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Pelvic Pain: What Could Be Causing It?

Updated on July 18, 2016

Pelvic pain can be caused by a range of different medical conditions. As the area is difficult to access easily, internal investigations will often be necessary to determine what is causing the pain. These can include ultrasound scans, transvaginal investigations and laroscopy.


Endometriosis is a condition in which the lining of the womb is not growing as it should be. Instead, it is growing outside of the womb - often on other reproductive organs. It is common for this lining to bleed as it would if it was in the correct location. As it cannot exit the body through the vagina, swelling will usually be experienced as the blood has nowhere to go. This can result in scar tissue and cysts in the affected areas. It can affect many areas of the pelvis including the ovaries, fallopian tubes, womb, bladder and bowel. Some women have no idea that they have the condition as it does not always cause any noticeable pain or discomfort. However, many sufferers will experience intense pain during menstruation. Painkillers will usually not be enough to relieve this, even those that are specifically designed for period pains. In this situation, surgery will often be an option to reduce pain.

The symptoms of endometriosis can include severe discomfort in the pelvis and back during menstruation, pain during sex, heavy periods, irregular periods, spotting (bleeding) between periods, pain when going to the toilet, infertility or struggling to become pregnant, and tiredness. If the condition affects the bladder or bowel, it may result in bloating or swelling in the lower abdomen. Blood in the faeces may also be experienced during menstruation.

Diagnosis involves making an incision just below the belly button so that the pelvis can be examined internally. This is known as a laparoscopy and is done under general anaesthetic. It is common for a piece of the endometrial tissue to be removed for examination. If the condition is not too severe, it is sometimes possible to remove the endometrial tissue during the procedure. There is no cure for the condition, but this can be a way to relieve the symptoms and make life more bearable for sufferers. If this is not possible, painkillers can be prescribed to manage the pain. In addition, hormonal treatments that change the levels of estrogen in the body can also be prescribed as treatment for the condition. These can include the combined contraceptive pill. These are not recommended for women who are trying to become pregnant as they can cause harm to the foetus.

Pelvic Inflammatory Disease

Pelvic Inflammatory Disease often affects the womb, fallopian tubes and ovaries. It usually starts as a vaginal infection that travels to the reproductive organs. Although this infection is often of the sexually transmitted variety (such as chlamydia or gonorrhoea), it can be a common bacterial infection in the vagina that triggers the condition. The infection causes inflammation, which can result in the fallopian tubes becoming narrower. If a fertilized egg attempts to travel down these tubes, it can become stuck. The end result can be an ectopic pregnancy in which the foetus is not growing in the womb, as it cannot get there. This is more common if the undiagnosed infection has become more severe. If it continues to be undiagnosed, it can eventually spread to the walls of the fallopian tubes, which makes it easier for the infection to pass through into the ovaries. It is most common in sexually active women who are aged fifteen and twenty-four. Many women will suffer another episode of pelvic inflammatory disease in their lifetime, even after being successfully treated. As many as twenty per cent of women will experience a further episode of the condition within two years.

The symptoms can include discomfort in the lower abdomen, pain during sex and in the rectum, an unusual vaginal discharge (especially if it is also thick) and bleeding between periods. Fever and vomiting can also be warning symptoms. Some women will not experience any symptoms at all, particularly if the infection is only in the early stages. By the time it is officially diagnosed, it may have had the opportunity to spread to other areas and do more damage.

Diagnosis can take a variety of forms. Initially, a cervical swab may be taken to test the bacteria that is causing the infection. Pelvic Inflammatory Disease can be caused by a number of different types of bacteria, which makes it important to determine which one it is so that the right antibiotics can be prescribed as treatment. Other forms of diagnosis can include blood tests and ultrasound scans. If this does not yield a diagnosis, you may need to have a laparoscopy to examine the pelvic area more fully. Treatment usually takes the form of antibiotics, which may need to be taken for one to two weeks.

Ovarian Cysts

Ovarian cysts are usually small in size and often cause no pain. Ovarian cysts are common during the menstrual cycle and will usually go away of their accord without ever making their presence known. However, they may cause problems if they are large. Large cysts can cause your abdomen to become swollen and painful. These would usually be surgically removed. Small cysts that are not causing problems will usually be left alone, although they may be monitored from time to time.

Symptoms can include abdominal swelling and pain (especially after sex), irregular periods that become heavier, lighter or more painful than usual, and discomfort when going to the toilet or needing to urinate more frequently than usual. The latter two symptoms are more common if the cyst is putting pressure on the bladder or bowel.

Ovarian cysts are usually diagnosed after an ultrasound scan. In addition, blood tests can be conducted to test for specific proteins. If a cyst is present in the body, levels of the CA125 protein will usually be higher than normal. Most ovarian cysts will simply be observed from time to time, unless they are cancerous or are large enough to require removal.


Fibroids are tumors that are found in the womb. They are not cancerous. Many women aged between thirty and fifty will develop fibroids, but they are more common in those who are overweight or have African-American heritage. Fibroids can vary in size quite dramatically.

The symptoms of fibroids can include heavy and irregular periods, pain and swelling in the abdomen, pain in the back and legs, frequent urination (especially if the fibroids are pressing on the bladder), constipation (especially if the fibroids are pressing on the rectum), pain during sex (especially if the fibroids are on and around the lower part of the cervix).

Fibroids are often diagnosed during an ultrasound scan or transvaginal scan. The latter involves a probe being inserted into the vagina to get a better internal view. Alternatively, a laparoscopy may be performed. Treatment for fibroids can involve injections of hormonal medicine. This alters the levels of estrogen in the body, which encourages fibroids to reduce in size. Alternatively, the combined contraceptive pill and anti-inflammatory medicines can be taken to manage the symptoms. If medication does not have any effect on fibroids, surgery may be necessary. This can involve removing the womb, although this is usually done as a last resort if the fibroids are particularly large or are causing severe bleeding.


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    • Hello, hello, profile image

      Hello, hello, 8 years ago from London, UK

      Another lot of great information. Thnank you.