Pelvic pain (pain below the belly button in the anterior lower abdomen including the sex organs) may develop from many diseases and conditions. For example, pelvic pain may come from normal menstruation, appendicitis, bladder problems; and may be associated with both benign and emergency medical conditions.
While there are many medical and surgical conditions that can lead to pelvic pain, the most common gynaecological causes of pelvic pain are:
- Painful ovulation
Short-term pelvic pain that occurs just prior to, and during ovulation as the membrane that covers the ovary stretches to release the egg. The blood and fluid that are released during ovulation cause discomfort or pain. The pain varies from woman to woman and may last minutes to hours. The pain eventually resolves without medical treatment and usually does not require emergency medical intervention.
- Premenstrual syndrome
Premenstrual syndrome (PMS) usually involves longer term (days before menstruation occurs) pelvic pain and discomfort outside the pelvic area such as low back pain, headaches, and tender breasts. Medications, along with lifestyle changes (diet, exercise, stress management) may often reduce PMS symptoms.
- Menstrual cramps
Primary menstrual cramps is pelvic pain that occurs when the uterus contracts to remove the blood and endometrial lining that accumulates monthly when an embryo is not implanted in the uterus. The pains may last about 1 to 7 days during a female’s menstrual cycle. Secondary menstrual cramps (secondary dysmenorrhea) are caused by other conditions or diseases, not regular menstruation (for example, endometriosis, fibroids, ovarian cysts, pelvic inflammatory disease).
- Ectopic pregnancy
An ectopic pregnancy is growth of an embryo outside of the uterus; it can cause sharp pelvic pain, usually on one side of the body, and may be accompanied by vaginal bleeding, nausea, and dizziness. Ectopic pregnancy, if detected early may be medically treated, but if bleeding or a Fallopian tube ruptures, it is a medical emergency that requires surgery.
- Pelvic inflammatory disease (PID)
Pelvic inflammatory disease (PID) is an inflammatory and infectious disease, and may be a complication of a sexually transmitted disease (STD) such as gonorrhoea. PID can cause damage to the Fallopian tubes, ovaries, and the uterus. Pelvic pain that radiates to the abdomen, an abnormal vaginal discharge, and pain during intercourse or urination are common symptoms. Although antibiotics may cure PID, some women may require surgery. If PID is untreated, it can cause infertility, ectopic pregnancy, and chronic pelvic pain.
- Ovarian cysts
Ovarian cysts are fluid-filled areas within the ovary formed by fluid that accumulates when a follicle fails to release an egg, or when the follicle recloses after egg release. There are several types of ovarian cysts. Common symptoms include sharp pelvic pain, irregular menstruation, pelvic pressure, or pain after intercourse. Pelvic pain and painful urination may occur especially with large cysts; although most cysts resolve on their own, some may require treatment with prescription medications or surgery to remove the cyst(s).
- Uterine fibroids
- Uterine prolapse
- Urinary tract infection (UTI)
A urinary tract infection (UTI) may cause pelvic pain, but usually has associated painful urination (dysuria), frequent urge to urinate, and lower pelvic pressure. UTI’s that involve the kidney may have flank pain in addition to fever and nausea. Almost all UTI’s can be effectively treated with antibiotics, but delays in treatment can result in kidney damage.
Chronic pelvic pain is often defined as pelvic pain that occurs below the belly button for 6 or more months. It usually interferes with sleep, it may increase or decrease daily or change due to some specific stimulus or position, and it may interfere with sexual relations. Seeking medical help to obtain a diagnosis and appropriate treatments are the key to diagnosing the cause and resolving chronic pelvic pain.