Pelvic pain: characteristics, causes and symptoms

How is pelvic pain characterised?

Pelvic pain is not a disease, it is a symptom. It can be anything from a sharp shooting pain that you feel is in your abdomen, to radiating to your back, potentially down to your legs or it can be a chronic problem , where you have a dull throbbing with sharp bouts from time to time. 

Pelvic pain can present in various ways and at different times. It can be acute, which is a sudden onset or it can be a chronic problem, which is more long-standing problema.

Chronic pain will usually last at least six months and is not necessarily related to your periods.

Which symptoms can accompany pelvic pain?

Symptoms that can accompany pelvic pain include pain during periods, before periods, in the middle of your cycle,  typically known as ovulation pain, which may occur halfway down the cycle.

You could have painful sex and you might have difficulty opening your bowels or pressure symptoms.

Another symptom could be a lower back pain which might be more musculoskeletal.

It may be a combination of these or it could be single; symptoms can vary depending on what condition you might have.

What can cause pelvic pain?

There are different things that can cause pelvic pain and not necessarily every bit will be gynecological. To establish the cause of pain, history taking and being open with your consultant is extremely important.

If it’s a sudden onset of pain, this may signfy that there has been an ovarian cyst accident, which may require an acute problem solving; you may need to go to A&E.

Period pains and ovulation can cause pelvic pain.

Chronic pain can be related to conditions such as endometriosis or adenomyosis. Pain can also develop due to scar tissue from previous surgery.

Additionally, you could have pain from scar tissue from a previous pelvic inflammatory disease, known or unknown.

Pain could be from nerve entrapment, potentially from previous surgery. The pain also could be from IBS (irritable bowel syndrome) or muscular, from an old injury which is now mimicking itself as period. This makes it difficult to diagnose.

Furthermore, pain could be from your bowels if you’re suffering from diverticulitis.

Another cause may be waterworks, potentially cystitis (a water works infection) or sometimes it can also be a psychosexual problem. If you had any difficulties in the past, they may present themselves later in life as pelvic pain.

When is pelvic pain serious?

Pelvic pain is serious if it’s an acute pain which is causing you to feel faint, to feel nauseuous and you’re actually vomiting. Furthermore, it is serious if you’ve had episodes or if you’re passing out.

At this is a stage you should not wait for an appointment, you should present yourself to A&E to resolve the problem.

Other than that, most pelvic pain is something which will develop over time and treatment can take some to work on, to establish either treatment of the symptoms or to get to the bottom of it.

Usually it is not a serious condition.

How is the cause of pelvic pain established? Which tests might doctors perform?

With period pain, history taking is the most important. It is essential to be honest about every little bit that may be attributing to the pain.

Once a history is taken, an examination is carried out to see what triggers the pain. If there are any specific findings in the examination, following that, doctors tend to do an ultrasound scan. They carry out the ultrasound to look for ovarian cysts and any large masses in the abdomen on the pelvis.

An MRI scan is often used for higher stage endometriosis but if it’s very mild endometriosis it will not be detected on ultrasound or MRI. MRI however, is good for adenomyosis.

Doctors can offer laparoscopy, which is a keyhole look into the abdomen to see whether endometriosis or adenomyosis is present or adenomyosis

Through laparoscopy, doctors can also detect scar tissue or any loaded bowel.