6 Conditions That Cause Pelvic Pain

It's common to experience minor cramps during your period. But if you're experiencing severe pelvic pain that is long-lasting, it could be caused by something else.

Chronic pelvic pain can feel sharp or like a stabbing pain. It may be located in a specific spot somewhere on your lower abdomen or it might feel like a dull pain that spreads out. It also may or may not be associated with your period, depending on the cause.

"Pelvic pain is a big puzzle that can be caused by many factors," Barbara Diakos, MD, a gynecologist at Northwestern Medicine Lake Forest Hospital in Illinois, told Health. "That's why it's so important for your doctor to listen to you, to hear what all your symptoms are, and to take you seriously."

The good news is once you and your healthcare provider find the cause of your pelvic pain, that can help determine your treatment. Learn more about the common causes of chronic pelvic pain.

Endometriosis

One major cause of pelvic pain is endometriosis. Endometriosis is a common condition affecting about 6.5 million people in the United States.

Endometrium is the tissue that normally lines your uterus. If you have endometriosis, tissue that is similar to the endometrium grows outside your uterus causing mild to severe uterine pain.

Symptoms

You may have endometriosis if, along with pelvic pain, you are experiencing:

• Painful menstrual cramps
• Chronic pain in the lower back and pelvis
• Bleeding or spotting between periods
• Pain during or after sex
• Painful bowel movements
• Infertility
• Diarrhea
• Constipation
• Bloating
• Nausea

Causes and Risk Factors

The cause of endometriosis is unknown but it may be related to genetics, hormones, problems with the immune system, or problems with menstrual flow. You are more likely to get endometriosis if you have never had children, have menstrual periods that last more than a week, or you have a family history of endometriosis.

Treatment

If your healthcare provider suspects you have endometriosis, they may suggest starting hormonal birth control as the first treatment option. Hormonal birth control is best for people who aren't experiencing severe pain or symptoms.

If you are trying to get pregnant, your healthcare provider may instead suggest a medicine that stops the body from making the hormones for ovulation. This medication is called a gonadotropin-releasing hormone agonist.

If you are experiencing severe symptoms, surgery may be necessary. A laparoscopy is a procedure in which a surgeon removes any areas of endometriosis.

Fibroids

Fibroids are another cause of uterine pain. Fibroids are a type of benign tumor that grows in the wall of the uterus. They may grow as a single tumor or there may be multiple growths and they vary in size—from as small as an apple seed to as big as a grapefruit.

Symptoms

Not all fibroids cause symptoms. Even large fibroids may not cause pain but symptoms vary widely from person to person. If you have larger or multiple tumors, your fibroids are more likely to cause symptoms like:

• Heavy bleeding during periods
• Unpredictable bleeding
• Pressure on the bladder
• Frequent urination
• Rectal pressure
• Lower back pain
• Complications during pregnancy and labor
• Enlargement of the lower abdomen
• Pain during sex

Causes and Risk Factors

The cause of fibroids is unknown but hormones and genetics may play a role. You are more at risk for fibroids if you have a family history of fibroids, are obese, or eat a lot of red meat. You may be able to protect yourself from developing fibroids if you eat a lot of green vegetables.

Treatment

Treatment options for fibroids depend on:

• Whether you have symptoms
• If you want to become pregnant in the future
• The size and location of the fibroids
• Your age and how close you are to menopause (since fibroids tend to shrink after menopause)

Treatment can include hormone therapy, embolization (in which small particles are injected into uterine arteries to cut off blood flow, causing the fibroids to die), and a range of surgical methods and medications. A healthcare provider will be able to help determine the best course of treatment for you.

Irritable Bowel Syndrome

"It can be hard to figure out whether pelvic pain is gastrointestinal-related or gyno-related, since parts of your colon lie near your pelvic area," said Health contributing medical editor Roshini Rajapaksa, MD, a gastroenterologist at NYU Langone Health.

It's possible your pelvic pain may be due to irritable bowel syndrome (IBS)—a group of symptoms that occur together without any visible signs of damage or disease in your digestive tract.

Symptoms

If you're unsure if your pelvic pain is gastrointestinal or gynecological, take a close look at your symptoms. You may have irritable bowel syndrome if your pain is accompanied by:

• Bloating
• Gas
• Diarrhea
• Constipation
• Mucus in your stool

You may also experience more symptoms during your period.

Causes and Risk Factors

Experts are not sure what causes IBS, but people with anxiety, depression, a family history of IBS, or history of a stomach virus are more likely to develop the condition.

Treatment

To manage IBS, you may want to make an appointment with a gastroenterologist to discuss first-line treatments. This may include:

• Dietary changes like cutting back on possible trigger foods (for example, dairy or gluten), eating more fiber, or following a special eating plan.
• Lifestyle changes like increasing physical activity, reducing stress, and getting enough sleep.
• Starting a probiotic, or live microorganisms, that can help to build up "good" bacteria in your gut.
• Mental health therapy such as cognitive behavioral therapy, gut-directed hypnotherapy, or relaxation training.
• Specific medications that vary depending on your symptoms and can include fiber supplements, antidepressants, or antibiotics.

Urinary Tract Infection

A common cause of pelvic pain is a urinary tract infection (UTI). In this condition, bacteria infect the parts of your body that create urine, like your kidneys, bladder, or urethra (the tube that carries urine outside your body).

Symptoms

UTI symptoms include:

• Pain or burning when urinating
• Frequent urination
• Feeling like you need to urinate but your bladder is empty
• Urine that is bloody
• Pressure or cramping in the groin or lower abdomen
  

If you notice symptoms such as fever, chills, nausea, vomiting, or lower back pain—these may be signs of a kidney infection which is more serious than a UTI.

