Pelvic pain: know the different causes and when to seek help

Learn more about persistent pelvic pain – what can cause it, how to describe it and what you can do.

9 Possible Reasons Why You Are Feeling Pain in Your Pelvis

Pain in the pelvic region could be a sign of issues with your urinary tract, reproductive organs, or digestive tract. And while some of the causes of suffering a painful pelvis are not anything to be alarmed about, others are concerning enough to necessitate a visit to a hospital or specialist as soon as possible [1].

So now take a look through the following list to pick out your symptoms, so that you can get a rough idea as to what may be causing your pelvic pain:

Number 1: UTI (Urinary tract infection)

This describes an extremely common bacterial infection somewhere along your urinary tract. It is due to tiny microbes that cannot be spotted without a medical microscope. Of note: while the majority of urinary tract infections are due to bacteria, some are generated by fungi, and in rare instances, by viruses. Look out for pain in and around the pelvic bone; and pain in the middle of your pelvis. Further UTI symptoms comprise:

• Needing to urinate as quickly as possible
• A feeling of pain or burning whilst urinating
• Strong-smelling, bloody or cloudy urine
• Fever
• If the infection is in your kidneys, then you will experience back and side pain [1].
Number 2: STIs (Sexually Transmitted Infections)
Chlamydia and gonorrhoea (which mainly affect young people), are both bacterial infections which are passed on during sexual relations. While a large percentage of people will not have symptoms, men can experience pain in their testicles, and females can have pain in their pelvis, particularly when they defecate or pass urine [1].
Other chlamydia symptoms include:
• Discharge from the penis or vagina
• Painful sex
• Swelling or tenderness in the testicles (males)
• Bleeding, pain or discharge from the rectum
• Pus in the urine
• Burning or pain whilst urinating
• Urinating more frequently [1].

Other gonorrhoea symptoms include:
• Abnormal discharge from the vagina (females)
• Bleeding between menses (females)
• Bleeding, pain or discharge from the rectum [1].

Number 3: Hernia
This condition describes an achy or painful bulge. It comes about when tissue or an organ is pushed out of place via a weak patch in the muscles of your thigh, chest or abdomen. It normally disappears when you lie down, and if you are not lying down, you may be able to push the bulge back into place. The pain becomes worse when you lift something, bend over, laugh or cough [1].
Further symptoms comprise:
• Pressure or weakness around the area of the hernia
• A feeling of heaviness where the bulge has come up
• Swelling and pain around the testicles (males) [1].
Number 4: Appendicitis
The appendix is a finger-shaped narrow pouch which projects out from the large intestine. Appendicitis comes on suddenly, and the pain can be very harsh as the appendix becomes inflamed and fills up with pus. Generally speaking, the pain is centred in the lower right section of the abdomen. However, it can also begin around the bellybutton and travel to the lower right area of the abdomen. Sneezing, coughing or deep breathing, makes the pain worse [1].

Other symptoms involve:
• A swollen belly
• Stomach discomfort
• A loss of appetite
• Feeling the need to be sick
• Vomiting
• Diarrhoea or constipation
• Low-grade fever [1].
Number 5: IBS (Irritable Bowel Syndrome)
This condition describes various symptoms such as pain and cramps coming from the intestines. (Note: it is not inflammatory disease which generates chronic inflammation throughout the digestive tract). IBS sufferers usually find that if they pass stool, the cramps and pain are not as bad [1].
Other Irritable bowel symptoms comprise:
• Mucus in the stool
• Constipation
• Diarrhoea
• Passing gas
• Bloating [1].
Number 6: Kidney Infection or Kidney Stones
Kidney Infection
A kidney infection can come about if bacteria enters your kidneys. When this occurs, you can experience pain in your groin, lower abdomen, side, and back. Of note: it is possible to have a kidney infection and kidney stones, simultaneously [1].
Other kidney stone symptoms comprise:
• Chills
• Fever
• Nausea
• Vomiting
• Pain, or a feeling of burning whilst urinating
• Needing to urinate more frequently than usual
• Foul-smelling or cloudy urine
• Blood in the urine. (This could be a brown, red or pink colour) [1].

Kidney Stones
Kidney stones (which are normally more prevalent in men), are generated due to minerals such as uric acid or calcium, clumping together in the urine and forming hard rocks. In most cases, the kidney stones only cause symptoms when they begin to travel through the small tubes that transport urine between the kidneys and the bladder (ureters). As the latter are rigid and small, they cannot broaden to enable the stones to pass through, and this is what brings on the pain. Moreover, the tubes generate a reaction, and clamp the stone to try to squeeze it out, thus inducing a painful spasm. Further, if a stone obstructs the urine flow, then it can cause severe pain if it backs up into the kidney. Generally, the pain begins in your back and side, however, it can spread to the groin and lower belly. In addition, you may feel some pain when you urinate [1].
Number 7: Cystitis
This condition describes an inflamed bladder, which causes pressure or pain in the lower belly and pelvis. In most instances, it is derived from a urinary tract infection [1].
Other symptoms incorporate:
• A low-grade fever
• Strong-smelling or cloudy urine
• Blood in the urine
• Only being able to urinate small amounts at a time
• Pain, or a feeling of burning whilst urinating
• A powerful urge to urinate [1].
Number 8: Scar-like Tissue

