Pelvic Pain

Pain is usually a sign that there is something amiss in your body. It generally occurs in the area where the problem is, but sometimes the pain can be found away from the source. The pelvis is the lowest part of your abdomen (tummy), and contains various organs including the bowel, bladder, uterus (womb), fallopian tubes and ovaries.

What causes pelvic pain?

In explaining the cause for the pain, the first thing to consider is whether the woman is pregnant. Although pelvic discomfort is common in pregnancy, pain with or without bleeding in early pregnancy may be a sign of a miscarriage or an ectopic pregnancy, which requires further assessment.

Women undergoing assisted reproductive techniques are also at risk of ovarian hyperstimulation syndrome. The condition may present with pelvic pain, distended abdomen and breathlessness.

In non-pregnant women, ovulation and ruptured ovarian cysts are common causes of pain. This pain usually lasts a few hours but can be severe. A more worrisome cause of pain is ovarian torsion, usually associated with the presence of an ovarian mass such as dermoid cyst. This happens when the ovary twists on its vascular stalk cutting off its blood supply. The swelling and necrosis lead to sudden and severe pain on one side. Urgent assessment is prudent to allow prompt action to save the ovary.

Dysmenorrhoea or painful menses, is typically cyclically occurring during the menses and resolving thereafter. Endometriosis is a cause of dysmenorrhoea. Pelvic pain occurring before and relief with the menses tend to suggest premenstrual syndrome. In women with fibroids, pelvic pain may result from degeneration of the fibroid when it outgrows its blood supply.

Pelvic inflammatory disease (PID) can also cause pain with associated vaginal discharge and abnormal bleeding. Infection, endometriosis and previous pelvic surgery can lead to adhesion formation, which may cause chronic pelvic pain.

Besides the above conditions, there are other non-gynaecological causes that would be considered. These include urinary tract infection, constipation, hernia, appendicitis, irritable bowel syndrome and musculoskeletal pains. Cancer can also cause pain typically if it has spread beyond its origin.

How is it diagnosed?

Diagnosis may sometimes be apparent on questioning and clinical examination. However, some tests are performed to explain the diagnosis including urine pregnancy test to exclude pregnancy; urine dipstick and/or microscopy and culture to exclude urinary tract infection; vaginal swabs to determine if there is any infective cause; and pelvic ultrasound scan to look for causes such as ovarian cyst, fibroid, adenomyosis, pyosalphinx. In pregnancy, the scan will also localise the pregnancy and establish its viability. Where the diagnosis is not apparent, a laparoscopy may be required to establish the cause. CT scan or MRI scan of the abdomen and pelvis may be requested. Gastroscopy and colonoscopy may also be requested to exclude bowel causes.

What are the treatment options?

Management depends on the cause and severity of the pain. Analgesia may be used to ease the pain while awaiting the diagnosis and treatment. For menstrual-related pain, contraceptive medication can be used to manage the pain if appropriate. For structural problems such as ovarian cyst, torsion or fibroid, surgery can be employed to resolve the pain. Antibiotics therapy is appropriate in PID, while painful miscarriages and ectopic pregnancy require surgery.

When do I need to visit a doctor?

Assessment by a doctor is helpful particularly if you are pregnant or do not know the cause of the pain. If the pain is not resolved with simple analgesia or it if is long standing, having a doctor to evaluate the cause is sensible.