Pelvic Pain in Women

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KEY POINTS

• Pelvic pain in women may be mild or severe, and the pain may come and go. It may have many different causes.
• Treatment may include medicines, physical therapy, surgery, and other supportive therapies to decrease or control symptoms.
• Take care of your health by exercising, eating a healthy diet, and getting support from your healthcare provider, family, friends, and a support group.

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What is pelvic pain?

Your pelvis is the lower belly area between your hips. A woman’s pelvis contains:

• The uterus, the muscular organ at the top of the vagina, ovaries, fallopian tubes, cervix, and vagina, which are part of your reproductive system
• Your bladder, ureters, and urethra, which are part of your urinary system
• Your intestines, rectum, and anus, which are part of your digestive system

Pelvic pain in women may be mild or severe, and the pain may come and go. It can happen before, during, or after your menstrual period. Some women have long-term (chronic) pelvic pain that has lasted longer than 6 months.

What is the cause of pelvic pain?

Pelvic pain may be caused by an injury, illness, or medical problem with your reproductive, urinary, or digestive system.

Causes of pelvic pain that involve the reproductive system include:

• Menstrual cramps, which is pain or discomfort in the lower belly just before or during your menstrual period (dysmenorrhea)
• Problems with tissue from the lining of the uterus growing outside the uterus (endometriosis)
• An infection of the female organs
• Stretched or swollen veins in the ovaries or pelvis (pelvic congestion syndrome)
• Problems with tissue or growths inside the uterus
• Cancer

Causes of pelvic pain that involve the digestive system include:

• Irritable bowel syndrome
• Long-term constipation
• Inflammatory bowel disease
• Cancer

Causes of pelvic pain that involve the urinary system include:

• Bladder infection (cystitis)
• Urethra infection or irritation (urethritis)
• Painful bladder (interstitial cystitis)

Other causes may be scar tissue, fibromyalgia, or problems with the muscles in the belly, pelvis, and perineal areas. Sometimes the cause of pelvic pain is not known even after lots of tests and procedures are done.

What are the symptoms?

The pain may be dull and achy or sharp and stabbing. It may come and go.

Symptoms may include:

• Pain or discomfort in your lower belly or lower back
• Pain during sexual activities, when urinating, or when having a bowel movement
• Pain in your genital area or in the inner part or front of your thighs
• Constipation
• Depression or anxiety
• Less appetite
• Trouble sleeping

These conditions can damage the nerves or change the way nerves send pain signals to your brain. Because of these changes, you may keep having pain even after the injury or condition has healed. You may find that you are cutting back on daily activities if you have long-term pelvic pain. You may feel worn out emotionally and physically.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Tests may include:

• Blood and urine tests including a pregnancy test
• Pelvic ultrasound, which is a test using sound waves to check for cysts or other problems with the abdominal organs
• Pelvic MRI, which uses a strong magnetic field and radio waves to show detailed pictures of the abdominal organs
• Cystoscopy, which uses a thin, flexible, lighted tube with a tiny camera to check the inside of your urethra and bladder
• Colonoscopy, which uses a thin, flexible, lighted tube and tiny camera put into the rectum and up into the colon to look for polyps
• Laparoscopy, which uses a small lighted tube put into the belly through a small cut to look at the organs and tissues

How is it treated?

Treatment depends on what is causing your pain. Your treatment may include:

• Medicine to help:
  • Regulate menstrual periods
  • Treat pain and anxiety
  • Prevent tissue thinning and dryness in the vagina
  • Treat infection
• Diet changes
• Surgery
• Physical therapy
• Kegel exercises or other therapies to manage pain and cope with chronic pain. Kegel exercises can help strengthen the muscles that support your bladder, vagina, uterus, and rectum. You use these muscles when you urinate, have bowel movements, and during sex. Your healthcare provider can teach you how to do Kegel exercises.

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider. Work as a partner with your healthcare provider and others providing care for you. Follow your healthcare provider's instructions, including any exercises recommended.

Different things work for different people. Here are some things you can try to see what works best for you.

• Take care of your health. Try to get at least 7 to 9 hours of sleep each night. Eat a healthy diet and try to keep a healthy weight. If you smoke, try to quit. If you want to drink alcohol, ask your healthcare provider how much is safe for you to drink. Learn ways to manage stress. Exercise according to your healthcare provider's instructions.
• Keep a pain diary. It can help you learn what helps your pain and what makes it worse. Share what you learn with your healthcare provider or counselor.
• Find a support group to help you understand that you are not alone. Groups also provide a safe place to share feelings.

Talk with your healthcare team before you try unproven therapies such as magnets, herbs, or fad treatments.

Ask your provider:

• How and when you will get your test results
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

You can get more information from:

• The International Pelvic Pain Society
  847-517-8712
  http://pelvicpain.org/home.aspx