Also known as adhesions, these refer to bands of tissue which are similar to scar tissue. Their function is to join the tissues and abdominal organs together. Generally speaking, they form after you have had abdominal surgery. While symptoms from these adhesions are not always inevitable, when they do arise, feeling pain in the belly region is the one that is most reported. Further, while these adhesions are not generally problematic, should the intestines stick together, and become blocked, severe abdominal pain and other or symptoms can result [1]. These include:

• A loud sound coming from the bowels
• Constipation
• A swollen belly
• Feeling sick
• Vomiting [1].
Number 9: Entrapment of the Pudendal Nerve

This particular nerve generates feeling in the urethra, anus and genitals. Further, if you have undergone surgery, had an injury, or there has been some form of growth, then this can generate pressure on the pudendal nerve in the region where it exits or enters the pelvis. Nerve pain derives from pudendal nerve entrapment. This generates a sensation of deep aching pain or an electric shock in the genitals. It is ameliorated when lying down or standing up, and exacerbated when sitting down [1].

Further symptoms involve:
• Erectile dysfunction (in males)
• Numbness in the vulva (in females)
• Numbness in the scrotum and penis (in males)
• Experiencing pain during bowel movements
• Constipation
• An urgent or frequent need to pass urine
• Difficulty getting the flow of urine to start [1].

For more detailed information on Men’s Pelvic Pain, please visit: Men’s Pelvic Pain
For more extensive information Women’s Pelvic pain, please visit: Women’s Pelvic pain

Pelvic pain: know the different causes and when to seek help

Pain that is felt in your lower belly and above your legs is called pelvic pain. The pelvis is an important part of the body because it is home to organs like your bowel, bladder, ovaries, uterus (womb), and fallopian tubes.There are many causes for pain in this area.

There may be problems with the skin, the muscles, the nerves, or the organs themselves. Sometimes the pain can come from more than one source. It’s important to understand the differences between the common causes of pelvic pain. It will help you to learn what is normal, what is not, and when you should seek medical help.

Persistent pelvic pain, sometimes called chronic pelvic pain, is pain that is present on most days for six months or more. It is estimated that about one in five women in Australia will experience this sort of pain. The actual number of women suffering from persistent pelvic pain may be even higher because as Jean Hailes gynaecologist Dr Janine Manwaring points out, the journey to getting the correct diagnosis can be a bumpy one.

She believes there is a lack of education about persistent pelvic pain – not just in the general community, but also in the medical community.

“There are many misconceptions about pelvic pain, particularly period pain,” Dr Manwaring explains.

“Pain can be downplayed by both doctors and by other women within the family. A lot of it comes down to getting the right information and knowing who the right people are to get in touch with.”

Jean Hailes gynaecologist Dr Janine Manwaring

So here are some of the conditions that can cause persistent pelvic pain, tips on how to spot the differences between them, and advice on when you need to see a trusted doctor.

Period pain

Period pain is a very common pain for people who get periods. Although the research varies on how common it actually is, one Australian study suggested it affected 93% of menstruating senior high school students.

The pain occurs when the muscles of the uterus (womb) contract or tighten. It often feels like cramping or a heaviness in the pelvic area, lower back or stomach. Despite it being a common feature of getting your period, if the pain is severe, it could be an indicator of something more serious, such as endometriosis.

Dr Mainwaring explains: “If your pain lasts longer than the first one or two days of your period, if it does not improve with period pain medications and/or the Pill, or if it’s stopping your from going about your normal daily activities, then you should see your GP.”

Jean Hailes gynaecologist Dr Pav Nanayakkara says that many people accept this sort of pain as ‘normal’ without questioning it. “But if you find yourself planning your work, study or your holidays around your period, then you might want to think about talking to your doctor to ensure that nothing else is going on,” she adds.

Endometriosis

Endometriosis (pronounced end-o-me-tree-oh-sis) is a condition that affects the female reproductive organs, and is often linked to pelvic pain.

In someone with endometriosis, cells like those that line the uterus (the endometrium) grow in other parts of the body – typically in the pelvic area such as the lining of the pelvis (peritoneum), on the bowel, bladder or ovaries.

These cells undergo the same menstrual changes as those inside the uterus. However, unlike period blood, these cells have no means of escape and so they build up. This results in pain, scarring and inflammation.

Three in every four women with endometriosis will experience pain. The pain can occur immediately before your period, during your period, or during or after sex. The pain can be felt in the pelvis, the abdomen (belly), the back, when you pass wind, wee, or poo, or when you ovulate.

