Health Articles
Pelvic pain: know the different causes and when to seek help
Pain that is felt in your lower belly and above your legs is called pelvic pain. The pelvis is an important part of the body because it is home to organs like your bowel, bladder, ovaries, uterus (womb), and fallopian tubes.
There are many causes for pain in this area.
There may be problems with the skin, the muscles, the nerves, or the organs themselves. Sometimes the pain can come from more than one source. It’s important to understand the differences between the common causes of pelvic pain. It will help you to learn what is normal, what is not, and when you should seek medical help.
Persistent pelvic pain, sometimes called chronic pelvic pain, is pain that is present on most days for six months or more. It is estimated that about one in five women in Australia will experience this sort of pain. The actual number of women suffering from persistent pelvic pain may be even higher because as Jean Hailes gynaecologist Dr Janine Manwaring points out, the journey to getting the correct diagnosis can be a bumpy one.
She believes there is a lack of education about persistent pelvic pain – not just in the general community, but also in the medical community.
"There are many misconceptions about pelvic pain, particularly period pain," Dr Manwaring explains.
Pain can be downplayed by both doctors and by other women within the family. A lot of it comes down to getting the right information and knowing who the right people are to get in touch with.
JEAN HAILES GYNAECOLOGIST DR JANINE MANWARING
So here are some of the conditions that can cause persistent pelvic pain, tips on how to spot the differences between them, and advice on when you need to see a trusted doctor.
Period pain
Period pain is a very common pain for people who get periods. Although the research varies on how common it actually is, one Australian study suggested it affected 93% of menstruating senior high school students.
The pain occurs when the muscles of the uterus (womb) contract or tighten. It often feels like cramping or a heaviness in the pelvic area, lower back or stomach. Despite it being a common feature of getting your period, if the pain is severe, it could be an indicator of something more serious, such as endometriosis.
Dr Mainwaring explains: “If your pain lasts longer than the first one or two days of your period, if it does not improve with period pain medications and/or the Pill, or if it’s stopping your from going about your normal daily activities, then you should see your GP.”
Jean Hailes gynaecologist Dr Pav Nanayakkara says that many people accept this sort of pain as ‘normal’ without questioning it. “But if you find yourself planning your work, study or your holidays around your period, then you might want to think about talking to your doctor to ensure that nothing else is going on,” she adds.
Endometriosis
Endometriosis (pronounced end-o-me-tree-oh-sis) is a condition that affects the female reproductive organs, and is often linked to pelvic pain.
In someone with endometriosis, cells like those that line the uterus (the endometrium) grow in other parts of the body – typically in the pelvic area such as the lining of the pelvis (peritoneum), on the bowel, bladder or ovaries.
These cells undergo the same menstrual changes as those inside the uterus. However, unlike period blood, these cells have no means of escape and so they build up. This results in pain, scarring and inflammation.
Three in every four women with endometriosis will experience pain. The pain can occur immediately before your period, during your period, or during or after sex. The pain can be felt in the pelvis, the abdomen (belly), the back, when you pass wind, wee, or poo, or when you ovulate.
Read more about endometriosis.
Adenomyosis
Adenomyosis (pronounced add-en-o-my-oh-sis) is often called the ‘sister’ condition of endometriosis because it also involves abnormal cell growth. However, in this instance the cells grow into the muscle wall of the uterus.
The symptoms – quite like those for endometriosis – include abnormal or heavy period bleeding, painful periods (often after years without pain), and painful sex.
Irritable bowel syndrome (IBS)
The exact cause of IBS is still not fully understood. It is believed that the muscle wall of the bowel becomes sensitive and contracts unevenly, resulting in pain and bloating. This type of pelvic pain usually improves after passing wind or stool (poo). IBS is often managed by avoiding potential food triggers and trying to reduce stress.
“However, if you see blood in your poo (bleeding may appear as bright red blood on the toilet paper, or a black colour in the poo), or if you experience extreme diarrhoea, incontinence or unexplained weight loss, see your GP,” advises Dr Manwaring.
