Pelvic pain can have many different causes. For example, pain can be caused by a gynecologic condition such as endometriosis, uterine fibroids, ovarian cysts and pelvic adhesions. It also can be the result of an intestinal, urinary or muscular problem. Pelvic pain can even be a manifestation of stress or depression.
Common reasons for pelvic pain include:
Pelvic Adhesions: Adhesions are bands of scar tissue that bind organs together. They are created by previous infections such as appendicitis or pelvic inflammatory disease, by pelvic or abdominal surgery or by endometriosis. Symptoms from adhesions include generalized pelvic discomfort or localized pain. Adhesions can be difficult to diagnose, however in some cases, the uterus and ovaries feel bound together on pelvic examination. A definitive diagnosis of adhesions is usually made during surgical exploration, frequently via laparoscopy. Surgery to cut bands of scar tissue can relieve pain. However, sometimes the adhesions re-form.
Uterine Fibroids: Fibroids are non-cancerous (benign) growths that develop within the uterus. Most women with fibroids have no symptoms and don't need treatment. When symptoms occur, women should seek medical attention.
Ovarian Cysts: Cysts are closed sacs that contain fluid, semifluid or solic material.
Irritable Bowel Syndrome: This is a very common cause of pelvic pain. It may be associated with diarrhea, constipation or a combination of both. Symptoms of bloating and discomfort may be relieved by a bowel movement. Stress and diet can aggravate the condition. The gynecology provider may make a referral to a gastrointestinal specialist for diagnosis and treatment.
Bladder Problems: Pelvic pain may be triggered by a bladder condition. Pain associated with the need to urinate frequently or urgently may need to be evaluated by a urologist.
Myofacial Trigger Points: Chronic pain can be created by spasm of the muscles that line the pelvis. On pelvic examination, there may be tenderness and tightness in particular muscles. Experts in anesthesiology and pain management specialize in relieving this type of pain.
Depression: Recurring or chronic pain can cause some women to feel depressed. These feelings are normal. In some cases, pelvic pain can be a symptom of depression or anxiety. Help is available from your health care provider and from mental health professionals.
Endometriosis: This is a condition in which the lining of the uterus (endometrium) grows outside the uterus. The lining can attach to the ovaries, fallopian tubes, intestines or other structures in the pelvis. It may cause pelvic pain, especially during menstruation. Hormones of the menstrual cycle cause the endometriosis to bleed each month. This can be painful and result in the formation of pelvic adhesions, also known as scar tissue. Blood trapped in the ovary can build up into a cyst. This is called an endometrioma.
Diagnosis
Endometriosis often can be suspected on the basis of a medical history and physical exam. Ultrasound examination can suggest endometriosis if an endometrioma is present. A definitive diagnosis of endometriosis requires surgical exploration, usually via laparoscopy.
Treatment
There are several different treatments available. Birth control pills or other types of hormones can slow the growth of endometriosis. Medications can be given for pain relief. Surgery may be performed to confirm the diagnosis of endometriosis and to remove it. Unfortunately, symptoms can come back despite good treatment.
Some women with endometriosis have trouble becoming pregnant. Infertility specialists can often help women with this problem.
