The pelvis is the structure responsible for connecting the spine to the lower body. The pelvis protects the bladder, intestines, and many important blood vessels. Many of the most important leg muscles and abdominal muscles attach to the pelvis and allow for body and function.
Pelvic pain occurs as a stabbing and sharp pain in a specific spot, or a dull pain that is spread out. It mostly happens in the lower abdomen areas and the pain can be either steady, or it can come and go – in most severe cases, pelvic pain can get in the way of your everyday activities. If you’re a woman, you may feel pelvic pain during your period. Pelvic pain can be a sign that there is a problem with one of the organs in your pelvic area, such as the uterus, ovaries, fallopian tubes, cervix, or vagina. If you’re a man, the cause could be a problem with the prostate. In men and women, it could primarily be a problem with the urinary tract, lower intestines, rectum muscle, or bone. Additionally, some female patients may have more than one cause of pelvic pain at the same time, while men typically have pelvic pain one cause at a time.
Causes & Symptoms
Generally, many different conditions can cause pelvic pain, therefore, it is often difficult to know exactly what is causing the pain – however, some common conditions associated with pelvic pain include the following:
- Appendicitis – Inflammation or infection of the appendix often produces lower right-sided pelvic or abdominal pain that can occur along with nausea, vomiting, and fever. An infected appendix needs to be removed by a surgeon because it may burst and infect the peritoneum and cause life-threatening peritonitis.
- Irritable Bowel Syndrome (IBS) – Symptoms of painful cramps in the pelvic and abdominal area, bloating, constipation, diarrhea, and other symptoms that may happen repeatedly over time are often signs of a condition known as irritable bowel syndrome (IBS). IBS is a chronic functional disease with recurrent symptoms.
- Painful ovulation (Mittelschmerz) – Short-term pelvic pain that occurs during ovulation is termed as ‘mittelschmerz’, a German word meaning “middle pain”. This type of pain occurs just prior to, and during ovulation, as the membrane that covers the ovary stretches to release the egg. The blood and fluid that are released during ovulation also may cause discomfort or pain. The pain varies from woman to woman and may last minutes to hours. The pain eventually resolves without medical treatment and typically does not require emergency medical intervention.
- Premenstrual Syndrome (PMS) – This condition usually involves longer-term pelvic pain and discomfort outside the pelvic area such as lower back pain, headaches, migraines, and other symptoms. In addition, medications, along with lifestyle changes may often reduce symptoms linked to premenstrual syndrome.
- Menstrual cramps – Menstrual cramps are a type of pelvic pain that occurs when the uterus contracts to remove the blood and endometrial lining that accumulates monthly when an embryo isn’t implanted in the uterus. The pain due to menstrual cramps lasts about 2-7 days during a female’s menstrual cycle.
Many symptoms are related to pelvic pain (from mild to severe) – the following symptoms linked to this condition include:
- Cramping – This is caused by a spasm in a soft organ, such as the intestine, ureter, or appendix.
- An onset of pain – caused by a temporary deficiency of blood supply due to an obstruction in the circulation of blood.
- Pain that involves the entire abdomen – This may suggest an accumulation of blood or pus.
- Localized pain – This may be due to inflammation and swelling in the pelvic area.
Who gets Pelvic Pain?
Although pelvic pain commonly refers to pain in the region of women’s internal organs, pelvic pain can also be present in either gender or can stem from various causes. Pelvic pain might be a symptom of infection or might arise from pain in the pelvis bone or in non-productive internal organs. In women, however, pelvic pain can be an indication that there might be a problem with one of the reproductive organs in the pelvic area.
In addition, for some women in pregnancy, the pelvic joints become stiff or less stable. This can cause inflammation and pain, which vary in severity. The pain can range from a dull ache to severe pain. Most sufferers are in the mild to moderate category due to Pelvic pain in pregnancy.
Other certain risk factors associated with pelvic pain include:
How Does it Affect You? How Serious is it?
In severe and life-threatening cases, pelvic pain may be a symptom of a serious condition that should be immediately evaluated, such as the following below:
Pelvic Inflammatory Disease (PID)
Pelvic inflammatory disease (PID) is a complex infection that affects a woman’s reproductive organs (the cervix, uterus, Fallopian tubes, and ovaries). It is often the result of an untreated sexually transmitted infection, such as chlamydia. Without treatment, pelvic inflammatory disease can cause irreversible scarring to the pelvic organs and lead to infertility. Women with this disease may experience fever, a dull ache in the pelvis, pain with urination or sexual activity, and a heavy yellow or green vaginal discharge.
Pelvic organ prolapse
Pelvic organ prolapse occurs when the ligaments and muscles supporting the organs in the pelvis weaken or stretch. This can cause the bladder, bowel, rectum, urethra, uterus, or vagina to prolapse, or slip out of place. More than one organ can prolapse at the same time. Pelvic organ prolapse may be a result of childbirth, genetics, or chronic stress on the pelvis straining during bowel movements when constipated.
