Sudden, sharp pelvic pain: when to see a doctor

Written by: Dr Shankar Ramaswamy
Edited by: Laura Burgess

The pelvis, by definition, is located below the belly button and above the legs. The pelvic organs consist of the bladder, uterus, cervix, vagina and part of the bowel (rectum).

Pelvic pain can happen in both men and women and may occur for many reasons, including an infection, problem in the internal organs or pain radiating from the pelvic bones or the supporting muscles and ligaments. In women, it may be related to the reproductive system.

We spoke to one of our top pain management specialists Dr Shankar Ramaswamy in more detail about the possible causes of pelvic pain and how it can be managed.

pelvic pain stretch

What are some of the common causes of pelvic pain?

Broadly speaking, we can diagnose pelvic pain as occurring in the:

Internal organs

This includes the bladder, rectum and back passage, vulva and vagina and the male scrotal part of the perineum. Common conditions include endometriosis, inflamed bowels, pain related to a urinary tract infection (UTI), pathology in the bladder or appendicitis.

Any infection, inflammation or extension of physical processes such as menstruation, for example, can lead to sudden, sharp pain. The pain may involve the vagina or the vulva and we would need to rule out pain related to the Fallopian tubes, ovaries or uterus.

Supportive structures

The structures that support the ovaries or the pelvic floor muscles can go into muscle spasm because of excessive core tightening exercises. The pain could be due to another pathology with a secondary reaction in the muscles. In some cases, there could be an unclear reason. Another possibility may include problems in the bones and joints in the pelvis, such as inflammatory arthritis in the joints, or inflammation of the pubic bone, or misalignment of the bones. If there is a sudden sharp pain, it could possibly be due to trauma and fracture of the pelvic bones.

Referred pain outside of the pelvis

The pain could be radiating from the kidney, such as in cases of kidney stones. Structures such as the spine and lower back can refer pain to the pelvis. Spasm and inflation of these structures can result in preliminary pain.

What are some rarer causes?

A less common cause of pelvic pain could be Mittelschmerz (or ovulation pain), which occurs during the middle of a woman’s menstrual cycle and is a very benign condition.

More serious conditions like an infection can spread to another area and lead to sepsis, cancer or a cause which would result in an emergency, such as rupture of ovaries, or bleeding. These have to be ruled out. Ectopic pregnancy or ruptured ovaries can be considered an emergency and you must go to the emergency room.

Is sudden pelvic pain something to worry about?

If you are systemically unwell, tired and lethargic, you should not ignore these symptoms and you should see your GP. If you are seriously not feeling well then call 999 as an emergency as the pelvic pain could be related to ruptured appendicitis or an ectopic pregnancy.

You need to look out for any red flag features, such as signs of underlying cancer, inflammation or infection. These are typically associated with symptoms such as a loss of appetite and weight loss.

Sometimes chronic pelvic pain is associated with psychosocial problems such as anxiety and depression. The vast majority of cases of pelvic pain tend to be episodic and chronic but it can be quite disabling.

What can I take to relieve pelvic pain and pressure?

The first approach is to take paracetamol or anti-inflammatory agents like ibuprofen. You may need something stronger, however, that needs to be prescribed by your doctor.

I recommend that you use heat pads or a TENS machine, to help if you live with chronic pelvic pain. It is important to understand the pattern of your pain and therefore you might be able to preempt it. As with period pain, for example, as you know it occurs at a particular time of the month.

If your pain is related to food, as in cases of IBS, you should avoid that particular food that causes a flare-up. In order to avoid constipation, you should drink plenty of water and eat foods that are high in fibre. It’s an art to manage your pain and know what makes it worse.

Another tip is to check if you are doing the right exercises and see a physiotherapist and work more on strengthening your pelvic floor muscles. You can keep active by walking in the meantime.