Adenomyosis

Adenomyosis (pronounced add-en-o-my-oh-sis) is often called the ‘sister’ condition of endometriosis because it also involves abnormal cell growth. However, in this instance the cells grow into the muscle wall of the uterus.

The symptoms – quite like those for endometriosis – include abnormal or heavy period bleeding, painful periods (often after years without pain), and painful sex.

Irritable bowel syndrome (IBS)

The exact cause of IBS is still not fully understood. It is believed that the muscle wall of the bowel becomes sensitive and contracts unevenly, resulting in pain and bloating. This type of pelvic pain usually improves after passing wind or stool (poo). IBS is often managed by avoiding potential food triggers and trying to reduce stress.

“However, if you see blood in your poo (bleeding may appear as bright red blood on the toilet paper, or a black colour in the poo), or if you experience extreme diarrhoea, incontinence or unexplained weight loss, see your GP,” advises Dr Manwaring.

“The difficulty with IBS is that it is often a ‘diagnosis of exclusion’”, says Dr Nanayakkara. This means that it can only be said to be IBS after other conditions with similar symptoms are ruled out. The diagnosis is commonly made by a gastroenterologist (a doctor who specialises in treating digestive disorders).

Pelvic muscle pain

The muscles in the pelvis can spasm (contract) and cause pain as a result of period pain, or any pain that occurs in the pelvic area. The pain can then change from pain that comes and goes, to pain that is more constant.

According to Dr Manwaring, pelvic muscle pain can feel like you have an ongoing cramp in your pelvic area. “The pain can also be sharp or stabbing and shoot up the vagina or rectum,” she explains. “You might have pain with sex or using tampons, which can last for hours afterwards.

“Pelvic muscle pain often gets worse with exercise, especially core-strengthening exercises such as Pilates, sit-ups or crunches. Women can often find some relief by lying in the foetal position, using a heat pack, doing pelvic muscle stretches (visit the Pelvic Pain Foundation website) and seeing a pelvic floor physiotherapist.”

Bladder pain and urinary tract infections (UTIs)

UTIs, which affect over 50% of women, are another common cause of pelvic pain. Symptoms can include a burning sensation when passing wee and/or lower abdominal pain.

They may be common but if left untreated, UTIs can develop into more serious kidney infections. If your symptoms persist for more than 24 hours and include fever, chills, back pain, nausea or vomiting, see your doctor immediately.

Read our guide to UTIs.

Another bladder condition is painful bladder syndrome (interstitial cystitis). Unlike a UTI, there is irritation but no infection.

Dr Manwaring suggests seeing your GP if you have troublesome bladder symptoms regularly, such as:

• needing to empty your bladder more than 8-10 times during the day
• needing to empty your bladder more than once a night
• pain with full bladder which improves with emptying
• pain with sex or intercourse
• a sense of urgency to urinate.

Vulval pain

Vulva is the name of the external parts of the female genitals. Vulval pain can be caused by irritation, infections, inflammatory skin conditions, tissue damage related to surgery or childbirth and other causes.

Many women assume that vulval pain and irritation is due to candida (thrush). However, there are many causes. Getting the right treatment will depend on getting the correct diagnosis.

Vulvodynia (pronounced vul-vo-din-ia) is a chronic condition that can last for months or years. It is associated with pain, discomfort or a burning sensation in the vulva that cannot be linked to a specific cause. The pain can be triggered by touch. It can be felt in one area of the vulva or across the whole area.

The pain can be so severe for some women that using tampons, having sex or even sitting down for long periods is very difficult, even impossible.

Key advice for persistent pelvic pain

It can be a confusing time for people affected by persistent pelvic pain, so Dr Manwaring has five key pieces of advice.

1. If you feel you are not being heard by your doctor or health professional, do not be afraid to seek a second opinion.
2. A multidisciplinary team (one made up of experts in different fields) has been shown to be the best for managing persistent pelvic pain. Chronic pain is not just the immediate pain, but also involves and affects a number of areas of health and life, so approaching it from different angles and treating the whole person is crucial. The multidisciplinary team can include a specialist women’s health GP, a gynaecologist, a a pain specialist, a physiotherapist, a psychologist, a sexual counsellor, a naturopath and other complementary therapists.
3. Keep track of your symptoms in a form that is easy and accessible for you. Jean Hailes has an excellent Period pain and symptom diary that you can download for free. Writing down your symptoms and treatments can be helpful when talking to different health professionals. It can also help you to work out if you are making progress.
4. Source reliable health material and self-care strategies. There is a lot of information on pain management on the internet and in chat forums. Try to focus on advice and information that is based on evidence and comes from a reliable source.
5. Always remember that you are not alone. Sometimes pelvic pain conditions can be difficult to manage, and it can feel like other people cannot relate to them because your pain cannot be seen. But don’t feel like you can’t seek help; there are people who will listen to you and take you and your symptoms seriously.

Learn more about persistent pelvic pain – what can cause it, how to describe it and what you can do.

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