affecting your quality of life, you should see a doctor. As pelvic pain can be caused by a variety of conditions, it’s always worth investigating to determine whether it’s serious and whether you need treatment.
When should you worry about pelvic pain?
If your pelvic pain is affecting your quality of life, if you don’t know what is causing your pelvic pain or it is severe, then it’s time to seek medical help.
Can dehydration cause pelvic pain?
Dehydration can cause abdominal or pelvic pain. Dehydration is also a risk factor for constipation, which can also cause pelvic pain.
What does pelvic pressure feel like?
Pelvic pressure can feel like a weight pressing on your pelvis. It can also make you feel as if you need to open your bowels.
What does ovarian cyst pain feel like?
Ovarian cysts do not always cause pain. However, when they do, you may feel a general discomfort or pain in your pelvis. If your ovarian cysts burst or become twisted, you may feel sudden, severe pain.
Can stress and anxiety cause pelvic pain?
Yes, stress and anxiety can cause pelvic pain by causing muscles in and around your pelvis to tense up.
What side is your uterus on?
Your uterus (womb) is located just below the level of your belly button and in a central position. This means pelvic pain caused by your womb can occur on either the left or right side of your body or centrally.
Can pelvic pain be a sign of pregnancy?
Yes, pregnancy can cause pelvic pain, also known as pregnancy-related pelvic girdle pain (PGP) or symphysis pubis dysfunction (SPD). It is caused by stiffness in your pelvic joints or uneven movement of the joints moving in front or behind your pelvis. This does not affect your baby and most women can still have a vaginal birth.
Can pelvic pain be muscular?
Yes, pelvic pain can be caused by damage, inflammation or tension in any of the muscles in and around the pelvis, as well as by muscles in your abdomen and back. This includes muscle spasms in your pelvic floor and adenomyosis, which affects your womb muscle.
Why does my lower abdomen hurt when I press on it?
If your lower abdomen is tender and hurts when you press on it, an underlying organ or tissue could be inflamed. This could be due to infection or disease. The pain may originate in your appendix, bowel, bladder, ovaries, urinary tract, womb or the lining of your abdomen (peritoneum).
If you're concerned about symptoms you're experiencing or require further information on the subject, talk to a GP or see an expert consultant at your local Spire hospital.
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