Pelvic Pain
Causes
Chronic pelvic pain may be caused by scar tissue (adhesions) that can form inside your body after surgery. It may begin after a pelvic infection or injury from a car accident or sexual abuse. Common disorders, diseases or conditions that can cause chronic pelvic pain include the following:
Female Diseases and Disorders
Male Disorders
Prostatitis is a common cause of chronic pelvic pain in men. The prostate is a small walnut-sized gland that makes the liquid part of semen. It is located just below the bladder and surrounds the urethra. When a man has prostatitis, his prostate gland swells and gets bigger. As it enlarges, the prostate can squeeze your urethra and make it difficult to urinate.
Prostatitis can be acute or chronic. While some men know what caused their prostatitis, others do not know. Men with prostatitis can have pain or burning when they urinate, trouble pushing urine out, blood in the urine or semen and/or pain during ejaculation. Treatment of prostatitis will depend on the cause. Prostatitis caused by an infection is treated with antibiotics. Other types of prostatitis are treated based on the signs and symptoms.
Nerve Disorders
Nerve disorders are also called “neuropathies.” The following nerve disorders represent some – but certainly not all – of the common conditions for which patients may go to a health care provider.
Pudendal Neuropathy
Some people have pain in the area between their legs. This is often caused by damage to the pudendal nerve and is called “pudendal neuropathy.” The pudendal nerve has branches of smaller nerves that send feelings from the external genitals, the rectum, and the perineum to your brain. When you are sexually excited, the pudendal nerve makes orgasm and ejaculation possible. People with pudendal neuropathy can have pain during intercourse (sex), when they go to the bathroom and when they sit down. Therapies such pudendal nerve blocks may help relieve this type of pain.
Pelvic Neuropathy
IBS is a common cause of pelvic pain. IBS pain is typically intermittent cramping in the left-lower quadrant of the abdomen. People with IBS may have changes in bowel function, such as diarrhea, constipation, bloating and/or gas (flatulence). Pain often decreases after a bowel movement. Symptoms may be worse after eating; during times of stress, anxiety or depression; right before a woman’s monthly period; or when you have intercourse. Treatment usually consists of a special diet, bulk-forming agents, stress reduction and medication. Other intestinal problems that can cause pelvic pain include inflammatory bowel disease, cancer of the bowel and polyps (benign tumors).
Interstitial Cystitis (IC)
IC is a disorder of the urinary system that can cause chronic pelvic pain. Symptoms include pain as the bladder fills with urine and relief upon emptying; the need to urinate urgently and often; pelvic pain; and pain during intercourse. Treatment of IC includes drinking more water, following a specific “bladder diet,” and having intravesical therapy. It includes medication, physical therapy, biofeedback and/or repeated nerve blocks around your uterus, vagina and pelvis. Other problems in the urinary system that can cause pelvic pain include:
Osteitis pubis is pain and inflammation of the front middle part of the pelvis called the pubic bone. It more commonly occurs in physically active males and females. Symptoms include pubic pain, pain with squeezing the legs together (adductor pain) and pain that gets worse with activity such as running, squatting, kicking and climbing stairs. This disorder is often managed with a support belt, ice packs and pain-relieving medicines.
Female Diseases and Disorders
- Acute dysmenorrhea is the medical term for painful menstruation, or monthly periods. It is the most common cause of pelvic pain for women. It is said to be responsible for the most absences by women in school and the workplace. Over-the-counter (OTC) pain relievers usually help relieve milder forms of this pain. Women who seek medical help suffer from either very severe or repeated menstrual pain that is not relieved enough by the OTC medications.
- Endometriosis is the second leading cause of pelvic pain in women. “Endometrium” or “endometrial tissue” is soft body tissue that is similar to the inside lining of the uterus. Endometriosis is a disease where endometrial tissue grows outside of your uterus. It can attach to the fallopian tubes, the bladder, intestines and ovaries.
Endometrial tissue acts just like the tissue in the uterus during your monthly period. The tissue inside the uterus slides off and bleeds out of the vagina (your menstrual period). Endometrial tissue that grows on the fallopian tubes or body organs slides off but remains trapped in your body. Symptoms of endometriosis include painful monthly periods, pain during sex, abnormal bleeding, and infertility. Hormone treatment or surgery can relieve some of the symptoms of endometriosis.
- Fibroids are abnormal growths, or non-cancerous “tumors,” that grow in the uterus. They can be smaller than a pinpoint or can grow as large as a grapefruit. Although fibroids are usually found in the uterus, they can also occur in the cervix and ligaments surrounding the uterus. Rarely, they can even attach to nearby organs and cause organ pain.
