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
- 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
and ulcerative colitis) or bowel obstruction, or fracture of the bones of the
- 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,
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
What other symptoms are associated with pelvic pain?
Depending on the cause of pelvic pain, there may be other associated
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
- 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
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
- 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
fractures, conditions affecting the urinary tract, or
other issues. The following are some of the main causes of pelvic pain in men
- Appendicitis, inflammation of the
appendix, can cause acute abdominal or pelvic pain along with nausea and
- 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
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
- 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
- Laparoscopy, a procedure in which
instruments and inserted through tiny incisions, allowing inspection of the
- 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.
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.
Watson, R. A., MD. "Chronic pelvic pain in men." Medscape. Updated: Jan 16, 2015.