Pelvic pain is steady or occasional pain that occurs in the lower abdomen or pelvic area. Although it can be mild in some cases, pelvic pain is often severe enough to interfere with a person's daily life.
The pelvis houses several organs, including the bladder, rectum and lower intestines. Women also have a uterus, ovaries, fallopian tubes and vagina in the pelvic region. Men's pelvic organs include the prostate and other glands. Pelvic pain may be the result of an infection (e.g., interstitial cystis, pelvic inflammatory disease, prostatitis) or other abnormality in one of these organs.
In addition to causing pain in the lower abdomen, pelvic pain can cause discomfort in other areas of the body, including the back, hip joints and upper abdomen. This is the result of the pain traveling along nerve pathways through the body. Pelvic pain may last anywhere from a few minutes or days (acute pelvic pain) to more than six months (chronic pelvic pain).
Patients experiencing pelvic pain should discuss the pain with their physician. To determine the cause of the pain, a physician may order a number of tests including blood tests, urine tests, cultures and imaging studies (e.g., x-rays, ultrasound, MRI). Pinpointing the cause is often a long process.
A single cause or multiple causes of pelvic pain may be identified. In some cases, chronic pelvic pain is recognized as the condition itself instead of being identified as a symptom of another condition.
Treatment for pelvic pain is aimed at its source. When the source of the pain cannot be identified, however, treatment may focus on managing the symptoms. Common treatment methods for pelvic pain include medications (e.g., antibiotics, pain relievers), exercise therapy, thermotherapy, stress management and surgery.
About pelvic pain
Pelvic pain occurs in the pelvis, the lower part of the abdomen (below the navel) between the hip bones. The pelvis contains a number of organs, such as the bladder and lower intestines (including the rectum). In women, the pelvis also contains the uterus, ovaries, fallopian tubes and vagina. In men, the pelvis also contains the prostate gland and accessory glands. Pelvic pain may indicate a disorder such as inflammation or infection in one of these organs.
For some people, pelvic pain is severe enough to interfere with daily activities. In other cases, the pain may be mild. A person with pelvic pain may experience the following sensations within the pelvis:
Mild or severe pain
Dull aching
Sharp pains
Cramping or pressure
Heaviness
Pelvic pain may occur steadily or intermittently (comes and goes). It may worsen after standing for a long period of time and be relieved by lying down. It may also be associated with certain activities or bodily functions. It may occur during sexual activity (dyspareunia), urination (dysuria), bowel movements (dyschezia), menstruation (dysmenorrhea) or when sitting.
Pelvic pain may be described as chronic or acute. Acute pelvic pain lasts a short time, such as a few minutes to a few days. Chronic pelvic pain is often defined as lasting six months or longer. Typically, chronic pelvic pain feels as if it is affecting the entire pelvic area and not just one specific spot.
Men and women experiencing pelvic pain should discuss the pain with their physician. This is especially important for those whose pain is disrupting their daily activities. Patients should also alert their physician when the pain appears to be getting worse.
Other pain areas related to pelvic pain
Pelvic pain can travel along nerve pathways through the body. As a result, the pain can appear at sites other than the pelvis. This type of pain is known as referred pain. A person suffering from pelvic pain may also experience:
Abdominal pain
Back pain
Hip joint pain
Leg pain
Sexual pain
In addition, men with pelvic pain may be experiencing testicular or scrotal pain.
Potential causes of pelvic pain
A number of conditions can cause pelvic pain, including gynecologic, urologic, gastrointestinal, musculoskeletal, neurological and psychological disorders. Common causes among men and women include:
Urinary tract infection. An infection that occurs along the urinary tract, which includes the kidneys, ureters, bladder and urethra.
Sexually transmitted disease (e.g., gonorrhea).
Muscle spasms (such as pelvic floor tension myalgia) or muscle strain.
Kidney stones. These can also cause back pain and abdominal pain.
Bladder stones.
Hernia. Bulging of a muscle through the pelvic wall.
Urethritis. Inflammation of the urethra.
Interstitial cystitis (painful bladder syndrome). Inflammation of the bladder wall.
Appendicitis. Inflammation of the appendix.
Pelvic fracture. This can result from severe acute trauma such as a car accident or fall from a great height. Pelvic fractures can also occur in elderly people because of a fall to the floor or osteoporosis.
Diverticulitis. Inflammation of an abnormal pouch (diverticulosis) in the intestinal wall.
Irritable bowel syndrome (IBS). A disorder in which the large intestine does not function properly.
Inflammatory bowel disease (IBD). Chronic inflammation of the digestive tract. The two main types of IBD are Crohn’s disease and ulcerative colitis.
Peritonitis. Inflammation of the lining of the abdominal cavity (peritoneum).
