Pelvic Pain Overview

Pelvic pain is pain that occurs below the belly button, in the front or back of the pelvic region. If pain lasts for at least six months, it is considered chronic pelvic pain. There are many causes of pain in this region. Learn more.

Pelvic pain is more common in women (an estimated 15%-20% of women in the United States are affected by it), but men can be impacted as well. It is estimated that pelvic pain affects between 2% to almost 10% of men. In males, pelvic pain is called chronic pelvic pain (CPP). It can begin with a bacterial prostate infection but once the infection goes away, the pelvic pain can remain and is related to pelvic floor muscle dysfunction (see below).

In some women, pelvic pain can be so severe that it interferes with activities such as work, exercising, or having intercourse. The pain can be constant or intermittent. In some people the pain is sharp and stabbing in a specific area, while in others it is a dull pain. It sometimes can radiate to the lower back, buttocks, or thighs. Some women only have pelvic pain during their menstrual periods.

Causes of Pelvic Pain

Common causes of pelvic pain include:

Endometriosis. The growth of uterine tissue outside the uterus can cause intense pelvic pain, painful menstruation, and sexual intercourse and contribute to infertility. According to the Endometriosis Foundation of America (EFA), the problem may affect as many as 10% of women during their reproductive years. 

Interstitial cystitis/painful bladder syndrome. This condition causes bladder pain and a need to urinate frequently and immediately.

Vulvodynia. This condition involves pain or discomfort of the vulva (the parts of the female sex organs that are on the outside of the body). 

Uterine fibroids. These are noncancerous tumors consisting of muscle cells and other tissues that grow within and around the wall of the uterus. They can cause heavy or painful periods, pain during intercourse, and lower back pain.

Pelvic floor disorders. There are two types: pelvic organ prolapsed and pelvic floor muscle dysfunction. In pelvic order prolapsed (POP), the bladder, uterus, cervix, or rectum can be falling down or sitting in a lower position, causing a pressure or pain sensation. Pelvic floor muscle dysfunction (PFMD) can be either overactive or underactive. Overactivity of the pelvic floor muscles causes pain, trigger points, shortening, and tension. Underactivity leads to incontinence, lack of support in the lower back and pelvis, and pelvic organ prolapse (drooping of any of the pelvic floor organs, including the bladder, uterus, vagina, small bowel, and rectum).

Irritable bowel syndrome. This digestive problem can cause pain, bloating, constipation, or diarrhea.

Adhesions. These are bands of tissue that form between internal tissues and organs. They can form due to surgery or infections, such as pelvic inflammatory disease or endometriosis.

Pelvic inflammatory disease (PID). PID is an infection of a woman’s reproductive organs. It can be a complication of some sexually transmitted diseases, such as chlamydia and gonorrhea. PID can cause pain in the lower abdomen, as well as fever, an unusual discharge with a bad odor from your vagina, pain and/or bleeding when you have sex, burning sensation when you urinate, or bleeding between periods.

Pregnancy and Childbirth. Approximately 50% to 75% of women have pregnancy-related pelvic pain, also known as pelvic girdle pain (PGP). The pain is disabling in 30% of women. An estimated 10% to 25% of these women will go on to develop chronic postpartum pelvic pain.

Pudendal Neuralgia.This condition affects the pudendal nerve, the main nerve of the perineum (the area between the testicles and anus of a man, and the vagina and anus of a woman). When this nerve suffers an injury, it can result in pudendal neuralgia. Othe rpossible causes are inflammation or an autoimmune illness, frequent infections, childbirth, surgery or tension on the nerve. The primary symptom is pain in the genitals or the anal-rectal area. The immense discomfort caused by pudendal neuralgia is usually worse when sitting and has been described as burning, knife-like or aching, stabbing, pinching and twisting. Some patients also report numbness. These symptoms are usually accompanied by urinary problems, bowel problems and sexual dysfunction. Sexual activity is extremely painful, or even impossible.

Some women have more than one cause of pelvic pain.

A study published in the journal Human Reproduction in 2015 found that a high proportion of reproductive-age women may be experiencing pelvic pain that goes untreated. The study of more than 400 women who were scheduled to undergo surgery or imaging for such reasons as infertility, menstrual irregularities, tubal sterilization, or pelvic pain, found reports of pain were highest for women diagnosed with endometriosis. However, one-third of those without any pelvic condition also reported a high degree of ongoing pain or pain recurring during the menstrual cycle.

Updated on: 03/28/18
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