If these suggestions don’t help, you should take stronger painkillers prescribed by a specialist. Talk to your GP who can refer you onto a specialist for your particular case, as you might need to be referred to a gynaecologist or a urologist depending on the features of your pelvic pain. If the pelvic pain remains chronic and does not respond to simple measures then you may be referred to a pain specialist.

How can a doctor find out what's causing it?

Your doctor may make other tests that involve taking a sample of your urine to check for infection or you may require a blood test. A specialist may ask for imaging tests such as an MRI, CT or ultrasound. Sometimes a diagnostic laparoscopy (a camera) may need to be inserted into the pelvic structure. You may either be examined as an outpatient or under general anaesthetic for the laparoscopic procedure.

When would you see a pain specialist for pelvic pain?

Typically, before seeing a specialist, your GP will rule out some underlying causes by doing a variety of tests and investigations. Usually, they will have a stable underlying cause under observation or there may be no cause identified at all. Chronic pelvic pain is categorised as pain that occurs for three to six months with or without episodic flare-ups.

In my clinic, we start off with an elaborate history and discuss the triggers that may potentially lead to a flare-up of pain and what are reliving factors in your case. This includes any association with the timing of the pain, certain foods and bowel and urine movements.

We may also involve a physiotherapist or a psychologist to help. Some patients may need specific injection therapy into the joints, muscles or into the nerves supplying the pelvis, which is often performed in a theatre under X-ray or ultrasound guidance.

Dr Ramaswamy is an expert in treating neck, back, pelvic, and neuropathic pain. He is available for an appointment in the clinic or online using our video call tool e-Consultation. Boon an appointment via his profile here now!

Dr Shankar Ramaswamy

By Dr Shankar Ramaswamy
Pain medicine

An important note with regard to the COVID-19 pandemic: We are offering video consultations to all patients at flexible times and at short notice. This is authorised by all insurance providers. Our team also offers physiotherapy via video consultation and we are able to offer interventions quickly for 'low risk' patients at safe premises in London. We will risk-assess all patients prior to this.

Dr Shankar Ramaswamy is a leading consultant in anaesthesia, pain management and neuromodulation based in Central London, Southeast London and Kent. Among the wide range of conditions that he manages are neck and back pain, headache and facial pain, cancer pain, neuropathic pain, musculoskeletal pain including fibromyalgia and joint pain, abdominal and pelvic pain, sports injury and trauma and accident-related pain including whiplash injury.

He is the clinical lead for the busy inpatient pain service at the Royal London Hospital and also the lead for pain management for the Newham MSK Collaboration. He is also the lead for education in pain management for Barts Health and QMUL and a course director and honorary senior lecturer for MSc Pain Management, University of Edinburgh.

His first qualifications and training in the field of anaesthesia were earned in India, including at one of the most prestigious medical and research institutions in India, the PGIMER. Once in the UK, he continued his anaesthetic training and then underwent the Advanced Pain Fellowship at the renowned Imperial Healthcare, London.

Over the duration of his career, he has garnered extensive experience that he uses to provide care of the highest quality to his patients. He commits to providing comprehensive pain management plans that are centred on each patient's individual needs. He uses a variety of techniques including self-management advice, pharmacotherapy, and cutting-edge (X-ray-guided and ultrasound-guided) interventions such as epidural, facet joint injections, peripheral joint injections (e.g. hips, knees, shoulder), radiofrequency, laser disc therapy, regenerative medicine (PRP) and neuromodulation. He is part of a large multi-disciplinary team to facilitate and individualise pain management approach.

Dr Ramaswamy has also received training in medico-legal report writing and is familiar with civil procedure protocols including CPR part 35 and PD 35 protocol. He can provide detailed insights into causality, prognosis, assessing capacity to work understanding specific roles, assess the ability to function and also comment on the prospect of achieving pain relief. He also offers medicolegal appointments at short notice and can produce a report with a quick turn around time. He sees patients for personal injury claims and criminal negligence claims.

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