Pelvic Pain in Women and Men

  • Medical Author:
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

  • Medical Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Facts about pelvic pain

  • There are a number of different causes of pelvic pain. Some are specific to women or men, while others can occur in anyone.
  • Pelvic pain in pregnancy can be due to an ectopic pregnancy, miscarriage, preterm labor, or other conditions.
  • Causes of pelvic pain in women and men can include kidney stones, urinary tract infections, intestinal conditions like inflammatory bowel disease (Crohn's disease and ulcerative colitis) or bowel obstruction, or fracture of the bones of the pelvis.
  • Symptoms of pelvic pain can occur along with other symptoms, depending upon the exact cause. Associated symptoms can include low back pain, vaginal or urethral bleeding or discharge, fever, and pain during sex.
  • Endometriosis is a common cause of pelvic pain in women that can cause heavy menstrual bleeding as well as pain during or after sex.
  • The diagnosis of pelvic pain involves laboratory studies as well as imaging tests like ultrasound, CT, X-ray, or MRI.
  • Treatment for and the prognosis of pelvic pain depends upon the exact cause.

What is the pelvis?

Technically, the pelvis refers to the bones of the hip that rest on the legs and support the spine. It also can refer to the cavity inside these bones, the lower portion of the trunk of the body.

What is pelvic pain?

Pelvic pain is typically considered to be pain in the lower front of the abdomen, below the umbilicus (belly button). Pelvic pain sometimes arises due to problems with the female reproductive organs, but pelvic pain can occur in both men and women due to other causes.

Pelvic pain can arise due to both acute and chronic problems. Acute pelvic pain is new pain that you have not experienced before. Chronic pain is pain that persists over time. In the pelvis, acute pain is more common than chronic pain.

Pelvic pain can have a number of different causes. Some of the most common causes will be discussed in this article.

Early Symptoms of Appendicitis

The main early symptom of appendicitis is abdominal pain. The pain is so difficult to pinpoint that when asked to point to the area of the pain, most people indicate the location of the pain with a circular motion of their hand around the central part of their abdomen. Other common symptoms of appendicitis include

  • loss of appetite,
  • nausea, and
  • vomiting.

What other symptoms are associated with pelvic pain?

Depending on the cause of pelvic pain, there may be other associated symptoms, including:

What are the causes of pelvic pain during pregnancy?

Some of the causes of pelvic pain described above, for example, pelvic inflammatory disease, also can occur in pregnant women. But there are other causes of pelvic pain that are specific to pregnancy:

  • Ectopic pregnancy is a pregnancy that develops outside the womb (uterus). The most common location for an ectopic pregnancy is the Fallopian tube. An ectopic pregnancy can lead to life-threatening bleeding if it ruptures. Symptoms of an ectopic pregnancy include abdominal and pelvis pain along with vaginal bleeding.
  • Miscarriage is the loss of a pregnancy in the first 20 weeks of gestation. Vaginal bleeding is a common symptom of miscarriage, although pain also may occur.
  • Preterm labor or premature labor is the onset of signs of labor before 37 weeks of pregnancy. Symptoms include pelvis fullness, pain, or cramping; backache; and leakage of fluid from the vagina.
  • Placental abruption, also known as abruptio placentae, is a serious medical condition in which the placenta becomes separated from the wall of the uterus. Pelvic or back pain may result, which can be accompanied by vaginal bleeding.

What are the causes of pelvic pain in women?

