Causes of Pelvic Pain
Pelvic pain can be caused by a variety of different things, some of which are serious and some of which are less serious. From pelvic inflammatory disease to kidney stones, there are a variety of conditions and diseases that can cause pelvic pain.
In this article, we will explore some of the most common causes of pelvic pain, so you can get an understanding of what might be causing your pain and take the appropriate steps to find relief:
Injury or trauma
Injury or trauma to the bones in the pelvic area can result in acute pelvic bone pain. This type of pain is usually caused by a fall or an accident that has damaged a bone, tendon, muscle or ligament surrounding the pelvic bone. Symptoms vary depending on the extent of the injury, but they may include immediate sharp pain and swelling around the affected area.
If swelling or bruising occurs, it typically takes just a few days to heal on its own with rest and/or treatment with medications such as anti-inflammatory drugs (NSAIDs) like ibuprofen and nonsteroidal creams. If the injury does not seem to be healing properly, further medical evaluation is recommended.
Infections are a common cause of pelvic pain. These often involve the reproductive organs, such as the uterus and ovaries, although they can affect other organs in the area as well. The infection may be caused by a virus or bacteria, and is usually accompanied by fever, fatigue, and other symptoms. Bacterial infections are typically treated with antibiotics.
Other potential causes of infection-related pelvic pain include:
- Endometriosis, which occurs when tissue from the uterus grows outside it.
- Pelvic inflammatory disease (PID), which is an infection that can occur after an untreated STI.
- Sexually transmitted infections (STIs), which can cause pelvic pain. Both bacterial and viral STIs can cause pelvic pain.
Treatment for these conditions will vary depending on the cause of the infection.
Pelvic organ prolapse
Pelvic organ prolapse occurs when one or more of the organs in the pelvis slip out of their normal place and press on the walls of your pelvis. Common pelvic organs are the uterus, bladder, urethra, rectum and vagina. This condition can cause mild to severe pain in your pelvic area and can lead to other problems such as urinary incontinence and difficulty controlling your bowels.
Risk factors for pelvic organ prolapse include:
- Chronic coughing
- Grinding teeth
If you are experiencing persistent or severe pelvic pain, talk to your healthcare provider about possible treatment options.
Pelvic inflammatory disease
Pelvic inflammatory disease (PID) is a general term for an infection in the lower pelvic area that affects several organs, including the uterus, ovaries, and fallopian tubes. PID is most commonly caused by sexually transmitted infections (STIs) such as gonorrhea and chlamydia. It can also be caused by other bacteria normally found in the body.
Symptoms of PID include:
- Pain in the lower abdomen and pelvis
- Irregular menstrual bleeding or spotting between periods
- Pain during sex or urination
- Fever, nausea, or vomiting
If not treated, PID can lead to infertility and an increased risk of ectopic pregnancy.
In most cases of PID diagnosed early enough to treat without long-term complications or damage to fertility, treatment consists of antibiotics prescribed by a physician. Most cases are curable with proper treatment but if left untreated it can cause serious problems such as pelvic abscesses, chronic abdominal pain, infertility and ectopic pregnancy. Health care providers may suggest surgery to remove any abscesses or scar tissue that may have developed as a result of untreated PID. It’s important for those who have been diagnosed with PID to inform any current sexual partners so they can be tested for possible STIs and receive treatment if necessary.
Endometriosis is a very common condition where tissue that normally lines the inside of your uterus – the endometrium – grows outside of it. This displaced endometrial tissue can attach to other organs or tissues in your lower abdomen, including your ovaries, fallopian tubes, bladder, and bowel. Studies show that 40-50% of women with pelvic pain suffer from endometriosis.
Your body’s reaction to this out-of-place tissue may cause inflammation which leads to pain and discomfort and can worsen during menstruation. If a woman has severe pelvic pain due to endometriosis, she may also experience painful intercourse, nausea or vomiting during her period, excessive bleeding or spotting between periods, and problems with her bowels or bladder.
