Pelvic pain can signify several things and, often, there isn’t one clear cause. For a more accurate diagnosis, pay attention to the type of pain you’re experiencing. To figure out the diagnosis, knowing the intensity, location, and frequency is helpful. For help figuring out the right treatment plan, we suggest discussing any changes with your primary care provider.

What is pelvic pain?

Your pelvis is the region between the lower part of your abdomen and your hips. When you experience pain originating in your genitals or other organs in and around the pelvis, you are likely experiencing pelvic pain. Pelvic pain may also be psychological rather than having a physical cause.

Types and categories of pelvic pain

There are two categories of pelvic pain: acute and chronic. Acute pain tends to come on suddenly and is often severe. If you experience pelvic pain for at least six months, whether it’s constant or if it comes and goes, you might have chronic pelvic pain. This type of pain often doesn’t have a cure, or may require a more lengthy process to work up, so treatment focuses on helping you manage it.

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Pelvic pain causes

It’s often challenging to identify a specific cause for your pelvic pain. Inflammation due to injury, fibrosis, or pressure may contribute to your discomfort, in addition to other things such as cramping sensations or nerve issues. Problems in the nervous, digestive, or urinary systems may also lead to pelvic pain. Conditions that lead to acute pelvic pain are different from those that cause chronic pain.

Acute pelvic pain is commonly caused by:

• Ectopic pregnancy
• Pelvic inflammatory disease (PID)
• Urinary tract infection (UTI)
• Appendicitis
• Ruptures to the fallopian tube(s)
• Ovarian cysts that have twisted or ruptured
• Miscarriages

Chronic pelvic pain can be caused by:

• Endometriosis or endometrial polyps
• Menstrual cramps
• Uterine fibroids or scar tissue in the pelvis
• Cancer affecting the reproductive tract

Symptoms of pelvic pain

There can be nuances to the origin of the type of pain you experience. Descriptions for pelvic pain include:

• A severe and steady pain
• Pain that comes and goes
• A dull ache
• Sharp cramping
• Pressure or heaviness in the abdomen

Diagnosis will be more accurate when symptoms are described as clearly as possible. The combination of symptoms you’re experiencing can help rule out certain conditions. Some possible conditions that cause pelvic pain include:

Appendicitis: If you have a sharp pain to the lower right of your belly, are vomiting, and have a fever, you might have appendicitis. If you are experiencing these symptoms, go to the ER to be evaluated immediately. The more quickly you can be seen and evaluated, the hope would be to prevent a ruptured appendix.

Irritable Bowel Syndrome (IBS): Can be thought of as having a 'spastic' digestive tract. IBS can be associated with some diagnoses, but oftentimes has unknown causes. Symptoms include cramps, bloating, and diarrhea or constipation that keeps returning. You may be able to relieve symptoms by managing your stress and diet and by taking certain medications. A full work up by your primary care provider is a great place to start if you think you have symptoms of IBS.

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Mittelschmerz (painful ovulation): Some women may feel pain between periods due to irritation from fluid and blood that’s released with the egg each month. This discomfort can happen on either your left or right side (whichever side you are ovulating from that month), and may change from month to month. It’s not likely to cause lasting harm and usually goes away within a few hours.

Menstrual cramps: You might have menstrual cramps when you have pain in your lower back or lower abdomen. To ease this pain, you can use a heating pad or take OTC pain relievers, specifically ibuprofen which tends to work pretty well for this cramping. Exercising and managing stress levels can also help relieve symptoms. Menstrual cramps can usually last for 1-3 days. 

Pelvic inflammatory disease (PID): PID is often a complication of an STD. It can damage your uterus, ovaries, or fallopian tubes, leading to infertility or other pregnancy problems. You might have PID if you’re experiencing belly pain, fever, abnormal vaginal discharge, or pain during sex or urination. It is important for you to visit your primary care provider or OBGYN for diagnosis and treatment, which oftentimes includes antibiotics. 

Ovarian cysts: Ovarian cysts can be found during pelvic exams or ultrasounds and many women have them without experiencing any symptoms at all. If the cyst is really large or worse, bursts, this can lead to symptoms such as severe pain, pelvic pressure, and bloating. If you have a cyst and have sudden pain, it is important to go to the emergency room as this could lead to something more serious such as an ovarian torsion.

Ectopic pregnancy: When an embryo grows outside of the uterus, usually in the fallopian tube, you have an ectopic pregnancy. Symptoms include sharp pelvic pain (particularly on one side), vaginal bleeding, nausea, and dizziness. Ectopic pregnancies can be life-threatening, so get emergency help right away.

Other conditions that may result in pelvic pain include some STDs (commonly chlamydia and gonorrhea), uterine fibroids, endometriosis, and kidney stones.

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Living with pelvic pain

Your primary care provider will require your medical history and will often do many tests. Possible tests in the diagnosis process include a physical and pelvic exam, blood tests, an ultrasound, and MRI, among others. The diagnosis will depend on:

• When and where you have pain
• How long the pain lasts
• What the pain feels like (for example, sharp or dull)
• Circumstances of the pain’s origin
• Whether the pain was sudden or not

Your treatment is dependent upon individual circumstances, including what the ultimate diagnosis is. It may include antibiotics, pain medication, physical therapy, surgery, oral contraceptives, stress management exercises, or some sort of combination treatment. Factors that influence your treatment plan include:

• Your health and medical history
• What caused the condition
• The extent and severity of the condition
• Your tolerance and preference for different treatment methods such as specific medications, procedures, and therapies

We suggest reaching out to your primary care provider as soon as you experience pelvic pain that goes beyond normal menstrual pain. An earlier diagnosis may lead to more effective management.