Pelvic pain: when should women seek medical help?

Pelvic pain can be debilitating to the point of severity that it requires medical treatment, whether it’s chronic or an emergency. What are the circumstances that lead to this eventuality? Leading consultant obstetrician and gynaecologist Dr Sharmistha Guha, speaks to Top Doctors about when women should seek medical help for pelvic pain.

What are the various symptoms of pelvic pain?

The pain can come on suddenly (acute) either in the central part of on any particular sides or can be present chronically over a period of time. The pain can be constantly present or comes and goes intermittently over a few hours in a day or over a few days in a week or a month. The pain can be of various types like dull aching/colicky or sharp in nature.

There could be some relieving or worsening factors such as position (like bending forwards, raising legs, sitting upright, lying down), association with food, bowel or bladder movements etc. The pain may or may not be associated with other symptoms such as nausea, vomiting, diarrhoea, vaginal bleeding or vaginal discharge. 

Pelvic pain could also be associated with early pregnancy and the causes would be different.

What are some possible causes of pelvic pain in women?

Pelvic pain has mainly three types of presentations. The causes are different according to the presentations.  Acute pelvic pain can be caused by:

• Urinary tract infection – common
• Pelvic infection – common
• Ovarian cyst rupture/bleeding – uncommon
• Ovarian torsion (twisting of the ovary) – rare
• Appendicitis – uncommon
• Constipation or diarrhoea (known as irritable bowel syndrome or IBS) - common
• Pelvic abscess such as tubo-ovarian abscess (severe infection involving fallopian tube and ovary) – rare
• Degeneration of fibroids – rare

Chronic pain can be caused by:

• Endometriosis
• Pelvic inflammatory disease
• Pelvic adhesions (due to previous surgery or infections)

Acute or chronic pain (Sudden worsening of pain in women who have history of chronic pelvic pain) can be caused by:

• Endometriosis during periods
• Degeneration of fibroids

Pelvic pain in pregnancy can be caused by miscarriage or ectopic pregnancy or in a normal healthy pregnancy with corpus luteal pain along with any of the possible above causes.

When should a woman seek medical help?

A woman should seek medical help if she can’t cope with the pain at home. The type of medical help will also depend on the presentation. If the pain is acute in onset with or without other associated symptoms such as nausea, vomiting, diarrhoea, vaginal bleeding or discharge and is not relieved on taking one or two doses of simple painkillers such as paracetamol or ibuprofen, then she should seek immediate medical help. She can contact her GP or attend A&E according to the symptoms and access.

If the pain is really severe that she can’t move at all or is very unwell with it, she should seek immediate help and attend A&E.

For chronic pain which comes and goes or happens on certain times of the month regularly, she should monitor the symptoms. If the symptoms happen regularly for one or more months, she should contact her GP to be seen first and be referred to a gynaecologist if needed.

How would you discover the cause and diagnose it?

There are many causes of pelvic pain hence the diagnosis will depend on a thorough history-taking and pelvic examination (including internal examination - speculum and digital) and some basic tests.

The tests done would usually be a urine test to check for infections and pregnancy, blood tests to check for infections and a pelvic ultrasound scan (transvaginal ultrasound scan unless contraindicated).

What ways can you ease/treat pelvic pain and what can make it worse?

Pelvic pain is treated according to the cause of the pain.

If there is an infection such as urinary tract infection or pelvic infection, it would be treated with antibiotics. The antibiotics can be given by mouth or through the veins depending on the severity of the infection. If there is a pelvic abscess, longer course of intravenous antibiotics may be needed.

In case of ovarian cyst rupture or bleeding, it can be managed conservatively with regular pain killers or in some situations may need surgery.

In case of ovarian torsion or appendicitis, immediate surgery may be needed.

For chronic causes of pain such as endometriosis, fibroids, pelvic inflammatory disease or pelvic adhesions, a planned surgery to diagnose the cause of pain is the gold standard test. The pathologies can be treated at the same time. However, they may also need long-term treatment with hormonal medications or hormone implants or coils. This can be initiated before or after the surgery depending on the clinical case of the patient.

Pelvic pain can also be managed by simple pain killers or nerve modulators given regularly. Often, pelvic pain patients are referred to pain team for pain management.

If you’re looking for specialist advice regarding pelvic pain, get in touch with Dr Guha. Visit her Top Doctors profile here.