Pelvic Pain

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Pelvic pain in the lower part of your abdomen and pelvis can be disabling. The most common origin is from the female reproductive organs such as the uterus & cervix, ovaries, tubes, and pelvic side walls.

If you develop sudden, severe pelvic pain, with or without vaginal bleeding, present yourself to the nearest hospital’s emergency department.

Pelvic pain can vary in its nature, depending on its site of origin. It can be constant, intermittent (off and on), or can be dull or sharp and vary in its intensity (mild, moderate or severe). Pelvic pain can sometimes radiate to your lower back, buttocks or thighs.

The pain can be exacerbated by certain activities or during certain periods. Women report pelvic pain with sexual activity, passing urine or opening bowels. One should always be wary of the pelvic pain in women who have had vaginal mesh surgeries for prolapse. Often, multiple pathologies can co-exist and may lead to chronic pelvic pain. These patients should be referred and evaluated by a gynaecologist at the earliest.

Sometimes, pelvic pain may arise from the digestive tract or may arise from ligaments and muscles of the pelvic floor. Rarely, irritation of pelvic nerves can also be the cause of pelvic pain. Gynaecological pathologies should always be ruled out.

Possible causes of Pelvic Pain arising from the female reproductive system:

Uterine Problems:

  • Menstrual cramps (Primary dysmenorrhea)
  • Pregnancy related
  • Ectopic pregnancy (or other pregnancy-related conditions)
  • Miscarriage (before the 20th week)
  • Pelvic inflammatory disease (PID) – infection of the Cervix, uterus, tubes and ovaries
  • Adhesions from previous surgeries or infections
  • Uterine malformation (septum, bicornuate uterus)
  • Fibroids
  • Adenomyosis

Ovarian Problems:

Vulval Problems:

  • Vulvodynia
  • Lichen Planus / Lichen Sclerosis

Psychological Problems:

  • Past physical or sexual abuse
  • Vaginismus – Pelvic floor muscle spasms

Non-Gynaecological Causes

Bowel Problems:

  • Chronic constipation
  • Appendicitis
  • Crohn’s disease
  • Diverticulitis
  • Ulcerative colitis
  • Irritable bowel syndrome
  • Inguinal hernia

Genito-Urinary Problems

  • Kidney stones
  • Interstitial cystitis (also called painful bladder syndrome)
  • Urinary tract infection

Investigations are used to localise the cause of the pain.

These include:

  • Pregnancy test
  • Infection Screen
    • Endo-cervical Swab to rule out Chlamydia and Gonorrhoea infections
    • High vaginal swab (HVS) for bacteria and endocervical swab
    • Urinalysis – to note urine infection
  • FBC – WBC to indicate infection
  • Ultrasound
  • Laparoscopy – may be needed if endometriosis is the suspected cause of pain

Management:

Acute episodes of pelvic pain should be presented to the Emergency Department to rule out and treat the cause (e.g. ectopic pregnancy, appendicitis). Identifying the cause of the pain is the most important step. Subsequent management is based on treating the identified cause. Appropriate referral to a Gynaecologist is required if the diagnosis cannot be established.

Chronic Pelvic Pain (CPP):

CPP is multifactorial in origin and different from other presentations of pain. In addition to treating the cause, there is usually a psychosocial cause that needs to be addressed. This can be achieved by a multidisciplinary team involving the Gynaecologist, pain physician, psychologist, and counsellors.