Pelvic pain occurs in the lower abdomen and pelvis. The pain can originate from organs close by, such as any of the reproductive organs, the digestive or urinary systems, or from the surrounding muscles and ligaments. It predominantly affects women, and may be acute, lasting a short time such as in period cramps or a urinary tract infection, or persisting as a chronic condition. Chronic pelvic pain is defined as intermittent or continuous pelvic pain that lasts for longer than 6 months and affects around 1 in 6 women.
For women, any conditions related to the reproductive organs can cause pelvic pain, including period pains either before or during menstruation, pelvic inflammatory disease, endometriosis, adenomyosis or fibroids, ovarian cysts or cancer, and pregnancy-related issues such as ectopic pregnancy or miscarriage. Men may suffer chronic pelvic pain for issues related to the prostate, such as prostatitis. Both men and women can suffer conditions in the urinary tract such as infections or kidney stones, or those arising from the bowel, such as appendicitis, inflammatory bowel disease, constipation or colon cancer.
If there is any chance you may be pregnant, you should be on alert that sudden and severe pelvic pain may be caused by an ectopic pregnancy. This is a medical emergency and urgent attention needs to be sought. If your pelvic pain accompanies any symptoms of infection, then you should seek medical attention by speaking to your GP or 111. Pelvic pain may point to cancer, and you should make an urgent appointment with your GP if you have additional concerns, including weight loss, poor appetite, night sweats, bloating, persistent vaginal bleeding with no obvious cause, or you or a family member has had cancer before. Pelvic pain that becomes chronic or affects your day-to-day life should be discussed with your GP in a routine appointment.
To identify the cause of pelvic pain your doctor will first take a detailed history from you to identify where the pain may be coming from. This may include asking you about your sexual history, urinary symptoms and menstrual history, if applicable. It will then likely include an intimate examination of the pelvis and abdomen. Blood tests may be performed looking for infections or hormonal dysfunction. They may suggest a sexually transmitted infection (STI) screen to look for chlamydia and gonorrhoea. More detailed investigations like ultrasounds may need to be performed and depending on the results or you may be offered a trial of treatment. You may be referred to a specialist team such as the gynaecology team, for further investigations.
Regular exercise, physiotherapy and changes in diet can help manage pelvic pain for some. Others may need medications to reduce the severity of the symptoms. Simple painkillers, muscle relaxants and occasionally antidepressants may be helpful. Hormonal treatments can be helpful for women with endometriosis, period pains or fibroids. In severe cases, surgery may be required to reduce the fibroids, endometriosis, or adhesions. Surgery is not always successful so is usually a last resort. Antibiotics are used to treat STIs. In the absence of a positive test, but with strong suspicion of chronic prostatitis in men or pelvic inflammatory disease in women, antibiotics are used to treat a presumed and persistent STI infection.