Cancer, such as colorectal or pelvic bone cancer.
Pelvic adhesions. Scar tissue in the pelvis.
Pelvic congestion syndrome. Varicose veins within the pelvis.
Pelvic abscesses. Pockets of pus in the pelvis.
Fibromyalgia. A condition characterized by widespread pain in joints, muscles, tendons and other soft tissues.
Somatization disorder. A condition in which psychological problems cause a person to make a number of physical complaints.
Overactive bladder (urge incontinence) is a common pelvic condition that is typically not painful. It can, however, impair quality of life. Most common in elderly people, it is caused by involuntary contraction of the smooth muscle of the bladder.
Common causes of pelvic pain in women include:
Menstrual cramps (dysmenorrhea) or premenstrual syndrome (PMS).
Vaginitis. Inflammation or infection of the vagina and vulva.
Ovulation pain.
Ovarian cysts. A fluid–filled structure located within or on an ovary.
Uterine fibroids. Growth of noncancerous tumors within the wall of the uterus.
Pelvic inflammatory disease. Infection of the endometrium (lining of the uterus), fallopian tubes (salpingitis) or ovaries.
Endometriosis. A condition in which cells that make up the lining of the uterus are found outside the uterine cavity.
Reproductive cancers (e.g., ovarian cancer, cervical cancer, endometrial cancer). Ovarian cancer, the deadliest gynecological cancer, often lacks symptoms in early stages. However, researchers have found that many women with ovarian cancer complained of pelvic or abdominal pain months or even years before diagnosis, but their physicians often ordered tests for gastrointestinal problems instead of cancer.
Polycystic ovarian syndrome (PCOS). An endocrine disorder involving overproduction of male-type hormones (androgens) by the ovaries.
Ovarian remnant syndrome. A condition in which pain is caused by ovarian tissue left behind after removal of the ovaries (oophorectomy).
Ectopic pregnancy. A pregnancy in which a fertilized egg implants in tissue outside the uterus.
Adenomyosis. A condition in which the cells that make up the lining of the uterus grow into the muscular tissue of the uterus.
Vulvodynia. Chronic pain of the vulva, which may involve factors such as allergies, muscle spasms, irritation of nearby nerves or a history of vaginal infections.
Retroversion of the uterus. A condition in which the uterus is tipped back instead of forward.
Nonspecific. May happen after a Caesarean section or an injury, including sexual assault.
Causes of male pelvic pain include:
Prostatitis. A common bacterial infection or other type of irritation of the prostate gland, which may be acute or chronic. Can cause chronic pelvic pain syndrome in men.
Benign prostatic hyperplasia (BPH, also called benign prostatic hypertrophy). Noncancerous enlargement of the prostate, common during middle and old age. Constricts the urethra and causes a painful burning during urination (dysuria). Can prevent the bladder from emptying, resulting in pelvic pain.
Testicular or scrotal injury, including testicular torsion, which needs immediate medical attention.
In addition, pelvic pain appears to be linked to patients with mental health issues. Pelvic pain appears to occur more frequently in people with a history of physical abuse, sexual abuse and depression.
Pelvic pain can be a symptom of another condition, or it can be diagnosed as a condition itself. In some cases, more than one factor can cause the pain.
Common tests performed for pelvic pain
There are a number of possible causes for pelvic pain, and pinpointing the source may be difficult. As a result, identifying the cause of pelvic pain can be a long process.
Physicians will typically begin an evaluation by taking the patient’s medical history. Patients should be prepared to answer a number of questions about pain, such as:
When did the pain begin?
Where is the pain located?
How strong is the pain?
How does the pain feel (e.g., dull, sharp, steady, cramping)?
When does the pain occur (e.g., during urination, menstruation or defecation)? Is there sexual pain?
How often does the pain occur?
Has the pain spread beyond its original location?
How long does the pain last?
Does the pain vary based on the time of day or time of week?
Is the pain linked with abnormal skin sensations, muscle pain, joint pain, back pain or abdominal pain?
Is the pain interfering with daily activities?
Is there anything that relieves the pain or makes it worse?
Does the pain affect sleep?
Has there been an infection?
Has there been constipation, diarrhea or other bowel disorders?
Has there been surgery in the pelvic area?
Is there a family history of pelvic conditions?
What medications are being taken?
Female patients may also be asked about their menstrual history, gynecologic history and obstetric history. Questions regarding sexual history, sexual abuse, domestic violence and substance abuse may be posed to patients of either sex. Patients may be asked to complete a pain assessment form.
A physical examination will focus on the lower abdomen. The physician will look for signs of tenderness and distention. The abdomen and pelvis may then be examined for trigger points. In a process known as pain mapping, the physician prods areas of the abdomen in a grid–like pattern. The patient alerts the physician when experiencing pain. The areas that cause pain are noted or mapped.
