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Pelvic Pain: Causes, Symptoms & Treatment

Although the cause and severity can vary, pelvic pain is common among women of all ages. Typically categorized as either acute or chronic, pelvic pain can be the result of infection, inflammation, or due to an issue with the reproductive, digestive, or urinary systems.

To understand more about the causes, symptoms, and treatment options for pelvic pain in women, keep reading. 

Pelvic Pain: Acute or Chronic?

Pelvic pain is typically felt below the navel and between the hips. Acute pelvic pain is described as a sharp or intense pain that starts suddenly and typically subsides within minutes, days, weeks, or as soon as the underlying cause has healed or been treated. 

Chronic pelvic pain is diagnosed when it lasts for six months or longer, either as a constant pain or one that comes and goes. The source of chronic pelvic pain can be difficult to identify, there is often only brief relief from pain medication, surgery is sometimes required, and long-term management is often required as treatment.   

Common Causes of Acute Pelvic Pain in Women

Acute, or sudden pelvic pain that disappears with healing or treatment is often caused by one of the following: 

  • Appendicitis
  • An ectopic pregnancy
  • Pelvic inflammatory disease (PID)
  • A miscarriage
  • A ruptured ovarian cyst
  • A ruptured fallopian tube
  • A urinary tract infection
  • Sexually transmitted infection
  • Vaginal infection
  • Uterine Fibroids

Causes of Chronic Pelvic Pain in Women

Due to the intricacy of the pelvic area, and the various organs and systems that operate within it, pelvic pain can be hard to diagnose. Sometimes it’s caused by one condition but it can also stem from a combination of conditions.   

The most common causes of chronic pelvic pain in women include the following:

Endometriosis 

A condition where tissue similar to the lining of the uterus (endometrium) is found growing on organs outside the uterus. In addition to chronic pelvic pain, endometriosis can also lead to problems getting pregnant and infertility.  

Uterine fibroids 

Fibroids are non-cancerous growths in the womb that can range from the size of a pea to a melon. Although many women aged 30-50 may have small fibroids with no obvious pain, large fibroids can cause pelvic pain, heavy menstrual bleeding, and more intense menstrual cramps.  

Chronic pelvic inflammatory disease (PID) 

When a bacterial vaginal infection or sexually transmitted infection (STI) is left untreated long-term, the bacteria can spread into the cervix and infect the fallopian tubes, ovaries, or womb, causing PID. Although PID can be treated with antibiotics if caught early, the scar tissue that develops around pelvic organs without treatment can cause chronic pelvic pain and infertility. 

Low Estrogen Levels During Menopause

As women’s reproductive system begins to change in perimenopause, estrogen levels start to drop, the vaginal pH of the vagina changes, natural lubrication is reduced, and vaginal dryness can set in. Collectively, these symptoms can result in vaginal infections, pain during sex (dyspareunia), and chronic pelvic pain. 

Estrogen also keeps the pelvic floor muscles strong and flexible throughout the reproductive years of a woman’s life. When levels drop during perimenopause, the pelvic floor muscles can weaken, leading to the possibility of vaginal prolapse and pelvic pain.  

Interstitial Cystitis 

A form of painful bladder syndrome, the pelvic pain associated with this condition stems from an inflamed or irritated bladder wall. The urge to urinate becomes more frequent with interstitial cystitis, and pain often intensifies each time the bladder fills. Although the pain subsides somewhat when the bladder is emptied, it returns each time the bladder fills again. 

The cause of interstitial cystitis is unknown; however, pelvic exams have revealed that many women diagnosed with interstitial cystitis also have fibromyalgia or irritable bowel syndrome.

Irritable Bowel Syndrome (IBS)

The common symptoms of IBS such as bloating, constipation, and diarrhea can often cause chronic pelvic pain. 

Underlying Health Issues 

Conditions like arthritis, fibromyalgia, and gout which can affect the bones, muscles, ligaments, and joints can result in chronic pelvic pain in women. In these cases, the pain can be caused by tight pelvic floor muscles or swelling of the pubic and pelvic joints. 

Pelvic Floor Muscle Dysfunction 

PFMD can drive pelvic pain. Poor coordination, tension, muscle gripping and guarding, falls, surgery, injury to the hip, spine, or pelvis, and the above-mentioned diagnosis can all lead to PFMD. 

This form of chronic pelvic pain is also caused by muscle memory reactions to previous pelvic trauma - like an injury, difficult childbirth, painful intercourse, or sexual abuse. When this type of traumatic pain occurs in the pelvic or vaginal area, the mind remembers the sensation and sends messages to the pelvic muscles to tighten to prevent any further pain.

Psychological pelvic pain is often debilitating for new mothers after giving birth, victims of sexual abuse or rough sex as teenagers, and women experiencing vaginal dryness during menopause.

Cancer

Cancer can manifest in several parts of the pelvic area including the cervix, endometrium, ovaries, and uterus. Each is known to cause chronic pelvic pain, heavy menstrual bleeding, and an unusual vaginal discharge. 