Pelvic congestion syndrome
Pelvic congestion syndrome results from pelvic varicose veins, which are abnormally enlarged veins in the pelvis, similar to varicose veins that occur in the legs. They begin in the ovarian veins, the deep veins of the pelvis, or sometimes both. The cause of this enlargement isn’t always known, however, it is associated with prior pregnancy and pelvic surgery.
Interstitial cystitis is a chronic bladder condition that causes frequent urination and mild to severe pain in the bladder and the surrounding area. Interstitial cystitis can cause discomfort with sexual activity or urination, an urgent need to urinate, and pressure and tenderness in the pelvis region.
Recommended Treatment & Rehabilitation
In order to diagnose the cause of pelvic pain, your doctor will begin with a medical history, perform a physical examination, and order additional tests to rule out other conditions associated with pelvic pain. Tests or exams your doctor may suggest include:
- Pelvic examination – A pelvic exam can help discover signs of abnormal growths, infection, or pelvic floor muscles. Your doctor will check for areas of tenderness as well.
- Ultrasound – This imaging test uses high-frequency sound waves to produce accurate images of structures within your body. This test is especially useful for detecting masses or cysts in the ovaries, uterus, or Fallopian tubes.
- Lab tests – During a pelvic examination, your doctor will order a check for infections, such as chlamydia or gonorrhea. He or she may also order bloodwork to check your blood cell counts and urinalysis to check for a urinary tract infection.
- Colonoscopy – In this specific test, your doctor can view the entire length of the large intestine, and can often help identify abnormal growths, inflamed tissue, ulcers, and bleeding. It involves inserting a colonoscope, a long and flexible tube in through the rectum up into the colon. Colonoscopy allows your doctor to see the lining of the colon, remove tissue for further exam, and possibly treat some problems that are discovered.
- Computed Tomography (CT) scan – This is an imaging test that uses X-rays and a computer to make detailed images of the body. A CT scan shows details of the bones, muscles, fat, and organs, and any abnormalities that may not appear on an ordinary X-ray.
Based on studies, a physiotherapist will be able to design a specific treatment program to meet your specific needs and goals. Your physiotherapy may perform the following:
- Patient education – Your physiotherapist will show you how to identify the appropriate muscles, such as the pelvic floor, deep abdominals, and diaphragm.
- Range of motion – He or she will teach you how to use these muscles correctly. Your physiotherapist can instruct you on the proper ways to do activities, such as exercising, correcting your posture, getting up from a chair, and squatting to pick up a child or an object from the floor.
- Improve your strength – Your physiotherapist will work with you on exercises to stretch and strengthen the affected muscles. The goal is to help your muscles work together in the best way possible.
- Return to daily activities – He / she will help you get back to doing your regular daily activities once your pain has subsided.
The following exercises will help to strengthen your pelvic region.
- Kegel exercise – Kegel exercise is one of the most appropriate exercises to preserve your pelvic floor and avoid pain. You can do Kegels standing, sitting, or lying down. First, contract the abdominal muscles as if you are resisting the urge of urination. While still holding on to the contraction, wait for about 10 seconds, and finally repeat 2-3 times a day.
- Standard double leg raises – If a standard double leg causes too much pain or strain, it is recommended to perform a more modified double leg raise, where only one leg is raised while the head and the shoulder are kept in constant contact with the floor.
- Straight back squats – With the feet shoulder-width kept apart and heels maintained on the floor, bend at the waist with your knees as if you are about to sit into a chair. Position yourself in a position that you will not need to lean forward as you squat. Repeat this method 2-3 times a day.
- Flat frog stretch – Lie flat on your back, with the soles of your feet together and your knees falling apart. Bring your feet comfortably close to your bottom. Lastly, hold a stretch for 30 seconds, then repeat this stretch 2-3 times a day.
- Child’s pose – Begin on your hands and knees. Relax your bottom down towards your heels (your knees should be wider apart, feet closer together). Hold this stretch for 30 seconds, then rest your head on the floor before repeating 2-3 times a day.
Alternative & Homeopathic Treatments
There are several homeopathic treatments that you can use to help reduce symptoms linked to pelvic pain. Some of these include:
- Heat application – Heat is one of the best home remedies you can use to treat pelvic pain. Applying a heat pack or having a warm bath can relax the pelvic muscles, which can reduce cramping and pain.
- Non-steroidal anti-inflammatory drugs (NSAIDs) – Anti-inflammatory medications can offer fast relief from painful cramping caused by pelvic pain. These medications include ibuprofen and naproxen.
- Turmeric – Turmeric has useful anti-inflammatory properties that can be very beneficial to patients experiencing pelvic pain symptoms. It can also be used to manage pelvic pain in the long term.
- Massage – Massaging the pelvic muscles can help relax them and reduce inflammation, reducing cramping. Using a few drops of lavender oil can also help further relax the muscles.
- Ginger tea – Some patients with pelvic pain experience nausea as a result of the condition. Ginger tea is a well-known home remedy for treating nausea.