For women, a pelvic examination (examination of the uterus, cervix and other pelvic organs) may be performed. This exam enables physicians to check the area for tenderness and changes in skin sensations. The test may also reveal abnormal growths, signs of infection or tense pelvic floor muscles. A rectovaginal examination, in which one finger is placed in the vagina while another is placed in the rectum, may also be performed.
Men may undergo a digital rectal exam (DRE) if a prostate problem such as benign prostatic hyperplasia is indicated or an examination of the scrotum and testicles if a condition such as testicular cancer is suspected.
A number of tests are usually required to determine the cause of pelvic pain. This allows physicians to eliminate a number of causes and close in on an exact source. Information provided in the medical history and factors revealed in the physical examination are used to help physicians determine which tests to order. These may include:
Cultures. These tests require samples to be taken from the urethra, vagina or cervix. They may reveal an infection, including sexually transmitted disease or prostatitis.
Blood tests. These tests can reveal infections.
Urine tests. Urine may be examined for signs of bladder or kidney disorders.
Pregnancy test. Female patients may undergo a pregnancy test to determine if an ectopic pregnancy may be causing the pain.
Cystoscopy. A physician inserts a thin, camera-tipped tube through the urethra to inspect the inside of the bladder.
Colonoscopy. This is a procedure where a camera can be introduced through rectum and lower colon can be visually examined. It is used to find cancer or polyps in the same area.
Laparoscopy. A small incision is made above or below the naval. A thin lighted tube (laparoscope) is then inserted into the abdomen. This enables physicians to view the pelvic organs. This procedure may reveal abnormal tissue or signs of infection. In some cases, the tissues are probed and pulled with surgical instruments during the procedure. Then the patient describes the severity and nature of the pain (laparoscopic pain mapping).
Biopsy. A sample of tissue may be taken for laboratory analysis if a condition such as prostate cancer, bladder cancer or ovarian cancer is suspected.
A number of imaging studies may also be ordered to detect abnormal masses including ovarian cysts, uterine fibroids and prostate growths. Possible imaging studies include:
An x-ray is a painless test in which an image is created of part of the body. It uses low doses of electromagnetic radiation that are reflected on film or fluorescent screens. The physician may order a specialized x-ray such as an intravenous pyelogram (IVP), in which a contrast dye injected into a vein in the arm highlights the urinary tract.
Pelvic, bladder, transvaginal or transrectal ultrasound. This procedure uses high–frequency sound waves to create images of organs and other body structures.
CAT scan (computed axial tomography). Also known as a CT scan, this test allows for multiple x–rays to be taken from different angles around the patient. A computer analyzes the cross–sectional images. Frequently after the first set of images is taken, the patient receives an intravenous (I.V.) injection of a contrast agent (dye) to better outline body parts. Then a second set of images is taken.
MRI (magnetic resonance imaging). MRIs use a powerful magnetic field to create images of structure and organs within the body allowing a computer to produce clear cross–sectional or three–dimensional images.
Sometimes in spite of all the testing, it may not be possible to find out the source of the pain. When the cause is not clear, physicians may ask their patients to maintain a journal of their symptoms. This may help the physicians narrow down the list of possible causes and help them determine what additional tests should be performed.
Relief options for pelvic pain
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.
Prevention methods for pelvic pain
Many causes of pelvic pain cannot be prevented. However, there are a few steps people can take to reduce their risk. These include:
Practicing monogamy with an uninfected partner.
Consistently and correctly using a condom during sexual intercourse.
Obtaining early diagnosis and proper treatment of pelvic disorders (e.g., sexually transmitted diseases, pelvic inflammatory disease, prostate conditions).
Avoiding use of an internal urinary catheter if possible. Recent research suggests that hospitalized men receiving an external condom-style catheter have a reduced risk of urinary infection, pelvic pain and even death than those given an indwelling catheter.
Maintaining a diet low in animal fats but rich in fiber, vegetables and fruits. This may reduce the risk of conditions including colon cancer, ovarian cancer and prostate problems.
Questions for your doctor regarding pelvic pain
Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about pelvic pain:
What may be causing my pelvic pain?
What tests may be used to determine the cause of my pelvic pain? What do these tests involve?
What do my test results show?
How can I relieve my pelvic pain?
What over-the-counter medications might help?
Do you recommend any prescription medications? What are the possible side effects or interactions of these medications?
Can heat, cold, exercise, biofeedback, acupuncture or other noninvasive treatments help me?
Will I require surgery?
How can I prevent pelvic pain?
At what point should I call you or seek emergency treatment for pelvic pain?
