Causes and Diagnosis of Pelvic Pain


Pelvic Pain - Causes & Diagnosis

The International Association for the Study of Pain define pain as "An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." Pain is subjective but always unpleasant and emotional. There is not always an identifiable stimuli and can instead be the result of pathophysiological causes.

Chronic pelvic pain is often a result of a change in the complex interactions that occur within your pelvis. Amongst the urinary, gastrointestinal, musculoskeletal, endocrine, neurologic and gynaecologic systems. The experience of the pain can be influenced by psychological and socio-cultural factors, such as personal outlook and available support.

You'll experience a change in the normal sensations and processes in your body. Consciously you may change your posture and movement. Involuntarily, the way that your organs function may change.


Chronic pelvic pain is often linked to depression and social isolation. The figures are staggering - 15% of all sick days taken by women are a result of suffering from pelvic pain. 50% of female sufferers report depression and 26% have considered suicide.

Common Causes of Pelvic Pain


The most common causes of pelvic pain are issues with the urinary system, gastrointestinal and gynaecologic system. Less common causes include musculoskeletal, social, environmental and psychiatric/neurologic issues. In most chronic pelvic pain cases, the original cause is no longer present.


You can be predisposed to experiencing pelvic pain more so than others if you already suffer with a gastrointestinal disease. You can also be genetically more susceptible to the sensation of pain or not have the correct psychological state to cope with it.


Issues with the urinary system:

  • Bladder Malignancy/Cancer

  • Urolithiasis - also known as Kidney Stones

  • Urinary Tract Infection (UTI)


Issues with the gastrointestinal system, including Bowel Problems:

  • Coeliac Disease - a long-term immune disorder that primarily affects the small intestine.

  • Colon Cancer

  • Diverticular Disease (Diverticulitis) - the general name for a common condition that causes small bulges (diverticula) or sacs to form in the wall of the large intestine (colon).

  • Irritable Bowel Syndrome (IBS) - a lifelong intestinal disorder that prevents the large bowel from functioning correctly.This kind of pelvic pain often fluctuates.

  • Pelvic Floor Dyssynergia - a loss of coordination between the pelvic floor muscles & other muscles in the pelvis.

  • Inflammatory Bowel Disease (IBD) - an umbrella term used to describe disorders that involve chronic inflammation of the digestive tract.

  • Ulcerative Colitis - is an inflammatory bowel disease (IBD) that causes long-lasting inflammation and ulcers (sores) in your digestive tract.This type of pelvic pain often fluctuates.


Issues with the female gynaecologic system:

  • Adenomyosis - Usually diagnosed during an ultrasound.

  • Endometriosis - Usually diagnosed through a hysteroscopy. It is found in 70% of women suffering from chronic pelvic pain, although is not always the only cause.

  • Endometrial Cancer - Associated with irregular bleeding in perimenopausal or postmenopausal women.

  • Fibroids

  • Ovarian Cyst

  • Pelvic Congestion Syndrome

  • Pelvic Inflammatory Disease - Often as a result of an untreated STD such as gonorrhea or chlamydia.

  • Vaginismus

  • Vulvodynia - Specific tenderness of the vulva and immediate area.


Issues with the male gynaecologic system:

  • Genital Dysaesthesia - is a form of cutaneous dysaesthesia (a condition defined as an unpleasant and abnormal sensation in the skin) and is described as a sensation of burning, heat, irritation, discomfort or increased sensitivity to touch of the penis, foreskin or scrotum.

  • Prostate Conditions


Other issues in the pelvis include musculoskeletal, social, environmental and psychiatric/neurologic issues:

  • Degenerative Disk Disease - an age-related condition that happens when one or more of the discs between the vertebrae of the spinal column deteriorates or breaks down, leading to pain.

  • Over-Exercising - leading to issues with the pudendal nerves (the main nerve of the perineum, which is the space between the anus and scrotum in the male and between the anus and the vulva in the female).

  • Pelvic Abscesses - is a life-threatening collection of infected fluid in a pouch. Usually, it occurs as a complication after operative procedures.