In addition to pelvic pain, endometriosis can also impair fertility as the growing out-of-place tissue may cause abnormal changes in nearby organs and block the fallopian tubes altogether. Treatment for this condition usually involves medications and surgery but lifestyle adjustments such as dietary treatment plans and exercise interventions have also shown success at improving symptoms of endometriosis.
It’s important to talk with a health care professional about your pelvic pain so that you receive accurate diagnosis for appropriate treatment.
Fibroids are a common form of pelvic pain and can cause severe discomfort. These non-cancerous, benign tumors are composed of muscle cells and tissue that develop within the wall of the uterus, often leading to distress within the pelvic region. Fibroids can range in size from being too small to be seen with the naked eye to becoming as large as a grapefruit. Fibroids can also disrupt other organs in the body such as the bladder, intestines and bowels, leading to an increased pressure on these areas.
Common symptoms of fibroid-related pelvic pain include:
- unusual bleeding from your vagina during menstruation or between periods
- painful or frequent urination
- frequent bowel movements with associated abdominal cramps
- pain during sexual intercourse
- lower back pain
- bloated abdomen
- fatigue due to anemia resulting from heavy menstrual flow caused by fibroids
If you think your pelvic pain might be related to fibroids, it is important that you talk with your doctor who may recommend treating them with medications or surgery depending on their size and location. Early diagnosis can help reduce the severity of symptoms and prevent severe complications associated with fibroids such as infertility.
Symptoms of Pelvic Pain
Experiencing pelvic pain can be an uncomfortable and concerning experience. It is important to recognize the signs and symptoms of pelvic pain so that you can seek treatment and get relief.
Common symptoms of pelvic pain include pain or discomfort in the lower abdomen, lower back, or groin area as well as pelvic cramping, a burning sensation, or bloating.
Let’s discuss the symptoms of pelvic pain in more detail:
Lower abdominal pain
Lower abdominal pain is a common symptom of pelvic pain and it can vary in intensity, location, and duration. It can be felt on one side or both sides of the lower abdomen. A feeling of pressure or tightness in the area may also be present.
Lower abdominal pain may indicate:
- Bladder or urinary tract infections
- Ovarian cysts/pelvic inflammatory disease
- Menstrual cramps/premenstrual syndrome (PMS)
- Irritable bowel syndrome (IBS)
- Miscarriage/Ectopic pregnancy
- Ovarian torsion
- Other medical conditions
If you experience lower abdominal pain for more than two days consult your healthcare professional for assessment and treatment options.
Pain during sexual intercourse
Pain during sexual intercourse (dyspareunia) is a common symptom of pelvic pain. It is generally caused by an underlying condition and should be evaluated promptly. In some cases, the cause may be physical, such as muscular tension or scarring due to pelvic surgery; in others, it may be psychological in nature, such as fear or anxiety about sex. Other potential causes may include infection or inflammation of the reproductive organs; endometriosis; ovarian cysts; fibroids; or prostate-related issues.
If you experience pain during sex and it is moderate to severe in intensity, it’s best to see a healthcare provider for an evaluation. Your doctor will likely inquire about your medical and sexual history, conduct a physical examination to identify any potential sources of discomfort, as well as recommend tests such as an x-ray or ultrasound to further assess your condition. Treatment will depend on the underlying cause, but could include:
- Hormones therapy
- Various therapy techniques such as physical therapy or psychotherapy
- Dietary changes
- Lifestyle modifications (including abstaining from sex)
- Pelvic floor strengthening exercises
- and/or assistive devices (such as vaginal dilators).
Pain during urination
Pain during urination, also known as dysuria, is a characteristic feature of pelvic pain in both sexes. Pain during urination can either be burning pain or sharp pains that start and stop throughout the urine stream. The sensation of feeling like you do not completely empty your bladder after you are done is also a common symptom.
