Pelvic pain is pain that affects the lower part of the abdomen (the area between the belly button and groin). Pelvic pain is a general symptom that may be the result of everything from menstrual cramps to a ruptured ovarian cyst. Pelvic pain is common among women, but its origins should always be examined.
Types of pelvic pain
- Sudden onset pelvic pain that is sharp or stabbing
Extreme pain in the pelvic area that comes on suddenly requires urgent medical attention. Pelvic pain that is sudden and severe may be a sign of a ruptured ovarian cyst, an ectopic pregnancy or an infection. All of these medical conditions must be treated urgently at a hospital or medical clinic. - Pelvic or abdominal pain that is constant
Pelvic pain that lingers around for weeks or months should always be investigated. Conditions such as endometriosis, fibroids or pelvic inflammatory disease (PID) may cause this type of pain. Other causes include endometrial polyps or cancers of the reproductive tract.
Common causes of pelvic pain
- Fibroids
- Endometriosis
- Pelvic inflammatory disease
- Ovarian cysts
- Functional cysts
Fibroids
Uterine fibroids are non-cancerous growths of the uterus that often appear in women during their reproductive years. Fibroids do not always cause symptoms but when they do, the following may be experienced
- Pelvic pain or severe menstrual cramps
- Unusually heavy menstrual bleeding that may include clots
- Bleeding between periods
- Increased urination frequency
The presence of these symptoms should always be discussed with your doctor.
A more detailed account of fibroids, its symptoms, diagnosis and management may be found here (INSERT LINK TO PELVIC PAIN -FIBROID SECTION.)
Endometriosis
Endometriosis is a medical condition in which tissue cells that normally line the inside of the uterus (the endometrium) begin to grow on the outside of the uterus instead. This can lead to symptoms of
- Heavy bleeding
- Cramping
- Painful intercourse
- Pain during bowel movements or urination
The presence of these symptoms should always be discussed with your doctor.
A more detailed account of endometriosis, its symptoms, diagnosis and management may be found here (INSERT LINK TO PELVIC PAIN -ENDOMETRIOSIS SECTION.)
Pelvic inflammatory disease
Pelvic inflammatory disease (PID) is an infection of a woman’s reproductive organs that usually follows on after infection with a STI. PID is often caused by STI’s like chlamydia and gonorrhea.
PID is a serious medical condition and must be treated by a doctor as soon as possible. Failure to treat PID quickly can lead to long term complications with infertility.
Symptoms of PID
- Pain in the lower abdomen
- A high temperature
- Symptoms of an STI (ie. unusual discharge from the vagina)
- Pain and/or bleeding during intercourse
- Burning sensation when passing urine
- Bleeding between periods
All of these symptoms, particularly a high temperature, unusual vaginal discharge and abdominal pain warrant a trip to see the doctor immediately.
Women at risk of getting PID
Women are more likely to get PID if
- They are infected with an STI that goes untreated
- Have more than one sex partner
- Have had PID before
Diagnosis and treatment
Pelvic inflammatory disease can be diagnosed by your doctor after they take a full medical history and carry out physical examination. Treatment of PID is usually a course of antibiotics. However, antibiotics will not be able to cure any damage that may have been done to the reproductive system as a result of the infection itself. That is why it is important to see your doctor immediately if these symptoms occur.
Ovarian cysts
Ovarian cysts are fluid-filled sacs that are found in an ovary or on its surface. Most ovarian cysts are harmless and will disappear on their own. In a few cases, cysts may become extremely large in size (and start to cause symptoms), they may rupture or develop worrying signs that need to be investigated.
Symptoms of a cyst
- Pelvic pain that is dull or sharp
- A sensation of fullness or heaviness in the abdomen
- Bloating
- Difficulty passing urine or frequent need to urinate
- Difficulty emptying the bowels
- Feeling of fullness after only eating a small amount
- Pain during intercourse
- Bleeding in between periods
Types of ovarian cyst and scenarios that may occur
The following are different types of ovarian cysts that may occur or scenarios that may be experienced
Functional cysts
The ovaries normally grow cyst-like structures called follicles each month. These follicles produce estrogen and progesterone and are related to the menstrual cycle. Functional cysts are non-cancerous (benign) and are usually harmless. Functional cysts may be follicluar cysts or luteal cysts. They can sometimes cause symptoms of pelvic pain. Most will disappear in a few months without needing any treatment.
Pathological cysts
Pathological cysts are cysts that are abnormal. They are not related to the menstrual cycle, are caused by abnormal cell growth and always require further investigation by a doctor. Pathological cysts include: dermoid cysts, cystadenomas and endometriomas. Pathological cysts share many of the same symptoms as functional (harmless) cysts. That is why it is important to see a doctor if the symptoms mentioned above are experienced. Formal diagnostic testing is the only way to determine whether a cyst is harmless or not.
Ruptured ovarian cyst
Although rare, a ruptured ovarian cyst is a medical emergency. A ruptured cyst can cause sudden, intense abdominal pain and internal bleeding. Any sudden and severe pain of the abdomen or pelvis requires urgent medical attention.
Diagnosis
Your doctor may be able to detect the presence of a cyst on routine pelvic examination. An ultrasound scan may be required to formally determine the type of cyst that has been found.
Treatment
Treatment of a cyst will depend on its size, appearance, the presence of symptoms and the type of cyst that has been found.
Because the majority of cysts disappear after a few weeks or months, your doctor may take what is called a watch-and-wait approach to see how the cyst behaves. To do this, they will recommend a repeat ultrasound test in a few weeks or months to check your condition.
A cyst that is not going away on its own or that is causing aggressive symptoms may be treated with birth control pills or a laparoscopy (surgical removal of the cyst).
If more worrying features of the cyst are found then more detailed treatment options will be discussed.