Pain in The Pelvis? Here Are 15 Possible Reasons Why

Feeling pain or discomfort in your lower abdomen usually isn’t something to worry about. It’s most likely the result of period cramps or ovulation.

But in rare cases, pelvic pain can be a sign of something more serious, like an infection, reproductive issues, or a chronic condition.

We’ve got you.

15 Causes of pelvic pain: Blame it on the…

Here’s a rundown of the key players in the pelvic pain game.

1. Menstrual pain and cramps

According to the American College of Obstetricians and Gynecologists (ACOG), cramps are the most common menstrual disorder. More than half of people who menstruate experience pain at least 1 to 2 days during each cycle.

Cramps usually show up right before or at the very beginning of your period, when your uterus is contracting and shedding its lining. This can cause a jabbing pain or a muscle spasm-like feeling.
You can soothe cramps at home by using a heating pad or hot water bottle. Over-the-counter meds like ibuprofen or naproxen can help too.

If cramps are seriously cramping your style and preventing you from living your best life, talk to your doctor. They can call in reinforcements with stronger meds and methods.

2. Ovulation

No, “mittelschmerz” isn’t German for the Middleditch & Schwartz comedy improv show. It’s actually the medical term to describe painful ovulation in the middle of the menstrual cycle, specifically on one side of the pelvis (whichever side releases an egg).

Mittelschmerz happens when your ovaries release an egg that travels through your fallopian tube and into your uterus. The egg is escorted by uterine fluid that spreads throughout your pelvic area, sometimes resulting in irritation and pelvic pain.

The discomfort can last for minutes or hours and can switch sides from month to month. Treatment isn’t necessary.

3. Irritable bowel syndrome (IBS)

Irritable bowel syndrome (IBS) is a gut disorder that causes pain, bloating, constipation, and diarrhea. There’s no cure for IBS, and the symptoms often appear and disappear over time — usually after going #2.

IBS is often managed with diet, stress management, and meds targeted at reducing specific symptoms.

4. Pelvic inflammatory disease (PID)

Pelvic inflammatory disease (PID) is an infection that happens when bacteria from your vagina or cervix enters your uterus and takes up residence there. It can damage the surrounding tissue and cause scarring. PID is often caused by complications from an STI like gonorrhea or chlamydia.

Women with PID can develop symptoms like pelvic pain, abnormal vaginal discharge, and unexpected bleeding. PID can also increase the risk of infertility. According to the CDC, 1 in 8 women with PID have problems conceiving.

Doctors usually prescribe antibiotics to treat PID. While antibiotics can treat the infection, they can’t treat scarring. Talk to your doctor ASAP if you notice symptoms of PID, so you can treat it early and prevent scarring.

5. Endometriosis

Endometriosis is a condition where the tissue that lines the inside of your uterus begins to grow outside the uterus. This tissue (called endometrium) responds to your body’s hormonal changes at the beginning of your period, causing inflammation and bleeding in your pelvis.

Endo pain can range from mild to severe. Endometriosis can lead to difficulty getting pregnant.
Your doctor can work with you to determine the best treatment plan based on how severe your symptoms are.

6. Ectopic pregnancy

An ectopic pregnancy happens when a fertilized egg implants itself outside the uterus.
This is a life-threatening condition that can cause sharp pelvic pain and cramping, especially on one side. Other symptoms include dizziness, nausea, and vaginal bleeding.

Seek medical attention immediately if you suspect an ectopic pregnancy.

7. Ovarian cysts

Sometimes there’s a glitch in the matrix and your ovaries don’t release an egg. This can happen because the follicle holding the egg is clogged with fluid or didn’t open wide enough for the egg to exit.

The result? A growth called an ovarian cyst. A cyst can cause pressure, bloating, and pelvic pain on the side of your body where it’s located.

According to ACOG, most cysts aren’t cancerous, and they’ll often disappear on their own. In rare cases, a cyst can bleed or burst, causing severe pelvic pain — this requires medical treatment.

If your doctor suspects an ovarian cyst, they’ll schedule an ultrasound to confirm a diagnosis. Treatment depends on the cyst. Most resolve on their own, while others may require surgery.

8. Uterine fibroids

Little lumps of muscle and fibrous tissue in your uterus are called fibroids. These lovely lady lumps are usually not cancerous, but they can cause pain and discomfort in your pelvis and lower back. They can also cause pain during sex or excessive bleeding and cramping during your period.

Usually, treatment isn’t needed. For particularly uncomfortable symptoms, your doctor may recommend medication, certain noninvasive procedures, or even surgery.

9. Interstitial cystitis

Ongoing bladder inflammation, aka interstitial cystitis, can trigger pelvic pain. It can also cause painful urination, pain during sex, and a frequent need to pee.

Doctors aren’t sure why interstitial cystitis happens. There’s no cure, so treatment generally aims to manage and relieve symptoms.