Other symptoms include:
- Cloudy urine
- Urine with an offensive odor
- Frequent urination (urgency)
- Pain during sexual intercourse
- Urinary tract infections
- Bloody, cloudy or altered color of the urine
- Lower back pressure and inflammation or swelling around the pelvis, hips or lower abdomen
Pain during bowel movements
Pain during bowel movements is a common symptom of pelvic pain. In some cases, the pain may be due to a medical condition, such as inflammatory bowel disease (IBD) or irritable bowel syndrome (IBS). If you experience pain during or after a bowel movement, this can be a sign of pelvic floor dysfunction.
Pelvic floor dysfunction is when the muscles that support your Pelvic organs become weak and unable to properly control your bowels. This causes them to spasm, leading to Pain. Other symptoms associated with pelvic floor dysfunction include:
- Difficulty holding in gas or stool
- Accidental leakage of stool or urine
- Pain during sex
- Bloating and/or constipation
- Lower back pain
- Trouble starting and/or releasing urine
If you are experiencing any of these symptoms it is important that you consult your doctor for proper diagnosis and treatment of your pelvic floor issues. Your doctor may suggest lifestyle changes such as increasing water intake, dietary modifications like eliminating processed foods, as well as physical therapy exercises specifically targeted toward strengthening the muscles in your pelvic area. Treatment for more severe cases may involve administered medications, injections, surgical procedures and sometimes even implantation of specialized devices used to assist with bladder control.
Diagnosis and Treatment
Pain in the pelvic area can be concerning, and it’s important to get a proper diagnosis to understand the cause and get the right treatment. The pelvic bone is a complex area, and pain can come from the bone itself, the muscles, ligaments, or other structures in the area.
Let’s discuss the diagnosis and potential treatments for pelvic bone pain:
Physicians use a physical examination to accurately assess and diagnose pain in the pelvic bones. During this test, your doctor will assess the area for tenderness and swelling, as well as areas of discomfort or pain. Your doctor may also press on certain areas to determine the source of your pelvic pain. It is important for you to be transparent about any unpleasant sensations that you experience during the physical exam, in order to facilitate a more accurate diagnosis.
Depending on your symptoms, your doctor may ask additional questions such as:
- How long you have been experiencing pain?
- Do any activities cause it to worsen or lessen?
If necessary, they may order imaging tests (e.g., X-ray) to look for any bone or tissue abnormalities that could be causing your pelvic bone pain. After conducting tests and assessing patient-provided information, the doctor will evaluate results and make recommendations on treatment options based on their findings.
Imaging tests can help your doctor get a better view of the pelvic area to identify the source of pain. Imaging tests may include:
- X-rays: X-rays use radiation to create images of dense structures, such as bones, on film. X-rays can detect infection or injury in pelvic area structures.
- Computerized tomography (CT) scan: CT scan combines a series of X-ray images taken from different angles and uses computer processing to create cross-sectional images (slices) of the bones, blood vessels and soft tissues inside your body. This can help diagnose problems with organs and tissues that may not show up on normal X-rays.
- Magnetic resonance imaging (MRI): An MRI uses a strong magnet connected to a computer that creates detailed pictures of organs and structures within your body – including in the pelvic area. It’s especially useful for detecting problems in soft tissue and organs, such as ligaments, muscles and reproductive organs.
These imaging tests give your healthcare provider more information about what’s causing the pain in your pelvic bone or area so they can recommend treatment options that provide you with relief.
Prior to commencing a diagnosis, medical advice may call for laboratory tests to confirm the diagnosis and for further clarification of the causes of pelvic bone pain. Lab tests required can include urine and/or blood tests or even specific imaging techniques.
Urine tests will typically look for signs of infection by examining the presence of bacteria, viruses and other microorganisms that could cause pelvic bone pain. Additionally, a urine culture test will be carried out in order to check for urine borne diseases that could manifest as pelvic bone pain.
Blood tests are used to detect inflammatory markers, signs of anemia or elevated levels of vitamins and minerals which may point towards a more serious underlying cause. Your doctor will also be able to examine your levels of red blood cells, white blood cells, platelets as well as any other indicators like glucose or iron concentrations. These results alongside symptoms may provide an accurate assessment on any potential illnesses or complicated health conditions that the patient is experiencing.