In women, pelvic pain can occur due to pregnancy-related causes or problems with the reproductive organs in women who are not pregnant. Causes of pelvic pain in women include:

  • Menstrual cramps or problems. The medical term for menstrual pain is dysmenorrhea. Many women experience mild menstrual pain, but for some women the pain is severe and disrupts their participation in day-to-day activities.
  • Ovarian cysts can cause pain if they become large, rupture (burst), or become twisted (known as torsion of an ovarian cyst). Most ovarian cysts are small, benign (non-cancerous) and do not cause symptoms.
  • Fibroid tumors are benign growths of muscle tissue (a fibroid is also known as a leiomyoma) that are common in the uterus (womb). These do not usually cause pain or symptoms, but if they are very large, they may cause heavy menstrual bleeding or swelling of the abdomen. Pelvic pain can arise if there is degeneration (death of tumor cells) within a large fibroid tumor. This happens when a fibroid tumor outgrows its blood supply and starts to shrink.
  • Pelvic inflammatory disease (PID) is a condition in which there is widespread inflammation within the reproductive organs, usually due to an infection. The infection is typically a sexually-transmitted disease like gonorrhea or chlamydia. Fever, vaginal bleeding, and vaginal discharge usually accompany the pelvic pain of PID.
  • Endometriosis is the presence of tissue like the lining of the uterus in other areas of the reproductive organs or elsewhere in the body. It is most common in women in their 30s and can cause heavy periods, severe menstrual cramps, and pelvic pain during sex. A similar condition is adenomyosis, in which areas of uterine lining tissue are located abnormally in the muscle wall of the uterus.
  • Ovulation can cause pelvic pain. This occurs when the ovary releases an egg at the midpoint of the menstrual cycle. Typically, it is felt on the right or left side, depending upon which ovary the egg has come from. The term "Mittelschmerz" has been used to refer to this kind of pain.
  • Pelvic congestion syndrome refers to a buildup of blood in the veins of the pelvis. This can cause pain in some women.
  • Vulvodynia is pain in the vulva that occurs for unknown reasons. It may be accompanied by burning or stinging sensations, or pain during sex.
  • Rarely, cancers, including cervical cancer, uterine cancer, or ovarian cancer are the cause of pelvic pain in women.

What are the causes of pelvic pain in women and men?

Causes of pelvic pain in both women and men include problems with the digestive tract, bone fractures, conditions affecting the urinary tract, or other issues. The following are some of the main causes of pelvic pain in men and women:

  • Appendicitis, inflammation of the appendix, can cause acute abdominal or pelvic pain along with nausea and vomiting.
  • Kidney stones or infection of the kidney (pyelonephritis) can cause flank pain and pelvic pain. Blood in the urine and fever may be present.
  • Cystitis and other urinary tract infections (UTIs) may cause pelvic pain accompanied by blood or pus in the urine. Low back pain can be another symptom of urinary tract infections.
  • Interstitial cystitis involves inflammation of the bladder walls and can cause chronic pelvic pain. With interstitial cystitis, there are no signs or symptoms of infection.
  • Intestinal conditions that result in inflammation or abscesses in the bowel can be a source of pelvic pain. These can include bowel obstruction, diverticulitis, or an abscess.
  • Inflammatory bowel diseases including Crohn's disease and ulcerative colitis are chronic conditions that can cause abdominal or pelvic pain.
  • A hernia occurs when the abdominal wall is weakened, and abdominal organs may protrude through the area of weakness. Sometimes the tissues that are found inside of a hernia have a decreased blood supply and cause severe pain.
  • Irritable bowel syndrome (IBS) is a condition that often causes abdominal or pelvic pain along with diarrhea, constipation, bloating, and gas.
  • Fracture of the bones of the pelvis is a potential source of pain in the pelvis.
  • Sexually-transmitted diseases (STDs), such as gonorrhea or chlamydia, can cause pain as well as burning with urination, and urinary or vaginal discharge.
  • Post-surgical adhesions (abdominal adhesions) occur when scar tissue forms abnormal connections between parts of the body after surgery. For certain surgeries involving organs of the pelvis, these adhesions can develop and cause pain.
  • Muscle spasms of the muscles of the pelvic floor can be a cause of pelvic pain that can become chronic. An example is the rectal pain caused by levator ani syndrome or levator syndrome, caused by spasms of the levator ani muscle. This has also been referred to as chronic proctalgia.
  • Anal fissure is a painful tear or crack in the lining of the anus.

What are causes of pelvic pain in men?

