The pelvis sits at the bottom of the spine between the hip bones and contains the intestines, bladder, and internal sex organs. Pelvic pain can result from problems with any of these organs or the bones and muscles in the pelvis itself. Pain from organs in the abdomen can also radiate into the pelvis.

Pelvic pain is chronic in some cases; in others, it develops quickly and severely. The cause of the pain typically determines its location, severity, and character.

Gynecological Causes

Most women experience some form of minor pelvic pain throughout their lives, whether related to ovulation, their menstrual cycle, or sexual intercourse. Some common gynecological conditions, including endometriosis, ovarian cysts, and pelvic inflammatory disease, can cause varying degrees of pelvic pain.

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Gastrointestinal Causes

Some gastrointestinal causes of pelvic pain may be due to chronic conditions, like irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), or even gas pains from intolerance to things like dairy or wheat. Acute abdominal or pelvic pain may result from something that requires more urgent treatment, like appendicitis or diverticulitis.

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Urological Causes

Any condition that affects the kidneys, ureters, or bladder can result in pelvic pain. Some of these, like urinary tract infections, may be easy to treat with antibiotics. Kidney stones are quite common and generally easy to treat, but large stones may require additional intervention.

Other urological causes of kidney pain may require more testing and in-depth treatment. For example, interstitial cystitis is caused by chronic bladder inflammation that may require multiple forms of treatment.

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Musculoskeletal Causes

Pelvic floor dysfunction results from anatomical changes in the musculature of the pelvic floor, the collection of muscles and ligaments that supports the bowel, bladder, and reproductive organs. It can cause pelvic pain, as can pelvic joint instability.

The pelvis has three joints: two in the back and one in the front. If these joints become unstable due to trauma, pregnancy, or arthritis, pain can result. Hernias, which occur when part of the bowel bulges through a gap in the abdominal muscles, can cause pelvic pain if they develop in certain places.

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Other Causes

Nerve-related pain can occur in the pelvis for a number of reasons, including pinched nerves, post-surgical scar tissue, or pudendal neuralgia, which is when the pudendal nerve running through the pelvic floor, is entrapped and damaged.

Infections in the gut or sexual organs can also cause pelvic pain, and it may even result from psychological factors, including depression, stress, or a history of abuse.

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Types of Pain

The type of pelvic pain will depend on the cause. For example, sharp or stabbing pain may occur with an ovarian cyst or from gas pains. Dull or aching pain can occur from ovulation or pelvic floor dysfunction, and cramping or spasms can result from food intolerance, IBS, or inflammatory bowel disease.

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Associated Symptoms

Other associated symptoms may result from whatever is causing pelvic pain. Abnormal vaginal bleeding may occur from an ectopic pregnancy or pelvic inflammatory disease, which can also cause pain during or after sex.

Painful urination can be a symptom of kidney stones or a urinary tract infection, while bloating and constipation are likely in IBS or IBD.

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Diagnosis of Pelvic Pain

Pelvic pain is diagnosed based on the patient's history and the location and severity of the pain. Some cases may be easier to interpret than others, but imaging is often needed to determine the exact location and cause of the problem. Ultrasound is often used during pregnancy, but it is also an effective tool for evaluating abdominal organs and blood vessels; however, it generally cannot be used to evaluate bones.

CT scans create a cross-sectional image of the abdominal and pelvic organs, including soft tissue, blood vessels, and bones. An MRI may be needed to investigate further if any masses are found during the ultrasound or CT scan.

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Laparoscopy and Other Diagnostic Tests

If imaging uncovers something that requires more investigation, the next step may be a laparoscopy. During a laparoscopy, the surgeon makes a few small incisions into the abdomen and inserts a long, thin tube with a camera on the end to look at the inside of the pelvis and abdomen.

If the surgeon finds something, they may collect a tissue sample to do a biopsy, or they can remove any growths or obstructions they discover.

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Treatment and Management of Pelvic Pain

Managing pelvic pain very much depends on what the cause is. Over-the-counter pain relievers may be enough for minor pain from common ailments like menstrual cramps, but other conditions may require prescription medication.

If the pain is severe, a doctor might prescribe stronger pain medication. They will likely prescribe antibiotics for an infection, and hormone therapy may be used to treat endometriosis.

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Physical Therapy

Depending on the cause, physical therapy may help relieve pelvic pain. Pelvic floor therapy, stretching, and strengthening exercises can improve pelvic floor muscle strength, which can help with pain from pelvic floor dysfunction or pelvic joint instability.

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Lifestyle Changes

Some lifestyle changes can help with pelvic floor pain, depending on the cause. If the pain results from psychological causes, exercise and physical activity can help. If the pain is gastrointestinal in nature, diet and nutrition changes may prevent flares or lessen the severity.

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Complementary and Alternative Therapies

There are alternative treatments for pain, too. Research shows that acupuncture can be effective, and massage may help some kinds of chronic pain and can be incorporated into physical therapy. Biofeedback has also been shown to be effective for pelvic pain.

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Surgical Interventions

If surgery is required, the surgeon may complete the necessary procedure during a laparoscopy, if possible. In some cases, open surgery may be required. For women with gynecological problems causing severe and chronic pelvic pain, the doctor may suggest a hysterectomy as treatment.

While a hysterectomy may stop pelvic pain, it also results in infertility. Women who want to have biological children should put the necessary consideration into this option and speak to professionals as needed.

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Prevention of Pelvic Pain

Regular checkups and screenings can catch problems and complications before pelvic pain becomes too severe and can help ensure any treatments are effective. Depending on the cause, maintaining a healthy lifestyle can go a long way to controlling symptoms.

For example, if pelvic pain is caused by IBS, avoiding trigger foods can help minimize symptoms, and regular exercise can help strengthen pelvic muscles and joints. Practicing safe sex can help avoid infections and associated pain.

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