Pelvic pain diagnosis and treatment

What is the pelvis?

The pelvis is the bony framework forming the base of the spine and connecting it to the legs. This structure provides support and stability to the body. Additionally, the term "pelvis" can refer to the cavity within this bony framework, which houses several organs and forms the lower part of the torso.

Causes of pelvic pain in women

In women, pelvic pain is often linked to reproductive health conditions, pregnancy-related complications, or other factors. Some common causes include:

• Menstrual discomfort: Known medically as dysmenorrhoea, menstrual pain can range from mild to severe. For some women, this pain significantly disrupts daily activities.
• Ovarian cysts: They are fluid-filled sacs that develop on the ovaries of the fallopian tubes. While many cysts are small and asymptomatic, larger ones can cause pain, especially if they rupture or twist.
• Fibroids: Also referred to as uterine leiomyomas, fibroids are non-cancerous growths of muscle tissue in the uterus. Larger fibroids or those undergoing degeneration may lead to pelvic discomfort, heavy bleeding, or a swollen abdomen.
• Pelvic inflammatory disease (PID): PID involves inflammation of the reproductive organs, often due to sexually transmitted infections like gonorrhoea or chlamydia. Symptoms can include unusual vaginal discharge, fever, and pelvic pain.
• Endometriosis: This condition occurs when tissue similar to the uterine lining grows outside the uterus, causing pelvic pain, heavy menstruation, and pain during intercourse. A related condition, adenomyosis, involves uterine lining tissue embedding within the uterine muscle.
• Ovulation pain: Known as Mittelschmerz, this mid-cycle discomfort occurs when the ovary releases an egg.
• Pelvic congestion syndrome: It is caused by blood pooling in the pelvic veins, which can lead to chronic pain.
• Vulvar pain: This may include burning or stinging sensations and discomfort during sexual activity.
• Cancers: Though less common, cancers of the reproductive organs, such as cervical, uterine, or ovarian cancer, may cause pelvic pain.

Pelvic pain during pregnancy

Pregnancy introduces unique factors that may result in pelvic discomfort. Common pregnancy-related causes include:

• Ectopic pregnancy: This life-threatening condition arises when a fertilised egg implants outside the uterus, often in a fallopian tube. Symptoms include sharp pelvic pain and vaginal bleeding.
• Miscarriage: A pregnancy loss before 20 weeks can result in pelvic pain and bleeding.
• Preterm labour: Labour that begins before 37 weeks of gestation can cause cramping, backache, and pelvic pressure.
• Placental abruption: This severe condition involves the placenta detaching from the uterine wall, leading to pain and potential bleeding.

Causes of Pelvic Pain in Men

The causes of Pelvic Pain in Men are due to several conditions, including:

• Chronic prostatitis: Often referred to as chronic pelvic pain syndrome (CPPS), this poorly understood condition results in persistent pelvic discomfort.
• Acute prostatitis: Prostate inflammation, typically caused by bacterial infection, can lead to significant pelvic pain and other symptoms such as fever or urinary issues.

Similar causes of pelvic pain in men and women

Both men and women may experience pelvic pain due to factors unrelated to reproductive health, such as:

• Appendicitis: Inflammation of the appendix causes severe, acute pain, often accompanied by nausea or vomiting.
• Kidney issues: Stones or infections in the kidneys can result in pelvic pain alongside fever and blood in the urine.
• Urinary tract infections (UTIs): UTIs are a common cause of pelvic pain, sometimes accompanied by backache, cloudy urine, or fever.
• Interstitial cystitis: A chronic bladder condition causing pain without signs of infection.
• Intestinal problems: Conditions such as bowel obstruction, diverticulitis, or abscesses can lead to pelvic discomfort.
• Inflammatory bowel disease (IBD): Chronic digestive disorders like Crohn's disease or ulcerative colitis may result in recurrent pelvic pain.
• Hernias: The protrusion of abdominal tissue through weakened muscles can lead to severe pain, particularly if circulation is compromised.
• Irritable bowel syndrome (IBS): This digestive disorder is characterised by bloating, pain, and changes in bowel habits.
• Pelvic fractures: A break in the pelvic bones can cause significant and persistent pain.
• Sexually transmitted infections (STIs): Infections such as chlamydia or gonorrhoea may cause pelvic discomfort, often accompanied by discharge or painful urination.
• Post-surgical adhesions: Scar tissue formed after abdominal or pelvic surgery can result in chronic pain.
• Pelvic muscle spasms: Conditions like levator ani syndrome are caused by pelvic floor muscle spasms, leading to long-term discomfort.
• Anal fissures: Tears in the lining of the anal canal can produce sharp pain during bowel movements.

What are the symptoms of pelvic pain?

Pelvic pain may occur alongside other symptoms, depending on the underlying cause. These can include:

• Abdominal tenderness, bloating, or cramping
• Fever, chills, or flu-like symptoms
• Nausea and vomiting
• Diarrhoea or constipation
• Pain during or following sexual activity
• Vaginal discharge or abnormal bleeding
• Blood in the urine or stool
• Cloudy or foul-smelling urine
• Lower back pain

When should you seek medical attention?

If you experience sudden or unexplained pelvic pain, it is advisable to consult a healthcare professional, especially if it is accompanied by severe symptoms such as fever, abnormal vaginal bleeding or occurs during pregnancy. Immediate attention is essential for conditions like appendicitis or ectopic pregnancy, which may be life-threatening.

How is pelvic pain diagnosed?

Diagnosing pelvic pain involves thoroughly evaluating the patient's medical history and symptoms. A physical examination is typically conducted, and laboratory tests may be performed. Depending on the suspected cause, diagnostic tools might include:

• Transvaginal ultrasound to evaluate female reproductive organs
• Imaging studies such as MRI, CT scans, or abdominal ultrasounds
• Colonoscopy or laparoscopy to investigate gastrointestinal issues
• Pelvic X-rays
• Testing discharge samples for signs of infection

Treatment options for pelvic pain

The approach to treating pelvic pain depends on its cause. For infections, antibiotics may be prescribed. Treatment may involve surgical interventions, pain management, or lifestyle modifications in other cases. For instance, fibroids or ectopic pregnancies may require surgery, while chronic conditions like endometriosis might need long-term hormonal treatments or pain relief strategies.

What is the prognosis for pelvic pain?

The outlook for individuals with pelvic pain varies based on the underlying condition. Acute issues such as UTIs often respond well to treatment and resolve quickly. However, severe conditions like inflammatory bowel disease or endometriosis may require ongoing management. For cancers, outcomes depend on the type and stage at which they are detected.

Can pelvic pain be prevented?

Prevention strategies depend on the specific cause of the pain. For example, practising safe sex can reduce the risk of sexually transmitted infections, while staying hydrated may help prevent kidney stones. Maintaining a healthy lifestyle, including a balanced diet and regular exercise, can lower the risk of chronic pelvic pain-related conditions.

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