Pelvic pain can have many causes, most of which now have successful treatment options so you no longer need to live in pain.
The most common reasons for pelvic pain in women are:
- Menstrual cramps
- Ovarian cysts
- Endometriosis, Adenomyosis
- Urinary tract infection (UTI), interstitial cystitis, kidney stones
- Pelvic infections (PID), sexually transmitted diseases (STDs)
- Uterine fibroids
- Ectopic pregnancy
- Appendicitis, irritable bowel syndrome (IBS), diverticulosis
Causes of Pelvic Pain Related to Your Menstrual Cycle
As your hormone levels increase, trigger ovulation and create the endometrium that you bleed with your period, inflammatory compounds are also formed which cause pain. This process can result in painful menstrual cramps or pain from an ovarian cyst. A cyst forms on the ovary and ruptures with ovulation releasing the egg. Most of the time women are not aware of ovulation. However, pain can occur when the cyst becomes either too large or when it ruptures.
Treatments for Menstrual Cramps and Ovarian Cysts
There are treatments which will relieve both menstrual cramps and the pain from ovarian cysts. These treatments consist of:
- NSAIDs – Non-Steroidal Anti-Inflammatory Drugs such as aspirin, ibuprofen and Aleve (naproxen sodium) prevent the formation of inflammatory compounds and thereby decrease pain and cramping with your period or from an ovarian cyst. They can also decrease bleeding. It is important to start taking these medicines as soon as you feel the bleeding and cramping are about to begin.
- Hormonal birth control methods – These suppress the higher and more variable hormone levels of a normal menstrual cycle and replace them with a much lower and steadier level. By doing this, less endometrium is made decreasing bleeding and cramping and ovulation is suppressed preventing ovarian cysts. With continuous use of hormonal birth control menstrual cycles are prevented, thereby eliminating the episodes of bleeding, pain and ovarian cysts.
- Hormonal IUD – The Liletta or Mirena IUD can lessen periods and eventually prevent them, thereby decreasing the episodes of pain, however this may not suppress the formation of ovarian cysts.
Causes of Pelvic Pain Related to Endometriosis and Adenomyosis
Endometriosis is when the endometrium (the lining of the uterus) gets outside of the uterus and spreads into the pelvis. The increases in hormones with the menstrual cycle stimulate endometriosis causing inflammation and pain.
Adenomyosis is when the endometrium burrows into the muscle layers of the uterus. It is also stimulated by increases in hormones with the menstrual cycle, causing the uterus to become inflamed and painful.
Treatments for Endometriosis and Adenomyosis
As discussed above, NSAIDs, hormonal birth control methods and the Mirena IUD can relieve pelvic pain. The mechanisms are the same for treating endometriosis and adenomyosis even though the endometruim is not in the uterine lining, hormone levels and inflammation are suppressed relieving pain.
If medications are not appropriate or successful for relieving pain related to endometriosis and adenomyosis, there are surgical options including laparoscopy and hysterectomy.
Laparoscopy To Treat Endometriosis
In Laparoscopy small incisions are made in the abdomen through which instruments are inserted into the pelvis. One of these instruments is a pencil-like operating telescope called a laparoscope, which allows the surgeon to visualize the inside of the abdomen. Endometriosis can often be visualized on the uterus, ovaries, fallopian tubes, bowel or inside lining of the abdomen. One of the instruments uses heat to destroy the endometriosis. In addition, laparoscopy can be used to treat pelvic inflammatory disease and ectopic pregnancies.
Causes of Pelvic Pain Related to Pelvic infections (PID), Sexually transmitted diseases (STDs)
Pelvic Inflammatory Disease (PID) is when an infection occurs in a woman’s reproductive organs. This can be the result of excessive bacterial growth from the vagina and cervix spreading into the uterus, fallopian tubes and pelvis. An example of an infection caused from bacteria that can normally be found in the vaginal or bowel flora in a woman is Toxic Shock Syndrome (TSS). Excessive tampon use or the contraceptive sponge have been linked to toxic shock syndrome because the bacteria are kept in the vagina for longer periods of time. This causes them to become more concentrated and allows them to spread up into the uterus. PID can also be caused by the sexually transmitted diseases chlamydia and gonorrhea. PID can lead to acute pelvic pain and cause chronic pelvic pain by forming scar tissue in the pelvis.
Treatments for Pelvic Inflammatory Disease (PID)
The initial treatment for Pelvic Inflammatory disease is antibiotics and pain medications. If not treated soon enough with oral antibiotics and pain medications, women can become so severely ill, they require hospitalization with intravenous antibiotics and possibly surgery. Laparoscopy can be used to treat Pelvic Inflammatory Disease by removing infected tissue in acute PID and the scar tissue that forms in chronic PID. In rare cases untreated PID can be fatal, therefore prevention is extremely important.
How to Prevent Pelvic Inflammatory Disease
- Use less absorbent tampons, change them more frequently and if possible alternate tampon use with sanitary pads. Do not use douches.
- Remove contraceptive sponges and diaphragms after the minimum time for contraceptive effectiveness per the manufacturer’s recommendations.
- Avoid multiple sexual partners and use condoms during sexual intercourse.
Causes of Pelvic Pain Related to Uterine Fibroids
We discuss causes and treatments of uterine fibroids under Treatments for Heavy Bleeding.
Causes and treatments of Pelvic Pain Related to Bladder/Kidney – Urinary tract infection (UTI), Interstitial Cystitis, Kidney Stones
Urinary tract infections (UTI’s) are when bacteria migrate into the bladder causing an infection with increased frequency and burning during urination. The best treatment for a UTI is increased water intake and antibiotics.
Interstitial Cystitis (IC) is when there is increased frequency and burning during urination when the lining of the bladder becomes inflamed, however, there is not a bacterial infection. The lining of the bladder can be inflamed by certain medications, supplements such as vitamin C and certain foods. All of these are very acidic causing the inflammation and symptoms. The best treatments are dietary changes, increased water intake and medications specifically for IC.
Kidney Stones are small salt and mineral stones that form in the kidney and pass out of the body in the urine. The most common symptom is severe pain in the lower back and abdomen. Other symptoms can be painful urination, blood or pus in the urine, nausea, vomiting or fever. Most stones pass on their own, but occasionally surgery is needed to remove them.
Ectopic pregnancy is when the fertilized egg attaches either in the pelvis or the fallopian tubes and begins to grow instead of continuing into the uterus. It occurs in about 2% of pregnancies and is a potentially life threatening condition.
Symptoms of ectopic pregnancy:
- Severe abdominal pain
- Vaginal Bleeding
Treatment of ectopic pregnancy can involve medication or surgery. In almost all cases the pregnancy cannot continue. If you suspect that you have an ectopic pregnancy, seek immediate medical care.
Appendicitis, Irritable Bowel Syndrome (IBS), Diverticulosis
Appendicitis, IBS and Diverticulosis are all conditions of the bowel which can cause pelvic pain. They can have some of the same symptoms as the OB/Gyn conditions listed above and are often diagnosed by a gynecologist. Treatments vary based on the condition.
A hernia is when the connective tissue in the abdominal wall separates allowing the abdominal contents to protrude and get trapped causing pain. Inguinal hernia is sometimes confused with gynecologic pelvic pain. The treatment for a hernia is surgery