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What causes pelvic pain and our expert's advice about it

September 23, 2021 Women's Health

Pelvic pain can come in many forms. Some women experience cyclic pain that comes and goes with their menstrual cycles. Others experience non-cyclic pain that's more persistent and chronic.

Pelvic pain occurs in the area below the belly button and typically involves the genital organs, bladder, or lower part of the colon. The pain, which can be anything from dull and throbbing to sharp and stabbing, can disrupt the quality of your life and make simple activities, like going to the bathroom or sexual activity, quite painful.

Joseph Gobern, MD, FACOG, a pelvic pain specialist and system chairman of obstetrics and gynecology at Main Line Health. Dr. Gobern, who specializes in minimally invasive and robotic-assisted gynecologic surgery, says pelvic pain is very common, but all too often the condition goes undiagnosed or misdiagnosed. In many cases, it can take several visits to different physicians to get a diagnosis or treatment that effectively improves your quality of life. Below are some of the different causes of pelvic pain, as well as whether gas or a yeast infection may be to blame.

How common is pelvic pain?

According to Gobern, pelvic pain is extremely common. Approximately six out of every 10 outpatient visits to gynecologists are related to pain or pelvic pain causes.

Pelvic pain comes in many forms. Some people experience throbbing and dull aches, whereas others develop sharp, shooting pains. It can occur in the bowels, bladder, genital organs, or musculoskeletal system.

Approximately six out of every 10 outpatient visits to gynecologists are related to pain or pelvic pain causes.

Often, pelvic pain is not well managed or properly treated. Getting a diagnosis can be time-consuming and elusive because the symptoms can be similar to those of other disorders, making it difficult to pin down the exact cause of pelvic pain.

What causes pelvic pain?

There are several possible causes for pelvic pain.

The bladder is another culprit of pelvic pain. Bladder pain syndrome, for example, can cause feelings of pain and pressure in and around the bladder. The bladder is a huge muscle and any disruption of that muscle can cause uncomfortable spasms and pain, explains Gobern.

The bowels may also be responsible for pelvic pain. Inflammatory bowel disorders, which are associated with constipation and diarrhea, can cause pain and spasms. The pain may also be related to inflammation in the bowel itself.

There are a range of gynecological conditions that are known to cause pelvic pain. Menstrual disorders — and in many cases, simply having a menstrual cycle — can also contribute to pain.

Endometriosis, a condition in which the uterine tissue grows outside of the uterus, commonly causes pelvic pain before, during, and after the menstrual cycle. Adenomyosis, a condition in which the uterine tissue grows into the walls of the uterus, can be similarly painful.

Some women develop uterine fibroids, or benign tumors in the uterine muscle. When enlarged, fibroids can cause pain and pressure in the pelvis. Fibroids can also cause heavy bleeding and intense cramping.

Can a yeast infection cause pelvic pain?

Infections are also known to cause pain. The immune system fights infections with inflammation, and that inflammation can cause painful symptoms.

A vaginal yeast infection, however, is unlikely to contribute to pelvic pain unless it spreads to or involves the internal organs in the abdomen.

Scar tissue or adhesions on the other hand, which can occur as a result of infection or surgery, can cause lasting pelvic pain and discomfort.

How is pelvic pain diagnosed?

Your physician will thoroughly evaluate your medical history and conduct a pelvic exam to determine if there are any abnormalities that may be contributing to the pain.

In certain cases, imaging tests like a pelvic ultrasound or magnetic resonance imaging (MRI) may be necessary to give a diagnosis.

Depending on the type of pain, your physician will likely work with a team of specialists, such as a urologist or gastroenterologist, to understand how the different systems in your body are interacting. Many people wind up seeing three to five physicians before they get a diagnosis.

According to Gobern, it's not uncommon to learn that multiple conditions are occurring simultaneously.

How is pelvic pain treated?

Sometimes, pelvic pain can be treated with over-the-counter medications like acetaminophen and ibuprofen. With certain conditions relating to the bowel or bladder, lifestyle changes like dietary adjustments can also lead to significant improvements. Eliminating caffeine or alcohol, for example, can prevent the bladder from becoming irritated. People with bowel dysfunction may also benefit from taking a probiotic and consuming more fiber.

If the cause of the pelvic pain is musculoskeletal in nature, pelvic floor physical therapy can help strengthen the pelvic floor muscles and reduce pain. There are also various medications available to help manage the pain and address any underlying causes of pelvic pain, such as endometriosis. In certain cases, providers may recommend minimally invasive surgical procedures.

Gobern recommends that patients experiencing pelvic pain consider seeing a behavioral health professional.

"Behavioral health assessment and management is very helpful in the initial components of pain," he adds. Pain can impact your emotional well-being, and a behavioral health assessment can teach you how to manage the pain along with the underlying contributors.

For people who have a history of sexual abuse or trauma, there may be psychological factors contributing to pelvic pain. These patients should divulge this information to a trusted physician who may also recommend a consultation with a behavioral health professional.

"Just like you have muscle spasms or cramps in your legs or your arm, you can have those muscle spasms in your pelvis," says Gobern. Trauma can trigger a psychosomatic manifestation of pelvic pain that disrupts how the bones and muscles normally function.

Main Line Health serves patients at hospitals and health centers throughout the western suburbs of Philadelphia. To schedule an appointment with a Main Line Health neurologist or headache expert, call 1.866.CALL.MLH (225.5654) or use our secure online appointment request form.