Some women with fibroids have no symptoms, while others have heavy bleeding, cramping or sharp pain. Pain may begin just before your monthly period and may gradually get worse until it becomes unbearable. Although many women get pain relief from OTC medicines, different medicines may be needed. Many medical experts believe that fibroids are caused by having too much estrogen (a hormone). Therefore, your health care provider may prescribe medicine to decrease the amount of estrogen you have in your body.
- Pelvic joint instability occurs when ligaments surrounding the pelvis fail to support the pelvic joints. If the pelvic muscles are weak as well, you may feel pelvic and/or low back pain. Pelvic joint instability is not common but can occur after childbirth or an injury to the pelvis. Persistent pelvic pain and pelvic joint instability in some women has been connected with early puberty (before age 8) and the use of oral contraceptives before childbirth.
Male Disorders
Prostatitis is a common cause of chronic pelvic pain in men. The prostate is a small walnut-sized gland that makes the liquid part of semen. It is located just below the bladder and surrounds the urethra. When a man has prostatitis, his prostate gland swells and gets bigger. As it enlarges, the prostate can squeeze your urethra and make it difficult to urinate. Prostatitis can be acute or chronic. While some men know what caused their prostatitis, others do not know. Men with prostatitis can have pain or burning when they urinate, trouble pushing urine out, blood in the urine or semen and/or pain during ejaculation. Treatment of prostatitis will depend on the cause. Prostatitis caused by an infection is treated with antibiotics. Other types of prostatitis are treated based on the signs and symptoms.
Nerve Disorders
Nerve disorders are also called “neuropathies.” The following nerve disorders represent some – but certainly not all – of the common conditions for which patients may go to a health care provider. Pudendal Neuropathy
Some people have pain in the area between their legs. This is often caused by damage to the pudendal nerve and is called “pudendal neuropathy.” The pudendal nerve has branches of smaller nerves that send feelings from the external genitals, the rectum, and the perineum to your brain. When you are sexually excited, the pudendal nerve makes orgasm and ejaculation possible. People with pudendal neuropathy can have pain during intercourse (sex), when they go to the bathroom and when they sit down. Therapies such pudendal nerve blocks may help relieve this type of pain. Pelvic Neuropathy
- Ilio-inguinal and ilio-hypogastric nerve disturbances: The ilio-inguinal and ilio-hypogastric are nerves in the pelvic cavity that can be injured by trauma such as surgery in the lower abdominal wall. Though not clearly understood, these nerve disturbances may be caused by the stretching or cutting of nerves located around the incision (cut) made during surgery. Many people with this problem have had repeated but unsuccessful surgeries to try to find and fix the source of the pain. People with pelvic neuropathy often have pain relief from repeated nerve blocks spaced over time—usually over a 4 to 6 week period. If nerve blocks do not help, cryotherapy or spinal cord stimulation may also be tried.
- Genito-femoral nerve disorders: These are also called genito-femoral neuropathies. Symptoms of this disorder are low abdominal pain or even back pain that has traveled to the front of your body and now goes down into the genital area between your legs. The pain can often feel unbearable when it occurs in sharp, repeated attacks. Almost all patients have a large amount of pain relief — usually within minutes of therapy — after nerve blocks and maximum trigger point injections.
Other Disorders
Irritable Bowel Syndrome (IBS)
IBS is a common cause of pelvic pain. IBS pain is typically intermittent cramping in the left-lower quadrant of the abdomen. People with IBS may have changes in bowel function, such as diarrhea, constipation, bloating and/or gas (flatulence). Pain often decreases after a bowel movement. Symptoms may be worse after eating; during times of stress, anxiety or depression; right before a woman’s monthly period; or when you have intercourse. Treatment usually consists of a special diet, bulk-forming agents, stress reduction and medication. Other intestinal problems that can cause pelvic pain include inflammatory bowel disease, cancer of the bowel and polyps (benign tumors).
Interstitial Cystitis (IC)
IC is a disorder of the urinary system that can cause chronic pelvic pain. Symptoms include pain as the bladder fills with urine and relief upon emptying; the need to urinate urgently and often; pelvic pain; and pain during intercourse. Treatment of IC includes drinking more water, following a specific “bladder diet,” and having intravesical therapy. It includes medication, physical therapy, biofeedback and/or repeated nerve blocks around your uterus, vagina and pelvis. Other problems in the urinary system that can cause pelvic pain include:
- Infiltrating bladder tumors
- Kidney stones
- Renal obstruction
- Recurrent steroid arthritis
- Urethral diverticulum
- Urethral syndrome
- Urgency-frequency syndrome
Osteitis Pubis
Osteitis pubis is pain and inflammation of the front middle part of the pelvis called the pubic bone. It more commonly occurs in physically active males and females. Symptoms include pubic pain, pain with squeezing the legs together (adductor pain) and pain that gets worse with activity such as running, squatting, kicking and climbing stairs. This disorder is often managed with a support belt, ice packs and pain-relieving medicines.