“The difficulty with IBS is that it is often a ‘diagnosis of exclusion’”, says Dr Nanayakkara. This means that it can only be said to be IBS after other conditions with similar symptoms are ruled out. The diagnosis is commonly made by a gastroenterologist (a doctor who specialises in treating digestive disorders).
Pelvic muscle pain
The muscles in the pelvis can spasm (contract) and cause pain as a result of period pain, or any pain that occurs in the pelvic area. The pain can then change from pain that comes and goes, to pain that is more constant.
According to Dr Manwaring, pelvic muscle pain can feel like you have an ongoing cramp in your pelvic area. “The pain can also be sharp or stabbing and shoot up the vagina or rectum,” she explains. “You might have pain with sex or using tampons, which can last for hours afterwards.
"Pelvic muscle pain often gets worse with exercise, especially core-strengthening exercises such as Pilates, sit-ups or crunches. Women can often find some relief by lying in the foetal position, using a heat pack, doing pelvic muscle stretches (visit pelvicpain.org.au) and seeing a pelvic floor physiotherapist."
Bladder pain & urinary tract infections (UTIs)
UTIs, which affect over 50% of women, are another common cause of pelvic pain. Symptoms can include a burning sensation when passing wee and/or lower abdominal pain.
They may be common but if left untreated, UTIs can develop into more serious kidney infections. If your symptoms persist for more than 24 hours and include fever, chills, back pain, nausea or vomiting, see your doctor immediately.
Another bladder condition is painful bladder syndrome (interstitial cystitis). Unlike a UTI, there is irritation but no infection.
Dr Manwaring suggests seeing your GP if you have troublesome bladder symptoms regularly, such as:
- needing to empty your bladder more than 8-10 times during the day
- needing to empty your bladder more than once a night
- pain with full bladder which improves with emptying
- pain with sex or intercourse
- a sense of urgency to urinate.
Read more on bladder pain on the Pelvic Pain Foundation website.
Vulval pain
Vulva is the name of the external parts of the female genitals. Vulval pain can be caused by irritation, infections, inflammatory skin conditions, tissue damage related to surgery or childbirth and other causes.
Many women assume that vulval pain and irritation is due to candida (thrush). However, there are many causes. Getting the right treatment will depend on getting the correct diagnosis.
Read more on vulval irritation.
Vulvodynia (pronounced vul-vo-din-ia) is a chronic condition that can last for months or years. It is associated with pain, discomfort or a burning sensation in the vulva that cannot be linked to a specific cause. The pain can be triggered by touch. It can be felt in one area of the vulva or across the whole area.
The pain can be so severe for some women that using tampons, having sex or even sitting down for long periods is very difficult, even impossible.
Key advice for persistent pelvic pain
It can be a confusing time for people affected by persistent pelvic pain, so Dr Manwaring has five key pieces of advice.
1. If you feel you are not being heard by your doctor or health professional, do not be afraid to seek a second opinion.
2. A multidisciplinary team (one made up of experts in different fields) has been shown to be the best for managing persistent pelvic pain. Chronic pain is not just the immediate pain, but also involves and affects a number of areas of health and life, so approaching it from different angles and treating the whole person is crucial. The multidisciplinary team can include a specialist women’s health GP, a gynaecologist, a a pain specialist, a physiotherapist, a psychologist, a sexual counsellor, a naturopath and other complementary therapists.
3. Keep track of your symptoms in a form that is easy and accessible for you. Jean Hailes has an excellent Period pain & symptom diary that you can download for free. Writing down your symptoms and treatments can be helpful when talking to different health professionals. It can also help you to work out if you are making progress.
4. Source reliable health material and self-care strategies. There is a lot of information on pain management on the internet and in chat forums. Try to focus on advice and information that is based on evidence and comes from a reliable source.
5. Always remember that you are not alone. Sometimes pelvic pain conditions can be difficult to manage, and it can feel like other people cannot relate to them because your pain cannot be seen. But don't feel like you can't seek help; there are people who will listen to you and take you and your symptoms seriously.
Published with the permission of Jean Hailes for Women's Health
jeanhailes.org.au – tollfree number 1800 JEAN HAILES (532 642) for women seeking further health information.
