Pelvic Pain

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• Women's Wellness
• Pelvic Pain

Medically Reviewed April 2023, by Mr. Bryan Mayou (GMC: 1414396) - founder of the Cadogan Clinic and one of the world's leading plastic surgeons

What causes Pelvic Pain?

There are a number of different things that may cause pelvic pain in women.

• Period pain:  Most women will experience period pain at some point in their lives. It is a normal part of the menstrual cycle.
• Endometriosis: Endometriosis is a medical condition where tissue similar to that found in the lining of the uterus is found growing outside of this space, such as on or in the fallopian tubes, ovaries, vagina or intestine.
• Fibroids: Fibroids are benign growths made up of muscle and fibrous tissue that develop in or around the uterus. They vary in size from the size of a pea up to the size of a melon.
• Ovarian cysts: Ovarian cysts are painless fluid-filled sacs that develop on the ovary and often come and go without needing any treatment. However, if a cyst is particularly large, ruptures or  blocks the blood supply to the ovaries then this can cause pelvic pain.
• Pelvic pain in pregnancy: Also known as pregnancy-related pelvic girdle pain (PGP) or symphysis pubis dysfunction (SPD), this is caused by stiffness in the pelvic joints or by these  joints moving unevenly. Women with PGP may find it hard to walk, climb the stairs or get out of a car.
• Ectopic pregnancy: This occurs when a fertilised egg implants itself outside of the uterus, usually in one of the fallopian tubes.
• Urinary tract infections (UTIs): UTIs are a collection of infections that affect the urinary tract, including the bladder, urethra or kidneys.
• Pelvic Congestion Syndrome: Pelvic congestion syndrome is a condition that affects the pelvic area or the lower part of your abdomen. It is believed to be caused by veins in that area of the body.
• Pelvic inflammatory disease (PID): PID is an infection of the female reproductive system which encompasses the ovaries, fallopian tubes and uterus. PID doesn’t always cause symptoms, but it does sometimes cause pelvic pain.
• Pelvic Organ Prolapse: A prolapse occurs when one or more of the pelvic organs bulge into the wall of the vagina. Some women may experience pain while others may not.
• Irritable bowel syndrome: Also known as IBS, irritable bowel syndrome is a common, often lifelong, condition that affects the digestive system.
• Constipation: Constipation affects people of all ages, but can usually be treated with lifestyle changes.
• Appendicitis: Appendicitis is a painful swelling of the appendix, which is attached to the large intestine.
• Peritonitis: Peritonitis is an infection of the inner lining of the stomach, which can become life-threatening if not treated promptly.
• Gynaecological cancers: Pelvic pain can also be caused by cancer of the uterus or ovaries. However this is rare.

What are the different types of Pelvic Pain?

• Fibroids: Some women may not even be aware that they have fibroids, but around one in three will experience fibroids symptoms including abdominal or lower back pain and pain during sex.
• Cystitis: A common urinary tract infection (UTI) of the bladder, cystitis can cause pain in the lower abdomen. This pain may be severe.
• Endometriosis: Pelvic pain in the abdomen or lower back is a common endometriosis symptom. Endometriosis pain during your period can feel so intense that it can actually stop you from carrying out day-to-day activities. This is because the uterine tissue that has grown on your ovaries or fallopian tubes can cause immense pain when shed.
• Ovarian cysts: This pain can come in various forms from a dull heavy ache to a sharp, severe, sudden pain.
• Ectopic pregnancy: Pain in one side of the lower abdomen may be a symptom of ectopic pregnancy. If the fallopian tube ruptures, you feel a sudden sharp and intense pain and should seek emergency medical help.
• Pelvic congestion syndrome: Women with pelvic congestion syndrome may have a dull, aching pain in the pelvic area and lower back. This pain may get worse when menstruating. The pain may last for months at a time and affect your day-to-day life.
• Pelvic inflammatory disease (PID): Symptoms of PID include pain around the pelvis or lower abdomen and pain or discomfort after sex which is felt deep inside the pelvis. If you experience severe pain in the abdomen, you should seek urgent medical attention.
• Pelvic organ prolapse: Women who have pelvic organ prolapse can experience frequent pain or discomfort, including a heavy or ‘dragging’ feeling around the lower stomach and genitals. Some women won’t experience any pain. It depends on the severity and nature of the prolapse.

How might Pelvic Pain be treated?

The treatment for pelvic pain depends on the diagnosis. Sometimes pelvic pain can be successfully treated with hormone medicines, painkillers, antibiotics, physiotherapy or simple lifestyle changes, such as making dietary changes.

It might be the case that the surgeon has to carry out laparoscopy surgery, for example draining a large ovarian cyst. If cancer is suspected, a tissue sample will be taken during the laparoscopy to be tested in a laboratory. Endometriosis can be treated via laparoscopy as the surgeon uses the images to carefully guide fine surgical instruments to apply heat, a laser, an electric current, or a beam of special gas to the patches of endometrial tissue. This will destroy the tissue.

If fibroids are the cause of your pelvic pain, surgery to remove the fibroids from the uterus, known as a myomectomy, may be carried out.

Vaginal prolapse surgery, an invasive surgical treatment to repair either the front or rear vaginal walls, may be required to return the vagina to its natural position, repairing the wall tissues and strengthening the vagina to help prevent a prolapse from recurring.

On rare occasions, a hysterectomy (surgery to remove the uterus) may be required to treat conditions like endometriosis, pelvic organ prolapse involving the uterus and certain gynaecological cancers. A hysterectomy is a major surgery and is usually only considered if there is no other alternative.

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