Pelvic pain refers to pain in the lower abdomen and can be acute (short-term) or chronic (lasting 6 months or longer). It may be sporadic or constant, dull or sharp, mild to severe and may be triggered or exacerbated by everyday activities and bodily processes, including exercise, sexual intercourse and orgasm, menstruation and ovulation, urination and defecation (bowel movements). This pain affects the lives of millions of men and women worldwide. You are not alone and there is no need to suffer in silence.
Pelvic pain is a common condition affecting millions of women worldwide. There is no need to suffer in silence. We are here to help end the cycle of pain so that you can get your life back again.
What causes pelvic pain in women?
This pain can stem from multiple causes and even in the same individual, the pain may be multifactorial in nature. In women, pain in the pelvis may be due to a problem with the uterus, tubes and/or ovaries, the urinary tract and lower intestines (rectosigmoid colon), the pelvic floor muscles and pelvic bones, the tissue that lines the pelvis (peritoneum), the pelvic nerves and blood vessels, the cervix, vagina, and vulva.
- Ovarian cyst rupture
- Ovarian torsion
- Ectopic pregnancy
- Kidney stones
- Acute bowel obstruction (often due to adhesions or invasive intestinal endometriosis)
- Pelvic and genitourinary infections (infection of the pelvis, urinary tract or genital tract)
- Gastroenteritis (acute inflammation of the gastrointestinal tract)
- Primary dysmenorrhea
- Interstitial cystitis (painful bladder syndrome)
- Ovarian cysts
- Pelvic floor dysfunction
- Pelvic and abdominal adhesions
- Gastrointestinal irritation and inflammation (proctitis, colitis, diverticulitis, motility problems, redundant colon, anal fissure, hemorrhoids, intestinal endometriosis, food allergies and sensitivities)
- Pudendal neuralgia and pudendal nerve entrapment
- Abdominal wall neuropathy
- Pelvic congestion syndrome
- Pelvic girdle syndrome
- Pelvic organ prolapse (prolapse involving the uterus, bladder and/or bowel)
- Ovarian remnant syndrome
- Foreign body giant cell reaction
- Müllerian abnormalities of the genitourinary tract
- Cancer of the pelvic organs
- Chronic appendicitis
- Generalized visceral hypersensitivity (increased sensitivity of the pelvic organs and tissues)
When is it time to seek help from a specialist?
If you experience a sudden and severe onset of pelvic pain, seek urgent medical help. This type of acute pain can present as a medical emergency requiring immediate evaluation and care.
If you are experiencing chronic pelvic pain that is interfering with daily activities, this is not normal. While this pain, especially in women, is sadly common, it is not normal or acceptable – often patients have lived with their symptoms for a prolonged period of time because their pain has been trivialized by others, including the medical community. No one should have to live with debilitating pain. With diagnosis and treatment from a pelvic pain specialist, you can restore your quality of life. Timely intervention can avoid years of unnecessary suffering and debilitation, and in some cases can prevent disease progression and the associated sequelae.
- You are finding you are relying on over-the-counter pain medications on a regular basis
- Over-the-counter pain medication may only partially relieve the pain
- You are having to plan around your pain i.e. avoiding certain activities or not scheduling events during certain times in your menstrual cycle
- Pain is disrupting your sleep
- You are missing time from school or work due to pain
- Pain is interfering with your ability to be intimate with your partner
How is pelvic pain investigated?
Due to the range of possible causes and different symptoms, the first step in evaluating your condition is to carry out a detailed patient history. You will be asked to provide previous medical records and fill out a detailed questionnaire to uncover the nature and duration of your pain. The initial assessment will help guide the subsequent evaluation and diagnosis of your pain.
If a gynecological origin is suspected, a comprehensive pelvic exam will be conducted. This will often be accompanied by a transvaginal ultrasound and/or an abdominal ultrasound. Sometimes further imaging may be indicated, including MRI.
The diagnosis of gynecologic pelvic pain may also require invasive procedures, including hysteroscopy (introduction of a camera into the uterus) and laparoscopy (introduction of a camera into the pelvis through the belly button).
Depending on the nature of your symptoms, stool samples, blood work, physical exam (examination of the abdomen and a rectal exam) and imaging (ultrasound, mri, colonoscopy) may be required to investigate the source of your pain.
In the assessment of pain associated with the urinary tract, urine cultures and blood work may be performed, as well as imaging of the bladder, ureters and kidney, and cystoscopy (introduction of a camera into the bladder).
If pelvic floor dysfunction is suspected, the pelvic floor muscles will be examined during a pelvic exam. A trained pelvic floor physical therapist can provide a comprehensive evaluation of your pelvic floor function.
What can be done about my pelvic pain?
Depending on the nature of your pain a multitude of invasive and non-invasive therapies are available to either resolve or manage your symptoms. Treatments range from minimally invasive surgical procedures involving the pelvic and abdominal organs and tissues, medical therapies to treat inflammation, infection, and pain, physical therapy to retrain and relax muscle groups, nutritional counseling to reduce inflammation and gastrointestinal problems, and various complementary therapies to aid in relaxation as well as promote coping strategies.
Through our careful patient follow-up, spanning more than a decade, we are able to effect dramatic, ongoing improvements in the vast majority of our pelvic pain patients, with many reporting a complete resolution of their pain. Diagnosing and treating pelvic pain can be complex and requires expertise and a comprehensive range of treatments of therapies to provide customized care to each individual patient.