  • Pelvic Adhesion's - are common in women who have endometriosis that is extensive, or left untreated. Adhesion's also form after Cesarean sections or other types of open surgery, and can be the result of infections and often occur as a result of a previous pelvic surgery or infection. Scar tissue can grow between two organs in the pelvic area and cause significant pelvic pain.

  • Pelvic Organ Prolapse (Vaginal Prolapse / POP)

  • Poor Posture - This kind of pelvic pain often fluctuates.

  • Stress Fractures - tiny cracks in a bone that are caused by repetitive force, often from over-use. These can also develop from normal use of a bone that's weakened by a condition such as osteoporosis (a bone disease that occurs when the body loses too much bone, makes too little bone, or both).

  • Tight (Overactive) Pelvic Muscles

  • Neurological Disorders - Neurological conditions can disrupt nerve signals, and these blockages cause damage. which can be painful. Neurological dysfunctions often contribute towards gastrointestinal causes of pelvic pain in women.


Diagnosing Pelvic Pain


It is rare for the original cause of chronic pelvic pain to be diagnosed. 61% of women do not find out what caused their pain to begin with, as often it has gone away before they have visited their doctor.


However, this pain can evolve into a chronic pain that now persists due to the changes that happened to the muscles, nerves and others tissues, as a result of the original cause. In these situations your GP will look to rule out serious diseases and conditions, and begin treatment for your symptoms.


Many women who do receive a diagnosis for the original cause of their pelvic pain, find that there is more than one condition that is contributing to the pain. These causes are evaluated for their malignancy and significance, to determine the speed and intensity of treatment required.


As part of the process of diagnosing your pelvic pain and symptoms, your doctor will hold a discussion with you, complete a gentle physical examination, and take some samples for laboratory testing.


The discussion may involve:

  • your medical history - bring any previous lab tests, prescriptions and x-rays with you.

  • any history of physical or sexual abuse - also used to evaluate current safety.


Questions asked may include:

  1. How and when the pain began?

  2. What makes the pain better or worse?

  3. Does the pain change throughout the day, week or month?

  4. Is the pain effected by your menstrual cycle?

  5. Does the pain affect your sleep?

  6. Has the pain spread since it first occurred?

  7. Are there any problems with your skin, muscles, joints or back?

  8. Is there pain when you urinate or defecate?

  9. Are you anxious or depressed as a result of the pain?

  10. What have you tried, to make the pain better and what has/hasn't worked?

  11. What medical treatments have you had, did they work?

  12. What do you believe is the cause?

  13. What concerns you most?


A gentle physical examination should take place to determine:

  • quality of the pain

  • areas and single points of tenderness

  • presence of any masses

  • your posture

  • condition of your pelvic skin

  • pelvic mobility

  • strength of your pelvic floor - this is often ascertained with an electronic biofeedback machine, which scores the 'squeeze' of your pelvic floor via a probe.

  • Carnett's sign abdominal test - lying on your back, you will be asked to raise both legs whilst the doctor places a finger on your abdomen. This will help determine whether the pain is within the abdomen rather than the visceral nervous system.

  • condition of pelvic organs - which may be functioning differently as a result of muscle tightness caused by the pain. Usually a hysteroscopy or ultrasound will be used to look inside you for any obvious issues (for women; your uterus will be examined to determine if endometriosis is present).


Laboratory tests may include:

  • cancer screening

  • pregnancy test

  • complete blood count

  • erythrocyte sedimentation rate - which can reveal the presence of inflamed activity in the body.

  • vaginal swabs for STD's - most notably chlamydia and gonorrhea, which often lead to pelvic inflammatory disease.

  • urinalysis and urine culture - to reveal any infection.


There are several warning signs that the cause of your pelvic pain is a result of other conditions, like:

  • unexplained weight loss

  • blood in your stool (hematochezia)

  • irregular bleeding in perimenopausal and postmenopausal women

Accordingly, if you experience any of these three symptoms above, it is even more important to speak to your Doctor as soon as possible.



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Original article: Kegel8 Website

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