Pelvic pain can be due to a number of causes, not all of them serious and not all of them due to the reproductive organs. Inflammation, infection, or abnormal tissue growth within any of these organs may cause pelvic pain, amongst other symptoms. Broadly speaking, the pain can be usefully categorised into acute and chronic.
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Acute causes
Ectopic pregnancy
If you are in the early stages of a pregnancy and develop sudden onset pain, it’s crucial to exclude an ectopic pregnancy, as it could become life threatening. This is where the pregnancy embeds abnormally outside of the uterine cavity. Abnormal vaginal bleeding, change in bowel habit, and shoulder tip pain can all be associated symptoms.
Pelvic inflammatory disease (both acute and chronic pain)
Pelvic inflammatory disease (PID) is an infection that affects the organs of a woman's reproductive system including her uterus, ovaries, fallopian tubes, and vagina. The majority of cases are caused by an STI, like gonorrhea or chlamydia. Pain may worsen during sex, and there may be other symptoms, like abnormal vaginal bleeding or discharge, as well as a temperature.
Mittelschmerz pain
There’s also a type of pain called mittelschmerz pain, which refers to the mild, one-sided pelvic pain felt when an egg is released from an ovary each month. It may also be associated with mild mid cycle spotting which can be perfectly normal. Typically, the pain settles down after 24-48 hours.
Ovarian cyst rupture
Ovarian cyst rupture is due to an ovarian cyst that a woman has. It may cause sudden and sharp pain that can begin after sex or strenuous physical activity. If they don’t rupture, ovarian cysts can cause chronic pelvic pain.
Ovarian torsion
Ovarian torsion occurs when the ligaments that hold your ovary in place rotate and twist, cutting off the ovary's blood supply. The cardinal symptom is sudden and severe pelvic pain that may be sharp, dull, or crampy. Sometimes the pain radiates to the lower back or groin, and some women develop a low-grade fever, nausea, and vomiting. Interestingly, the pain may subside after a while, only to return again later. It’s a critical diagnosis to make to save the ovary.
Appendicitis
This can produce sudden pain that begins near the belly button and moves to the lower right part of the abdomen (which is why it may be mistaken for pelvic pain). Other symptoms include a loss of appetite, fever, vomiting, and pain with movement. It requires immediate medical attention.
Urinary tract infection
Aside from pain over the bladder region, there could be increased frequency of urination, a burning pain when urinating, having an urge to urinate, and blood in the urine. In older women, symptoms may be subtler, such as tiredness and incontinence.
Kidney stones
These may develop when substances in the urine, like calcium, oxalate, cystine, or uric acid, build up and form crystals. A stone can cause excrutiating pain if it becomes large and gets stuck in the urinary tract system.
Chronic causes
Endometriosis
Endometriosis is a condition where the tissue that normally grows within your uterus (the endometrium) begins to grow outside it, like on the ovaries, fallopian tubes, and your intestines. Pelvic pain is a common symptom of endometriosis, especially during menstruation and sex. The pain can sometimes be felt with a bowel movement or while urinating.
Uterine fibroids
Uterine fibroids are benign pelvic growths that can commonly cause heavy or prolonged periods as well as a dull pressure or pain and if they become very large, can press on surrounding structures like the bladder or bowel, and cause problems with urination and bowel habit.
Gynecologic cancer
Pelvic pain can be a symptom of most types of gynecologic cancer, though sadly it usually only manifests when the cancer has progressed. As pelvic pain can be the first sign of a whole range of different far more benign conditions and as there is no adequate ovarian cancer screening tool, there is often be a delay in diagnosis, especially with ovarian cancer. Other symptoms include bloating, lower back pain, abnormal vaginal bleeding and a change in bowel habit.
Irritable bowel syndrome
Irritable bowel syndrome typically causes crampy abdominal pain that may be worsened by stress or eating, as well as bloating and changes in bowel habit. Sometimes treating stress can help improve symptoms considerably. This condition can also be associated with endometriosis.
Muskuloskeletal
The pelvis is made up of many muscles, ligaments, and tendons. Sometimes a hernia can form, which is when an organ protrudes through the wall of the cavity containing it. This can also cause sudden onset acute pain and if so, it’s critical to diagnose in case bowel is within the hernia, which could get strangulated. Something as straightforward as a muscle sprain after twisting or lifting can cause pelvic pain.
BIO: Dr Larisa Corda is an Obstetrician and Gynaecologist and Fertility Specialist MBBS BSc MRCOG. She qualified from Imperial College London and trained in the UK and Australia, gaining a wide understanding of womens’ health issues across an international population. She believes in a holistic approach to treatment that addresses many lifestyle factors as well as a combination of Eastern and Western principles, that underpin The Conception Plan she has devised, as seen on TV. Larisa is a passionate womens’ rights campaigner, with roles on a number of charities, and supports the use of natural and mild IVF techniques to assist conception where needed. She regularly appears in the media, and has several research interests including the effect of stress on fertility. To follow her advice and tips, including The Conception Plan, go to www.drlarisacorda.com and @drlarisacorda on Instagram.
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