Symptoms of Chronic Pelvic Pain

Although the location of pelvic pain is often designated to the area below the navel and between the hips, women can feel pelvic pain in various parts of the pelvis when it comes to Chronic pain. This form of pain can also feel different for each person. For example, it can feel like a constant dull ache, sharp, or cramping, it can feel mild and come and go, or it can feel like persistent pressure within the pelvis.   

An apparent symptom of chronic pelvic pain is that it typically worsens during sex. It can also become more severe after sitting or standing for too long and is also known to intensify while urinating or moving the bowels. 

Additional symptoms include a frequent urge to pee, abdominal bloating, constipation, diarrhea, and stomach upset or nausea.  

Traditional Treatments for Chronic Pelvic Pain

The first step in treating chronic pelvic pain is to receive a correct diagnosis as to the cause of it. This is typically done by scheduling an appointment with your healthcare provider who will ask questions regarding the type of pain, how often it occurs, and for how long. They may also ask about your medical history, and schedule some blood tests and a pelvic exam to learn more. 

Depending on their findings, antibiotics, hormone therapy, or pain medication may be prescribed to treat the condition. Alternatively, an ultrasound, MRI, or laparoscopy could be suggested for further investigation, and surgery might be scheduled to remove fibroids, twisted ovarian cysts, or endometrial growths that are determined to be the cause of the pain. 

There are also effective natural remedies are recommended as accompanying treatments.  

Natural Remedies for Pelvic Pain

Because chronic pelvic pain often requires long-term pain management, a combination of traditional and natural treatments is often advised. 

Physical Therapy & Diet

Pelvic physical therapy, for example, is highly recommended for massaging deep pelvic trigger points, softening pelvic scar tissue, and relaxing tense pelvic floor muscles associated with chronic pelvic pain. Specific diets that eliminate trigger foods for women with endometriosis, interstitial cystitis, and IBS are also beneficial. 

Pelvic Wands

Ergonomically designed pelvic massage wands are recommended for home use to massage tender trigger points within the pelvic region and relax tight pelvic floor muscles associated with chronic pelvic pain. Pelvic wand massage is especially helpful in relieving the clenching that can occur in the pelvic floor muscles due to interstitial cystitis and endometriosis.

Vaginal Dilator Therapy

Vaginal dilator therapy, which is also practiced at home, is effective in managing pain with intercourse, tampon use, or medical examination. They are helpful in preventing the formation of scar tissue that can cause pelvic pain after surgery for pelvic injuries, cancer, or removing uterine fibroids.

Involving the slow and gentle stretching of vaginal tissues and pelvic floor muscles, dilator therapy is also helpful in reducing scar tissue that forms from radiation treatment, PID, and endometriosis. 

Yoga, Relaxation & Acupuncture

Many women practice yoga regularly to reduce pelvic pain by gently stretching the pelvic muscles and reducing the stress of ongoing pain with breathing exercises. Acupuncture is also considered an effective natural therapy for managing ongoing pain. 

Natural Treatments for Pelvic Pain in Menopause

Vaginal dilation therapy is particularly useful for women in perimenopause or menopause to relieve the symptoms of chronic pelvic pain due to low estrogen levels. By patiently moving through a set of vaginal dilators, vaginal dryness can be relieved, natural lubrication is improved, pain during sex is alleviated, and narrowing vaginal canals can be slowly widened. 

While hormone replacement therapy is the first line of treatment for low estrogen levels during this time of life, natural remedies like Chasteberry supplements can be just as effective without any of the side effects. 

Conclusion

Pelvic pain in women can be temporary or long-term depending on the underlying cause. While acute pelvic pain is usually easily treated or disappears on its own, chronic pelvic pain requires a more comprehensive approach to diagnose and treat. For best results in managing chronic pelvic pain, a combination of traditional medicine and natural therapies is often recommended.  

References 

Johns Hopkins Medicine – Pelvic Pain - https://www.hopkinsmedicine.org/health/conditions-and-diseases/pelvic-pain

U.S. Department of Health & Human Services – How is Pelvic Pain Diagnosed? https://www.nichd.nih.gov/health/topics/pelvicpain/conditioninfo/diagnosed

Medline Plus – Premenstrual Pain - https://medlineplus.gov/premenstrualsyndrome.html

Endometriosis Foundation of America – Endometriosis: Defining It, Recognizing It, and Treating It - 

https://www.endofound.org/endometriosis

Cleveland Clinic – Uterine Fibroids - https://my.clevelandclinic.org/health/diseases/9130-uterine-fibroids

The Pelvic Hub – Dyspareunia - https://www.thepelvichub.com/pelvic-health/dyspareunia-symptoms-treatment

Bladder & Bowel Community - After Menopause, Vulvovaginal Troubles Are Common And Linked With Other Pelvic Problems - https://www.bladderandbowel.org/news/after-menopause-vulvovaginal-troubles-are-common-and-linked-with-other-pelvic-problems/