Pelvic pain - Causes and Symptoms

Definition

Pelvic pain is a symptom related to the pelvis, or the lower part of the trunk, which corresponds to the pelvis. This region borders on the upper part with the abdomen, laterally with the lower limbs and below with the perineum. The disorder is frequent in women and can originate from the pelvic or extra-pelvic organs. In some cases, the symptom is attributable to a systemic disease. Other times, no cause is found.

Pelvic pain can start suddenly or gradually. Furthermore, this symptom can take on a cyclic character (for example: when it tends to recur in the same phase of the menstrual cycle) or chronic (if it lasts more than 6 months).

The quality, intensity, location of pain and, in women, the correlation to the menstrual cycle, may suggest the most probable causes.

Gynecological disorders

Pelvic pain may occur in the presence of some pathological processes affecting the cervix, uterus or uterine appendages. The most frequent causes include dysmenorrhea (painful menstruation), ovulation (mittelschmerz) and endometriosis.

Pelvic pain that occurs in the case of dysmenorrhea is typically acute or crampy, dull and constant; it occurs a few days before or after the onset of menstruation, and is often associated with headache, nausea, constipation, diarrhea or increased frequency of urination. Usually, dysmenorrhoea reaches its maximum intensity 24 hours after the onset of menstrual flow and can last for 2-3 days.

Caused by the abnormal growth of uterine tissue outside the uterine walls, endometriosis, on the other hand, causes acute or cramp-like pain, related or not to menstruation. In the various phases of the pathology, dyspareunia, irregularities in the menstrual cycle, ovarian and pelvic masses, uterine retroversion and infertility may also arise.

Mittelschmerz is characterized by the sudden appearance of unilateral pain, located in the lower abdomen on the right or left side. It occurs during ovulation and tends to subside after 1-2 days. The ovulatory pain is caused by a brief and moderate peritoneal irritation which coincides with the rupture of the mature ovarian follicle and the release of the egg cell. Sometimes, even slight blood loss may occur (vaginal spotting).

Pelvic pain unrelated to the menstrual cycle, on the other hand, can be caused by pelvic inflammatory disease, rupture of an ovarian cyst, degeneration of uterine fibroid, ovarian or tubal torsion, vulvodynia, uterus prolapse and spontaneous abortion.

Sexually transmitted diseases (eg chlamydia and gonorrhea), uterine or ovarian neoplasms, adhesions and scar tissue in the lower abdomen (results of abdominal surgery or consequence of pelvic infections) also cause this symptom. In women of child-bearing age, pregnancy should be excluded during diagnostic tests.

Non-gynecological disorders

Pelvic pain can result from gastro-intestinal diseases, such as gastroenteritis, inflammatory bowel disease, appendicitis, diverticulitis, tumors, constipation, intestinal obstruction, perirectal abscess and irritable bowel syndrome.

The symptom can also occur in the context of urinary tract diseases, such as cystitis, pyelonephritis, urolithiasis and tumors.

Furthermore, pelvic pain can be of musculoskeletal origin (eg stretching of the abdominal muscles and diastasis of the pubic symphysis).

Finally, this manifestation can result from psychological problems, such as somatization and consequences of physical, mental or sexual abuse.

Other causes

Pelvic pain may be due to conditions that represent a medical-surgical emergency, including ectopic pregnancy, rupture of a tube-ovarian abscess, peritonitis and intestinal perforation.