Imaging techniques include:
- Ultrasound scans (which utilize sound waves)
- Magnetic resonance imaging (MRI) scans (which rely on strong magnetic fields)
- Computed tomography (CT) scans (which use Xan-ray emission).
These are used to identify abnormalities within bones and tissues as well as pinpointing areas that are in need of treatment from medications, injections or physical therapy programmes.
When pelvic bone pain is caused by a musculoskeletal condition or injury, treatment depends on the underlying cause. With this in mind, several management options are available:
- Physical therapy: Physical therapists (PTs) treat musculoskeletal disorders and injuries using exercises, joint mobilization techniques, and other modalities that improve muscle strength and reduce inflammation. PTs may also offer lifestyle recommendations to prevent future pelvic pain.
- Medication: Over-the-counter (OTC) medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve pelvic pain due to inflammation caused by conditions such as endometriosis and prostatitis. Prescription pain medications may be necessary for more severe cases.
- Surgery: Surgery may be necessary if the cause of pelvic bone pain is a structural abnormality such as hernia or if a tumor is present. Neuromodulation treatments such as shunts and nerve blocks are also used to alleviate chronic pain conditions associated with the pelvis.
- Complementary therapies: Complementary therapies such as acupuncture, massage therapy, chiropractic care, or biofeedback can all be used to provide relief from pelvic bone discomfort caused by musculoskeletal issues or injuries. Other self-care treatments include hot or cold packs, stretching exercises, and posture correction techniques.
Pelvic bone pain can be debilitating and can interfere with living a normal life. Therefore, prevention is essential.
Some of the ways to avoid pelvic bone pain are to maintain proper posture and body alignment, exercise regularly, and keep your core muscles strong. Additionally, you can take some simple steps to reduce the risk of pelvic bone pain, such as strengthening your gluteal muscles and avoiding activities that place a strain on your pelvis.
Exercising regularly is a key component of preventing pelvic bone pain. Regular physical activity helps strengthen the muscles and ligaments in your core and lower body, which can reduce the amount of pressure placed on your pelvic bones.
Low-impact exercises such as walking, swimming, low-impact aerobics and yoga are excellent ways to improve overall muscular strength without causing further damage. Pay special attention to developing good form while exercising in order to gain maximum benefit and reduce any potential risk of injury.
Additionally, strengthening your core muscles helps maintain good posture, which can also help relieve pelvic bone pain over time.
Maintain a healthy weight
Staying within a healthy weight range is essential in helping to prevent pelvic bone pain. Being overweight places added strain and pressure on the pelvis, while also increasing the risk of developing osteoarthritis, which can be a major source of pelvic bone pain.
Maintaining a healthy weight can be achieved through incorporating regular exercise into your daily routine and following a nutritious balanced diet. If you are finding it difficult to maintain a healthy weight, it is important to talk to your doctor for personalized advice.
Smoking has been linked to pelvic pain in women. Smoking can lead to a number of reproductive issues, such as difficulty carrying and delivering a baby, early menopause and impaired uterine blood flow. Research has also suggested that smoking contributes to chronic pelvic pain.
In addition, nicotine can cause an imbalance of hormones, leading to an increase in inflammation, which may perpetuate the symptoms of pelvic bone pain. Quitting smoking is key to reducing the risk factors for pelvic bone pain and other health complications from smoking.
Practice safe sex
Practicing safe sex is an important way to prevent pelvic bone pain. Unprotected sexual intercourse can put you at risk for sexually transmitted infections (STIs), which can lead to pelvic infection and cause pelvic bone pain.
The use of condoms, female and male latex condoms, during both oral and anal intercourse has been found to reduce the risk of transmission of some STIs, including genital herpes, chlamydia, gonorrhea, syphilis and HIV/AIDS. To protect against other STI’s such as Human papillomavirus (HPV) it is recommended that both partners receive the HPV vaccine prior to having sexual intercourse. Also other means of barrier protection such as dental dams or gloves during oral sex or use of Safer Sex tools (toys) are recommended.
Talk to your health care provider or a Sexual Health counselor if you have any questions about practicing safe sex.