Treatment options for pelvic pain vary according to the cause of the pain and its severity and frequency. When a particular cause is identified, treatment is aimed at relieving that cause. When the cause is uncertain, however, treatment may focus on managing the symptoms rather than treating the source.

Physicians may recommend medication to treat the causes of pelvic pain. Commonly recommended drugs include:

• Over-the-counter medications. Analgesics such as acetaminophen may be suggested to reduce pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin or naproxen) may be suggested to lessen inflammation and pain.
  
  
• Birth control pills. The hormones contained in oral contraceptives may lessen pain during the menstrual cycle by preventing ovulation. Birth control pills can also sometimes control the pain of endometriosis.
  
  
• Progestins. A synthetic form of the hormone progesterone, progestin may control symptoms by reducing or stopping menstruation and preventing ovulation.
  
  
• Gonadotropin-releasing hormone (GnRH) agonists. These drugs induce a chemical menopause by decreasing the production of the hormone estrogen.
  
  
• Antibiotics. These drugs may be prescribed to treat bacterial infections (e.g., urinary tract infection, vaginitis, prostatitis).
  
  
• Alpha blockers or DHT (dihydrotestosterone) inhibitors. These are common treatments for benign prostatic hyperplasia (BPH).
  
  
• Antidepressants. These medications are often prescribed when other forms of treatment have failed. In addition to relieving depression, many antidepressants have a pain-reliving effect. Low doses are commonly prescribed to patients who have pain but do not suffer from depression.
  
  
• Muscle relaxants. These drugs may be prescribed to relax the muscles and reduce pain.
  
  
• Opioids.  Narcotic painkillers are typically prescribed as a last resort for severe pain because they carry a risk of dependency.

A number of other treatment methods exist, many of which can be performed or taught by a physical therapist or an occupational therapist. Additional pain relief options include:

• Heat therapy and cold therapy. Applications of heat (e.g., ultrasound therapy) and cold to the pelvis may relieve pelvic pain. Heat or cold treatments may incorporate hydrotherapy, such as a sitz bath.
  
  
• Exercise therapy. Relaxation exercises, such as deep breathing, and stretching may lessen pelvic pain. Kegel exercises and other exercises directed at strengthening the pelvic floor muscles may reduce pelvic pain.
  
  
• Stretching exercises. Stretching exercises targeted at the pelvic region may lessen episodes of pain when they occur.
  
  
• Massage. Deep tissue massage in the pelvic region may relieve pelvic pain.
  
  
• Electrical therapy. Techniques such as transcutaneous electrical nerve stimulation (TENS) deliver mild electrical pulses that may relieve pain.
  
  
• Stress management. Stress can intensify pelvic pain. As a result, stress management techniques can help reduce stress-triggered pain.
  
  
• Biofeedback. This method uses electronic monitoring devices to help people consciously regulate their bodily functions through relaxation or imagery.
  
  
• Acupuncture. This method involves puncturing the body with needles at specific spots to relieve pain.
  
  
• Acupressure. This method involves using the thumbs and fingertips to apply pressure at specific spots on the body.
  
  
• Cognitive behavioral therapy or other psychological counseling. For patients whose pelvic pain is linked to psychological or social problems, counseling may be beneficial.
  
  
• Trigger point injections. This procedure may be used for patients who have undergone pain mapping. During this procedure, a physician injects a long-acting anesthetic or other form of numbing medication into painful spots (trigger points) in the abdomen.
  
  
• Nutritional supplements. Vitamin B1 or magnesium supplements may be recommended to help alleviate or reduce pelvic pain.

In some cases surgery may be recommended. It is most often used when abnormalities in the pelvis can be seen. The type of surgery used is dependent on the pain’s cause. Laparoscopic surgery (surgery similar to arthroscopy except the camera is inserted into the lower abdomen instead of a joint) may be used as treatment in a number of situations including endometriosis and uterine fibroids.

Treatments such as nerve ablation may be performed during laparoscopic surgery. Used in patients whose pelvic pain is linked to the nervous system, nerve ablation aims to control the pain impulses sent to the pelvic area. It may involve removing specific nerves, injecting medicine into the nerve to lessen its sensitivity, or using heat or a laser to destroy nerve tissue.

A hysterectomy, surgical removal of the uterus, may be recommended as a last resort. Although it may alleviate pelvic pain in some cases, a hysterectomy is not always successful in doing so. In addition to hysterectomy, surgical treatments for gynecologic cancers include removal of an ovary (oophorectomy).

For men, a prostatectomy (surgical removal of the prostate gland) may be indicated for prostate cancer or severe cases of prostatitis. Prostatectomy or less radical procedures such as transurethral resection of the prostate (TURP) may be used to treat serious cases of BPH. If testicular cancer is diagnosed, a common treatment is surgical removal of a testicle (orchiectomy).

Frequently, a patient will need to try a number of treatment approaches before finding relief. Combinations of different treatments are often suggested. In patients whose pain is caused by more than one source, each cause will have to be addressed.