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Pelvic Pain

 

What is pelvic pain?

 

Pelvic pain is a common problem among women. Its nature and intensity may fluctuate, and its cause is often unclear. Sometimes, no cause can be found. Pelvic pain can be categorised as either acute, meaning the pain is sudden and severe, or chronic, meaning the pain either comes and goes or is constant, lasting for a period of months or longer. Pelvic pain that lasts longer than 6 months and shows no improvement with treatment is known as chronic pelvic pain. Pelvic pain can originate from any organs within the pelvis such as the womb, ovaries, bladder or bowels, or even muscles and nerves. Things like stress, depression and anxiety tend to make symptoms worse and in some people, pain can be a physical expression of psychological distress. 

 

What causes pelvic pain?

 

Pelvic pain may have many causes, including:

  • Inflammation or direct irritation of nerves caused by injury, fibrosis, pressure, or  inflammation in the abdomen

  • Contractions or cramps of muscles in organs like the bladder, bowel or uterus, or skeletal muscles (eg the muscles which help you perform a sit-up)

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Some of the more common sources of acute pelvic pain, or pain that happens very suddenly, may include:

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  • Ectopic pregnancy (a pregnancy that happens outside the womb)

  • Pelvic inflammatory disease (also called PID, an infection of the reproductive organs)

  • Twisted or ruptured ovarian cyst

  • Miscarriage or threatened miscarriage

  • Urinary tract infection

  • Appendicitis

 

It is crucial to remember that if you are suspecting any of the above reasons, you must contact your GP or your local A&E department urgently.

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Some of the conditions that can lead to chronic pelvic pain may include:

  • Menstrual cramps

  • Endometriosis

  • Uterine fibroids (abnormal growths on or in the uterine wall)

  • Scar tissue between the internal organs in the pelvic cavity

  • Endometrial polyps

  • Cancers of the reproductive tract

  • Other causes may be related to problems in the digestive, urinary, or nervous systems.

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What are the most common types of pelvic pain?

 

The following are examples of the different types of pelvic pain most commonly described by women, and their possible cause or origin. 

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   Type of pain

 

  • Localised pain: May be due to inflammation

 

  • Cramping: May be caused by spasm in a soft organ, such as the intestine, ureter, or appendix

 

 

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  • Sudden onset of pain: May be caused by a temporary deficiency of blood supply due to an obstruction in the circulation of blood

 

 

 

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  • Slowly-developing pain: May be due to inflammation of the appendix or bowel obstruction

 

 

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  • Pain involving the entire abdomen: May suggest an accumulation of blood, pus, or intestinal contents

 

 

  • Pain aggravated by movement or during exam: May be a result of irritation in the lining of the abdominal cavity

How is pelvic pain diagnosed?

 

Tests will be done to determine the cause of the pelvic pain. In addition, we may ask you questions regarding the pain such as:

 

  • When and where does the pain happen?

  • How long does the pain last?

  • Is the pain related to your menstrual cycle, passing urine, and/or sexual activity?

  • What does the pain feel like (for example, sharp or dull)?

  • Under what circumstances did the pain begin?

  • How suddenly did the pain begin?

 

Additional information about the timing of the pain and the presence of other symptoms related to activities such as eating, sleeping, movement and exercise can also help us in determining a diagnosis.

 

In addition to a complete medical history and physical and pelvic examination, you may have other tests including:

 

  • Blood tests

  • Pregnancy test

  • Urine dip

  • Cervical smear test

  • Ultrasound. A diagnostic imaging technique that uses high-frequency sound waves to create an image of the internal organs. This is usually performed transvaginally.

  • Computed tomography (CT or CT scan). This is an imaging test that uses X-rays and a computer to make detailed images of the body. A CT scan shows details of the bones, muscles, fat, and organs, and any abnormalities that may not show up on an ordinary X-ray.

  • Magnetic resonance imaging (MRI). A noninvasive procedure that produces a two-dimensional view of an internal organ or structure.

  • Laparoscopy (keyhole surgery). A minor surgical procedure in which a laparoscope, a thin tube with a lens and a light, is inserted into an incision in the abdominal wall. The camera can be used to carefully examine organs and structures within the abdomen and pelvis to diagnose conditions such as endometriosis or adhesions (scarring internally).

  • X-ray is used to produce images of bones and internal organs.

  • Colonoscopy can be used to view the entire length of the large intestine, and can often help identify abnormal growths, inflamed tissue, ulcers, and bleeding. It involves inserting a colonoscope, a long, flexible, lighted tube, in through the bottom up into the colon. The colonoscope allows the healthcare provider to see the lining of the colon, remove tissue for further exam, and possibly treat some problems that are discovered.

  • Sigmoidoscopy. A diagnostic procedure that allows the healthcare provider to examine the inside of a portion of the large intestine. It is helpful in identifying the causes of diarrhea, abdominal pain, constipation, abnormal growths, and bleeding. A short, flexible, lighted tube, called a sigmoidoscope, is inserted into the intestine through the rectum. The scope blows air into the intestine to inflate it and make viewing the inside easier.

 

How is pelvic pain treated?

 

Specific treatment for pelvic pain will depend on the cause of the pain; the final decision relies on factors such as:

 

  • Your overall health and medical history

  • Extent of condition

  • Cause of the condition

  • Your tolerance for specific medicines, procedures or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

 

Treatment may include:

 

  • Antibiotic medicines

  • Anti-inflammatory and/or pain relief

  • Oral contraceptives

  • Surgery

  • Physiotherapy

  • Relaxation exercises

 

Key points about pelvic pain

 

Pelvic pain is a common problem among women. Its nature and intensity may fluctuate.

 

Its cause is sometimes unclear and not only due to one condition .

 

Pain can be acute or chronic.

 

Specific treatment will depend on the cause.

 

Treatment may include medicines, surgery, physiotherapy and pain management techniques.

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