Pelvic pain

There are many causes of pelvic pain, some of which can be serious. The causes of acute and chronic pelvic pain are different:

Acute pelvic pain

Acute pelvic pain is a pain which displays itself suddenly and for the first time, and lasts a short time. With this kind of pain, immediate medical attention may be required.

In non-pregnant women, causes of acute pain may include:

• Ovarian cysts: these are are fluid-filled sacs that develop on an ovary.
• Pelvic Inflammatory Disease (PID): this is a bacterial infection in the womb, often occurring as a result of a sexually transmitted infection, particularly chlamydia or gonorrhoea. PID requires immediate treatment via antibiotics, as leaving it untreated can lead to infertility.
• Urinary Tract Infection (UTI): this is an infection of the urinary system which causes a painful burning sensation when using the toilet, or the need for frequent urination.
• Constipation: this causes pain in the abdomen and normally occurs because of dietary changes, some medications, or Irritable Bowel Syndrome (IBS).
• Appendicitis: this is when the appendix swells up. This is normally very painful on the right-hand side of the lower abdomen.
• Peritonitis: this is the inflammation of the peritoneum, the tissue which lines the inside of the abdomen. Symptoms are a sharp, sudden pain in the abdomen which slowly gets worse. Immediate treatment is vital.

Some people may develop acute pain at the same time as chronic pelvic pain. This may be caused by:

• Pelvic abscesses: these are caused by a collection of pus between the vagina and womb. This requires urgent medical treatment in A&E.
• Endometriosis: this is a chronic, long-term condition where the tissue which lines the womb grows outside the uterus and causes frequent pain, particularly during menstruation.

Chronic pelvic pain

Chronic pelvic pain lasts for six months or more, and can affect one in six women. It can be constant or intermittent. The pain may be related to the menstrual cycle or bladder or bowel function.

There are several causes of chronic pelvic pain, some of which are the same as those of acute pelvic pain:

• Endometriosis
• Chronic Pelvic Inflammatory Disease
• Irritable Bowel Syndrome: a long-term condition affecting many people. Symptoms include bloating, abdominal (stomach) cramps, constipation and diarrhoea.
• Recurrent ovarian cysts
• Recurrent UTIs
• Lower spinal pain
• Fibroids: tumours growing in or around the womb. They are typically non-cancerous, but in a few cases, can cause pain.
• Prolapse: this is where the womb has slipped down into a different position, causing a ‘dragging’ feeling rather than sharp pain.
• Adenomyosis: this is endometriosis that affects the womb muscles and causes heavy, painful periods.
• Chronic Interstitial Cystitis, a long-term condition where the bladder is inflamed.
• Inflammatory bowel disease: this includes two chronic conditions, Crohn’s disease and Ulcerative Colitis.
• Hernia: this is an internal body part that has pushed through into the muscle or tissue wall surrounding it.

Some causes of pain, especially if acute and not related to any obvious cause, can be serious and life threatening, and therefore medical advice will be needed.

In the case of chronic pain, your GP may refer you to a specialist. To help with diagnosis, it would be a good idea to keep a diary of the pain, its location, severity and its relation to other factors which may influence the pain.

Your doctor will probably want to undertake a pelvic examination too, which might include a cervical screening test, allowing them to check for possible abnormalities of the cervix, vagina, uterus and ovaries.

• Urine sample test: as one of the common causes of pain may be related to urinary tract infection, a urine sample is taken to check for this. GPs normally perform a urine dipstick test, and if infection is suspected, the sample is sent to a laboratory for a further test of ‘culture and sensitivity’.
• Swab test: if a sexually transmitted infection is suspected, the GP may send swab samples to check for common infections such as chlamydia and gonorrhoea.
• Blood test: this may be helpful to check for raised inflammation markers and white blood cells, which may reveal an inflammatory cause of the pain.
• Pregnancy test: it is important to confirm if the pain is related to pregnancy; if this is confirmed, an urgent ultrasound will be advised to determine if the pain is caused by an ectopic pregnancy or a miscarriage.
• Pelvic ultrasound: as well as checking for any pregnancy-related causes, a pelvic ultrasound can be helpful in ruling out other common causes of pelvic pain conditions such as ovarian cysts or fibroids.

After an initial assessment, a gynaecology specialist may need to perform some of the above investigations if they have not already been carried out, or if a repeat test is deemed appropriate. This will help to identify the cause of the pelvic pain and arrive at a diagnosis.

In some cases, a keyhole test such as a diagnostic laparoscopy may be advised to aid with diagnosis. This is undertaken when pain is persistent, severe and an underlying cause cannot be found through normal medical investigations. A laparoscopy involves making small incisions in the abdomen and then using a small telescope to see inside the body.