10. Cystitis or UTI

“Cystitis” is a fancy word for bladder inflammation caused by a bacterial infection. It happens when vaginal, rectal, or skin bacteria enter the urethra and travel to the bladder.

Cystitis affects your bladder, while a urinary tract infection (UTI), which is also caused by bacteria getting where it shouldn’t be, can develop anywhere in your urinary system.

Cystitis can clear up on its own, but some cases require antibiotics. UTIs, on the other hand, typically require antibiotics, but uncomplicated ones may go away without meds.

11. Urinary stones

Some things are harder to get rid of than others: your tattered childhood blanket, your favorite concert tee, and urinary tract stones.

Your body can sometimes have a hard time getting rid of salts and minerals in your urine. As these minerals build up, they can form crystals, or stones, in your bladder or kidneys.

This can cause pain in your pelvis or lower back. It may even turn your pee pink or red with blood.
Sometimes urinary stones pass on their own. Be warned: This can be painful. In other cases, your doctor may prescribe medications that can break up the stones and make them easier to pass. In rare cases, surgery may be needed to remove them.

12. STI's

If you’re sexually active, pelvic pain may be the result of a sexually transmitted infection (STI) like chlamydia or gonorrhea.

According to the Centers for Disease Control and Prevention (CDC), about 2.86 million new cases of chlamydia and about 1.14 million new cases of gonorrhea occur in the United States each year.

Other signs of an STI:

1. abnormal vaginal discharge
2. pain when you pee
3. bleeding in between periods

If you think you might have an STI, see your doctor right away. They can give you an accurate diagnosis and set you up with a course of treatment.

Only you can prevent the infection from spreading, so give your sexual partners a heads-up if you’ve been diagnosed.

13. Pelvic adhesions

Adhesions happen when scar tissue in your body connects two areas that shouldn’t be connected. This can be painful. Scar tissue is often the result of endometriosis, past infections, or other traumas affecting the area.

A doctor may recommend minimally invasive surgery to shrink adhesions and ease symptoms.

14. Appendicitis

Your appendix is a tiny organ located in your lower-right abdomen. An infection can cause inflammation in your appendix, known as appendicitis.

Appendicitis is common, but it can be severe. Along with a sharp pain in your lower-right abs, it can trigger other symptoms like vomiting and fever.

If you experience these symptoms, seek medical attention stat!

15. Tumor

In rare cases, a tumor in your reproductive system, gastrointestinal system, or urinary tract may be to blame for your pelvic pain. A tumor is a malignant growth.

Your doctor will need to do a thorough evaluation to diagnose the issue. This may include blood tests or imaging tests. Your doctor will be able to determine a course of treatment depending on the specifics of the diagnosis.

When to Call the Doc

Pelvic pain won’t usually mean taking a trip to the doctor’s office. But sometimes pain indicates that something more serious is going on.

Talk to your doctor if you:

1. have pain that’s new and severe
2. think you have an infection (letting this go untreated could lead to complications!)
3. have unexpected vaginal bleeding and severe pain
4. have a known medical condition and experience sudden changes in your pain

You should also see a doctor right away if you start to experience other symptoms along with your pelvic pain, like nausea, vomiting, or fever.

Your doctor can fully evaluate your symptoms, give you a diagnosis, and recommend the best treatment plan for you. They’ve got this.

Sources:

1. Abdominal adhesions. (2015).
   niddk.nih.gov/health-information/digestive-diseases/abdominal-adhesions
2. Chlamydia - CDC fact sheet (detailed). (2016).
   cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm
3. Definition & facts for appendicitis. (2014).
   niddk.nih.gov/health-information/digestive-diseases/appendicitis/definition-facts
4. Definition & facts for irritable bowel syndrome. (2017).
   niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/definition-facts
5. Dysmenorrhea: Painful periods. (2015).
   acog.org/patient-resources/faqs/gynecologic-problems/dysmenorrhea-painful-periods
6. Ectopic pregnancy. (2018).
   acog.org/Patients/FAQs/Ectopic-Pregnancy
7. Endometriosis. (2018).
   womenshealth.gov/a-z-topics/endometriosis
8. Gonorrhea - CDC fact sheet (detailed version). (2019).
   cdc.gov/std/gonorrhea/stdfact-gonorrhea-detailed.htm
9. Ovarian cysts. (2017).
   acog.org/patient-resources/faqs/gynecologic-problems/ovarian-cysts
10. Pelvic inflammatory disease (PID) statistics. (2017).
    cdc.gov/std/pid/stats.htm
11. Treatment: Cystitis. (2018).
    nhs.uk/conditions/cystitis/treatment/#:~:text=Mild%20cystitis%20will%20usually%20clear,to%20improve%20within%203%20days
12. What is interstitial cystitis (IC) / bladder pain syndrome? (n.d.).
    urologyhealth.org/urologic-conditions/interstitial-cystitis

Important Notice: This article was originally published at www.greatist.com by Saundra Montijo on August 3, 2020, where all credits are due. Medically reviewed by Alana Biggers, M.D., MPH.