Chronic nonbacterial prostatitis or chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a condition that can cause chronic pelvic pain in men. The cause is poorly understood. This pain is sometimes referred to as prostatodynia.

Acute or chronic prostatitis (inflammation of the prostate often due to bacterial infection) is another source of pelvic pain in men.

When to seek medical care for pelvic pain

It's important to seek medical care for any unexplained or new pain that is associated with troubling symptoms. In particular, seek medical care if you notice pain, cramping, or bleeding during pregnancy; blood in the urine or stool; abnormal vaginal bleeding or discharge; high fever; or severe pain.

Which specialties of doctors treat pelvic pain?

Because the causes of pelvic pain are so numerous, the type of doctor consulted will depend on the nature of the pain and the associated symptoms. It is always appropriate to seek care from a primary care provider, including internists, family physicians, and pediatricians. Gynecologists may diagnose and manage pelvic pain related to organs of the female reproductive system. Surgeons may be consulted for problems that require surgical correction. Other specialists that may be involved with managing certain causes of pelvic pain include gastroenterologists, orthopedists, urologists, and oncologists.

How is pelvic pain diagnosed?

Your health-care professional will first ask you questions about the pelvic pain, including when the pain began, if there are other associated symptoms, what relieves the pain, and if you have any other medical conditions. A physical exam and laboratory studies of blood and urine are the next step in the evaluation. Depending upon your situation, a number of different diagnostic tests may be [performed to help establish the cause of the pelvic pain, such as:

  • Transvaginal ultrasound, when conditions involving the female reproductive organs are suspected
  • CT, MRI, or ultrasound imaging studies of the pelvis and abdomen
  • Colonoscopy
  • Laparoscopy, a procedure in which instruments and inserted through tiny incisions, allowing inspection of the internal organs
  • Cultures of abnormal discharge from the vagina or urethra
  • X-rays of the pelvis

What is the treatment for pelvic pain?

Treatment for pelvic pain depends upon the underlying cause of the pain and may involve medications or surgery.

Can pelvic pain be prevented?

Pelvic pain can only be prevented to the extent that the specific cause of pain can be prevented. For example, safe sex practices can help prevent sexually-transmitted diseases, reducing the risk of pelvic pain from these infections. Maintaining adequate hydration can help reduce the risk of kidney stones in some cases.

What is the prognosis for a person with pelvic pain?

The prognosis can be excellent for certain types of pelvic pain, such as an ectopic pregnancy that has not ruptured or an uncomplicated UTI. Other types of pelvic pain are likely to recur and may become chronic, such as prostatitis, endometriosis, interstitial cystitis, or muscle spasms. Conditions like ulcerative colitis and Crohn's disease persist over time. Pelvic pain due to cancers likely has the most guarded prognosis, and outcomes in these cases depend upon the stage (extent of spread) of cancer, the specific type of cancer that is present, and the types of treatments available.

REFERENCES:

Bhavsar, A. K., et al. "Common questions about the evaluation of acute pelvic pain." Am Fam Physician. 2016 Jan 1;93(1):41-48A.

Singh, M. K., MD. "Chronic pelvic pain in women." Medscape. Updated: Jan 13, 2015.
<http://emedicine.medscape.com/article/258334-overview>

Watson, R. A., MD. "Chronic pelvic pain in men." Medscape. Updated: Jan 16, 2015.
<http://emedicine.medscape.com/article/437745-overview>

Last Editorial Review: 7/7/2016

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Reviewed on 7/7/2016
References
REFERENCES:

Bhavsar, A. K., et al. "Common questions about the evaluation of acute pelvic pain." Am Fam Physician. 2016 Jan 1;93(1):41-48A.

Singh, M. K., MD. "Chronic pelvic pain in women." Medscape. Updated: Jan 13, 2015.
<http://emedicine.medscape.com/article/258334-overview>

Watson, R. A., MD. "Chronic pelvic pain in men." Medscape. Updated: Jan 16, 2015.
<http://emedicine.medscape.com/article/437745-overview>

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