Causes and Risk Factors

Bacteria can enter the urinary tract in different ways. For instance, sexual activity can move bacteria to the urethra. And certain forms of birth control like spermicides, diaphragms, unlubricated condoms, or spermicidal condoms, can also increase the risk of UTIs since there is an increased risk of bacterial growth.

Additionally, these factors can increase your risk for developing a UTI:

• Having a UTI previously
• Menopause
• Pregnancy
• Being an older adult or young child
• Poor hygiene (children who are potty-training)

Treatment

Healthcare providers will prescribe antibiotics to fight the infection. If you have frequent UTIs, they may also prescribe you antibiotics or several months of low-dose antibiotics.

Prevention is key. Be sure to urinate after sexual activity and stay well hydrated. You don't want to put any sprays or powders in the genital area and avoid douching (cleaning out the vagina with a solution) as well. If you are a caregiver that is potty training, it's important to teach girls to wipe front to back to avoid getting any bacteria inside the urethra.

Painful Bladder Syndrome

Painful bladder syndrome (also known as interstitial cystitis) is another condition that causes pain when urinating. This chronic condition causes painful urinary symptoms.

Symptoms

Symptoms of interstitial cystitis can vary with each person. Symptoms may be mild, severe, or change as time goes on. Typically, most people have repeated discomfort, pressure, or pain in the bladder, lower abdomen, and/or pelvic area. Other symptoms include:

• Feeling the urgent need to urinate
• Urinating more than normal
• Bladder pain that gets worse until you urinate
• Pelvic pain that worsens during sex

Causes and Risk Factors

The cause of this condition is still unknown. As of July 2022, the American Urological Association believes painful bladder syndrome may be associated with other chronic pain conditions like IBS.

Some people may notice that certain factors can cause flare-ups. This may include factors such as:

• Stress
• Sexual activity
• Menstrual cycle
• Having a UTI
• Skipping meals
• Dehydration
• Wearing tight pants and undergarments
• Standing for long periods of time

You can work with a healthcare provider to determine what causes your flare-ups and see what treatment options are available.

Treatment

Since symptoms vary for each person, treatment will vary as well. Some options may work better for you than others, or you may need to use a combination of treatments to manage your symptoms such as:

• Lifestyle changes like eliminating foods and drinks that can irritate your bladder, reducing stress, being physically active, and quitting smoking.
• Medications can include over-the-counter pain relievers like Tylenol or Advil, cyclosporine, or pentosan polysulfate (Elmiron).
• Physical therapy can help specifically with pelvic floor problems to stretch and relax your muscles.
• Bowel training, or training yourself to have regular bowel movements, may also be recommended.
• Bladder training, similar to bowel training, can help your bladder hold more urine.
  

Pelvic Floor Dysfunction

Pelvic floor dysfunction (PFD) is a group of symptoms and changes that relate to abnormal function of the muscles in the pelvic floor. Conditions may vary from urologic, gynecologic, or colorectal.

"Imagine the bones of your pelvis as a bowl, and on top of them are muscles that support organs such as your uterus, bladder, and bowel," Magdy Milad, MD, MS, chief of minimally invasive gynecologic surgery at Northwestern Memorial Hospital, told Health.

"When these muscles are inflamed, they can contract, which causes pain and other symptoms, such as constipation and even pain during intercourse."

Symptoms

Because PFD is a wide array of conditions, it comes with a wide array of symptoms which will vary depending on what condition you have. Some symptoms may include:

• Difficulty urinating
• Urinary or fecal incontinence
• Pain during or after sex
• Constipation
• Pelvic pain

Causes and Risk Factors

About one in four women in the United States experience pelvic floor dysfunction. The cause of PFD is unknown but risk factors can include:

• Obesity
• Chronic constipation
• Heavy lifting
• Chronic coughing
• Age (the muscles weaken with age)
• Having had a hysterectomy
• Prior childbirth

Treatment

Talk to your healthcare provider about a physical exam to check your pelvic floor muscles for spasms, knots, or weakness. If they suspect you have pelvic floor dysfunction, they can use tests like checking muscle control with electrodes.

After getting a diagnosis, you should work with a pelvic floor physical therapist, according to Dr. Milad. Treatment can involve learning to relax and contract your pelvic muscles, often with the help of techniques such as biofeedback. Other treatment options include:

• Lifestyle modifications may include modifying your diet to avoid specific foods or weight loss which can decrease urinary incontinence.
• Medications may include topical vaginal estrogen, anticholinergics, or beta3 agonists.
• Surgical procedures may be recommended for people who are experiencing organ prolapse (displacement of an organ such as the vagina, uterus, or rectum) and aren't getting relief with other treatment options.
• Pain management with medications, trigger point injections, or acupuncture.

Additionally, some healthcare providers will inject Botox directly into a patient's pelvic. Several studies have found that the injections are effective, and the pain did not return one year after treatment.

A Quick Review

Pelvic pain may be a side effect of your period, or it might be a symptom of an underlying condition. These conditions could be urologic, gynecologic, or colorectal—depending on which symptoms you're experiencing along with the pelvic pain.

Pelvic pain is a symptom of endometriosis, fibroids, irritable bowel syndrome, urinary tract infections, painful bladder syndrome, and pelvic floor dysfunction. If you are having other symptoms, talk to a healthcare provider so they can help determine the cause of your symptoms and guide you through treatment options.