The causes for pelvic pain in women are widespread, that can affect all structures, not just the reproductive organs. This can pose a medical challenge to doctors.
However a gynaecologist diagnoses and treats pelvic pain due to the reproductive organs. Pelvic pain is classed as pain below the belly button. When investigating pelvic pain in a woman, it is not always straightforward as there are so many structures in the female pelvis that can cause pain, so sometimes it takes various tests to ascertain exactly the cause and may require referral to a general surgeon or orthopaedic consultant. The cause might be lower back pain, or irritable bowel syndrome, ulcerative colitis or hernia.
Acute pelvic pain can have many characteristics depending on the cause, it might be sharp and stabbing or dull. It may be intermittent or constant and be mild in nature, moderate or severe. Pelvic pain may originate in the pelvis, it can radiate to the thighs, buttocks or lower back. It can also threaten life or the fertility of the patient.
This information is not intended to supply definitive treatment but to show the types of pelvic pain that Mr Penman diagnoses and treats.
Causes of Acute Pelvic Pain of Gynaecological Origin
If you have acute pelvic pain, you should visit your GP as a matter of urgency. If it is very serious and you have further symptoms such as vomiting and a temperature, it would be advisable to go straight to Accident and Emergency at your local hospital.
Ovarian Cyst – Ovarian cysts are not usually the cause of acute pelvic pain. However, an ovarian cyst could twist or burst causing sudden acute pelvic pain.
Pelvic Inflammatory Disease (PID) – Clamydia or Gonorrhoea are sexually transmitted diseases that can cause a bacterial infection of the uterus, fallopian tubes and ovaries. This can have a sudden onset of severe pelvic pain.
Urinary Tract Infection – Urinary tract infections or UTI’s can sometimes start with an acute onset and be very painful but usually will be accompanied by other symptoms such as urgency or burning/stinging during peeing. This is normally dealt with by your GP but sometimes can present as acute pelvic pain.
Pelvic Abscess – A pelvic abscess is very a unusual cause for pelvic pain. It will follow a bout of PID or appendicitis where the infection has become ‘walled off’. They can grow quite large before making the patient acutely ill. Urgent admission to hospital for medical treatment is required although in females it is quite a difficult diagnosis to reach and may well be found during an exploratory laparoscopy.
Endometriosis – This is bleeding within the pelvis due to endometriotic deposits. This can be an acute occurrence which is extremely painful but usually patients present with chronic pelvic pain. Read more on endometriosis.
Ectopic Pregnancy – This can be a life threatening cause of acute pelvic pain. The fetus starts growing in the fallopian tube causing localised pain. If you are in early pregnancy and have sudden lower pelvic pain, an ectopic pregnancy should be considered. Read more on ectopic pregnancy.
Causes of Chronic Pain of Gynaecological Origin
Chronic gynaecological pain is pain that you have suffered for more than 3 months. This may be intermittent, perhaps depending on your menstrual cycle. It is always helpful to Mr Penman if you can take note of where you are in your cycle and how severe your pain is. The type of pain can vary from woman to woman and whilst it may not be urgent, it requires diagnosis and treatment.
Recurrent UTI – Having a recurrent urinary tract infection is miserable for a woman. A deep dragging pain, with possible stinging and burning when peeing is no fun once, but having it recurring is even worse. Because the urethra is very short in a woman, its easy to get backtracking infection or for the infection initially not clearing. Usually the GP will deal with this cause for pelvic pain, prescribing antibiotics, but sometimes if it’s recurrent, he may refer you to a gynaecologist for more in-depth treatment.
Recurrent Ovarian Cyst – Women have a cyst every month where the egg develops – a functional cyst. At ovulation, it can leave behind what is called a corpus luteal cyst. If these are found on a scan, you may well be asked to return for a second scan in a different part of your cycle to ensure that the cyst has gone. Recurrent ovarian cysts are a nuisance as they cause recurring pain. Recurrent non- cyclical ovarian cysts will be removed if the symptoms become unmanageable.
Pelvic Inflammatory Disease – Generally if the acute phase of pelvic inflammatory disease is correctly treated at the initial infection, the pelvic pain will disappear and by following recommendations for the patient’s sexual health, it should not recur. However if the initial infection that causes PID is not treated or there is a delay in treating, the pain will become chronic and longterm and can lead onto fertility difficulties later.
Endometriosis – Endometriosis causes many symptoms that could quite reasonably be symptoms of other conditions, so usually a diagnosis is made through laparoscopy. It doesn’t necessarily have to be treated if it is not causing pain, it may well clear up by itself. Treatment is required if the symptoms are severe or fertility is in question.
Prolapse of the Womb – Moderate to severe prolapse will cause longterm dragging pain which needs medical intervention. The problem of a uterine prolapse doesn’t stop with the chronic pain, it also causes discharge, issues with sexual function, recurrent bladder infections. Surgery may well be recommended.
Adenomyosis – This conditions is where the lining of the uterus – the endometrium, moves into the muscle layer of the uterus causing menstrual pain, cramps and heavy periods. This condition can be diagnosed using ultrasound or MRI. It is sometimes misdiagnosed as uterine fibroids but a correct diagnosis allows the consultant to offer the best form of treatment, either to alleviate the symptoms or if family is complete, a more permanent solution.
Chronic Interstitial Cystitis – Chronic cystitis requires longterm antibiotics to treat the resistant infection. Pain and the symptoms of cystitis can be severe so management of the pain, whilst treating the infection can take several months.
Dysmenorrhoea – Period pain is miserable. It is shortlisting but occurs every month for some women, affecting their everyday life for several days a month. Various medications are available that Mr Penman can prescribe to alleviate both the pain and any heavy bleeding that may accompany the pain.
Adhesions – Adhesions are bands of scar tissue that may occur within the pelvis as a consequence of surgery or infection. The pain suffered varies from woman to woman. Usually the internal structures of the pelvis have slippery surfaces that slide over each other as the body moves however when fibrous bands of adhesions form between tissues and organs, they pull and cause pain. The only treatment for adhesions that are causing pain is to undergo laparoscopy and have the adhesions divided.
Mr Penman has gynaecology clinics throughout the week at both The Spire Alexandra Hospital and KIMS. He operates at both hospitals too. If you are suffering from acute or chronic pelvic pain, make an appointment by either calling the hospital directly or clicking the gynae appointment button to the side of this article.