The pelvic floor muscles are located between the legs and run from the pubic bone (at the front), right through to the base of the spine (at the back). They are shaped like a sling of muscles and nerve endings, and their job is to hold the pelvic organs (uterus, vagina, rectum, bowel and bladder) in place.

What Does Pelvic Pain Feel like?

Pelvic pain is much more common in women than men and can be caused by a wide variety of health conditions or diseases. It is felt in the lowest part of the abdomen and pelvis, below the belly button.

A woman may briefly experience a dull or sharp pain, which comes on suddenly and is severe (acute pelvic pain), or as a constant or intermittent pain which lasts for six months or longer (chronic pelvic pain).

Pelvic pain can also vary in its severity. In fact, sometimes it is so intense that it feels like a hot poker is inside the vagina. In any scenario, the pain may also transfer to the lower back, buttocks or thighs.

Pelvic Pain Causes

There are many causes of pelvic pain, some of which are much more serious than others. Gynaecologists have, in recent years, reported that chronic pelvic pain can arise from multiple conditions.

Acute Pelvic Pain

Acute pelvic pain is pain which manifests itself suddenly and for the first time. If you are experiencing this type of pelvic pain, it is important to seek immediate medical attention.

In women who are not pregnant, there are several common causes of acute pelvic pain, which includes:

  • Ovarian Cysts – which are fluid-filled sacs that develop on an ovary.
  • Pelvic Inflammatory Disease (PID) – which are bacterial infections 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) – an infection of the urinary system which causes a painful burning sensation when using the toilet, or the need for frequent urination.
  • Constipation – which causes pain in the abdomen and normally occurs because of dietary changes, some medications, or Irritable Bowel Syndrome (IBS).
  • Appendicitis – where the appendix swells up. This is normally very painful on the right-hand side of the lower abdomen.
  • Peritonitis – which is the inflammation of the peritoneum; the tissue which lines the inside of the abdomen. Symptoms are sharp, sudden pain in the abdomen which slowly gets worse. Immediate treatment is vital.

Other, less common causes of acute pelvic pain are:

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

Chronic Pelvic Pain

Pelvic pain which has lasted for six months or more is known as chronic and affects around 1 in 6 women. It can either come or go, or may be constant, and is normally more severe than normal pain experienced during a woman’s period.

If you are experiencing chronic pelvic pain, you should speak to your GP at the soonest opportunity.

There are several common causes of this type of pelvic pain, some of which are the same as acute pelvic pain:

  • Endometriosis
  • Pelvic Inflammatory Disease
  • Irritable Bowel Syndrome – which is a long-term condition affecting many people. Symptoms include bloating, abdominal (stomach) cramps, constipation and diarrhoea.

Other, less common causes of chronic pelvic pain include:

  • Recurrent ovarian cysts
  • Recurrent UTIs
  • Pain of the lower back
  • Fibroids – which are tumours growing in or around the womb. They are typically non-cancerous, but in a few cases, can cause pain, particularly where they have become twisted.
  • Womb prolapse – which is where the womb has slipped down into a different position, causing a ‘dragging’ feeling.
  • Adenomyosis – which is endometriosis that is affecting the womb muscles and causing heavy, painful periods.
  • Chronic Interstitial Cystitis – which is a long-term condition where the bladder is inflamed.
  • Inflammatory bowel disease – which includes two chronic conditions; Crohn’s disease and Ulcerative Colitis.
  • A hernia – which means an internal body part has pushed through into the muscle or tissue wall surrounding it

When to see a doctor

In most cases, pelvic pain is caused by benign conditions which are non-cancerous, but that is not to say that pelvic pain which is not cancer-related cannot still be very serious. For instance, some situations causing sudden, severe pelvic pain, like ectopic pregnancy or appendicitis, need to be dealt with as a matter of urgency, as they can be life-threatening.

In other instances, such as where severe pelvic pain suddenly develops, where you do not know what the underlying cause of the abdominal pain is, or where the pain keeps coming back, you should also seek medical attention as soon as possible, as it can be a sign of something very serious.

In certain cases, your GP might refer you to a specialist gynaecologist, particularly if the cause of the pelvic pain is not immediately clear.

To help your GP come to an accurate diagnosis, it is a good idea to keep a record of where your pain occurs, how severe it is and what you were doing when it took place. You can also write down what helped relieve the pain, such as paracetamol or a hot compress. Creating pain diaries are particularly useful for those who experience chronic pelvic pain.

Investigation and clinical diagnosis

When seeking medical attention for pelvic pain, your GP will ask several questions, such as medical and family history, and you will also undergo a medical examination. Based on what is found, you may be treated, or you may have to undergo further tests or be referred to a specialist.

Because one of the most common causes of pelvic pain is a urinary infection, your GP will normally ask for a urine sample. You may also be screened for various common sexually transmitted infections, including Chlamydia and Gonorrhoea. Blood tests may also be necessary to diagnose certain causes.

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

If there is a chance you might be pregnant, a pregnancy test might be undertaken. Where the patient is pregnant, an emergency ultrasound may be necessary to determine if a miscarriage or ectopic pregnancy is the cause of pelvic pain. In such cases, you will likely be referred to a local hospital which has such scanning devices. Routine ultrasound scans can also be used to help diagnose other common causes of pelvic pain, such as ovarian cysts.

In some cases, further investigations may be required and patients may be referred to specialist gynaecologists for a diagnostic laparoscopy (keyhole surgery). This is undertaken when pain is persistent, severe and an underlying cause cannot be found be normal medical investigative means.

A laparoscopy involves making small incisions in the abdomen and then passing through a small telescope to be able to see inside the body.

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