Gynaecology Pelvic Pain

Pelvic pain is pain that occurs in the lower abdomen and pelvis. The pelvic region is the area between the umbilicus (belly button) and the groin in the front and between the buttocks at the back. Within the pelvic area lie the (female) reproductive organs, urinary and digestive systems. Pelvic pain can be acute or chronic. Acute pelvic pain occurs suddenly and stays only for a short period of time. Chronic pelvic pain lasts for more than six months and does not show any improvement with or without treatment. Pelvic pain of a gynaecological origin will usually be cyclical and/or be associated with pain during sex.

Symptoms

Gynaecological pelvic pain may be dull or sharp; persistent or intermittent; mild to severe, and can extend to your lower back or thighs. The common symptoms with pelvic pain are:

  • Pain in the hip and groin area
  • Pain and cramps during menstruation
  • Pain during urination, bowel movements
  • Fever or chills
  • Pain with Sex (dyspareunia)

Causes

Usually pelvic pain is considered as an indication for infection or problem in the pelvic area. The common causes of acute pelvic pain of gynaecological origin (in the absence of pregnancy) are:

  • Pelvic inflammatory disease (infection of the reproductive organs)
  • Urinary tract infection
  • Endometriosis
  • Ovarian cyst accident

The common causes of chronic pelvic pain are:

  • Chronic pelvic inflammatory disease
  • Endometriosis
  • Adhesions
  • Ovarian cyst
  • Uterine fibroids
  • Psychological factors such as stress, depression or a history of physical abuse

Assessment

A thorough history should be taken when assessing pelvic pain, as this will often point to a likely diagnosis. A pelvic scan should be undertaken as this can confirm or refute potential causes of pain. For chronic pain a laparoscopy is often a useful investigation as it can definitely confirm or refute some causes such as endometriosis/adhesions and if present can be treated at the same time.

Treatment

  • Treatment for pelvic pain depends on the cause of pain, intensity and frequency of the pain. Conservative management of pelvic pain includes rest and participating in regular physical therapy and exercise. Medication can be used to relieve pain (pain killers), muscle spasm/ contraction (muscle relaxants) and to treat infection (antibiotics). I may also advise you to take hormonal medications for pain relief during ovulation and menstruation.
  • Laparoscopic surgery can be a useful means of treating some causes of pelvic pain. Uncommonly a hysterectomy may be the appropriate surgical intervention for those woman whose pain is very debilitating and they no longer wish to have children.