Pelvic pain

Pelvic pain occurs below the belly button, where the uterus, ovaries, bladder and bowel are located. The pain can be:

• Acute, occurring abruptly and out of the blue, which should be evaluated by a physician immediately.
• Chronic, persisting for six months or longer and varying from a dull ache that comes and goes to a steady, severe pain that interferes with your quality of life.

Who gets pelvic pain?

It's very common. It's estimated that 30-50% of all women will experience it at some point in their lives.

What causes pelvic pain?

Common benign causes include:

• Reproductive system issues such as:
  • Adenomyosis — when the lining of the uterus grows into the uterine wall
  • Endometriosis
  • Fibroids
  • Ovarian cysts
  • Pelvic congestion syndrome caused by varicose veins in the pelvic area
  • Infection
  • Pregnancy-related issue such as missed abortion or ectopic pregnancy
• Non-gynecologic issues.
  • Adhesions (scar tissue)
  • Hernia
  • Ligament, joint or muscle issues related to the pelvis, lower back or hips
  • Fibromyalgia
  • Pelvic floor dysfunction when the muscles surrounding the vagina, bladder or rectum do not function properly
  • Urinary tract or bowel issues (such as irritable bowel syndrome), interstitial cystitis, diverticulosis or kidney stones
  • Issues related to depression and/or stress/

Sometimes the cause remains unknown, despite extensive testing.

What are the symptoms of pelvic pain?

Pain can be sharp or dull, constant or intermittent. It also might correspond with ovulation or your period.

Besides pain, you also could experience:

• Bleeding
• Discharge
• Painful intercourse
• Painful or frequent urination
• Painful bowel movements
• Fever: This could be a sign of infection, and you should contact your gynecologist right away
• Eating/digestive issues

How is pelvic pain diagnosed?

Determining the cause of the pain may be a long process. Your HonorHealth gynecologist will begin with a gynecologic workup that includes a discussion about your symptoms and may include the following:

• Lab testing
• Urine sample
• Pelvic exam
• Vaginal ultrasound
• A pregnancy test in reproductive age women
• Tests for sexually transmitted diseases
• Further testing might include an MRI or CT scan

Your gynecologist might ask about any past sexual trauma. Of those who experience chronic pelvic pain, nearly half have experienced some type of sexual abuse.

If you report a dull ache that worsens when you're standing for long periods — and there's is no other obvious cause of your pain — your gynecologist may refer you to an interventional radiologist to evaluate you for pelvic congestion syndrome, a condition related to the veins in your pelvic area.

How is pelvic pain treated?

Treatment depends on the cause. If the pain is severe and just started, you should see your gynecologist immediately to avoid an emergency situation.

Other treatment options for chronic pelvic pain that lasts six months or longer, might be:

• Over-the-counter anti-inflammatory medications, such as ibuprofen or naproxen
• Birth control pills or hormonal treatment
• Pain injections
• Minimally invasive surgery
• Physical therapy
• Acupuncture
• Antidepressants
• Cognitive behavioral therapy or biofeedback to help manage the perception of pain

If pelvic congestion syndrome is confirmed by an interventional radiologist, you might be a candidate for ovarian vein embolization. This minimally invasive treatment removes the blood supply from the varicose veins that may be causing your pain.