Pelvic Pain in Women: Possible Causes, Evaluation and When to Seek Care

What it involves

MedlinePlus explains that pelvic pain occurs mostly in the lower abdomen. It might be steady or come and go, sharp in one spot or dull and spread out, and severe pain can get in the way of daily life. In women it can be felt during a period or during sex. It can signal a problem with the uterus, ovaries, fallopian tubes, cervix or vagina, or with the urinary tract, bowel, muscle or bone.

Who this is for

• Women with lower belly pain that has lasted for days or keeps coming back.
• Patients with pain during periods, during sex or with urination or bowel movements.
• Women with pelvic pain plus unusual discharge, fever or bleeding.
• Anyone who has been told the pain is nothing but still has it and wants a fresh look.

What to expect

• Questions about where the pain is, when it started, how it changes and what else you feel
• An exam of the abdomen and urine and blood tests when they help narrow the cause
• A referral for a pelvic exam, ultrasound or other imaging, since the practice does not list those services
• A plan for treating the likely cause, or for urgent evaluation if the pain is severe

Where the pain comes from

Many organs share the pelvis, which is why the same ache can have several explanations. MedlinePlus lists the uterus, ovaries, fallopian tubes, cervix and vagina, along with the urinary tract, lower intestines, rectum, muscle and bone. Infection can also cause it. It adds that some women have more than one cause at the same time. Cysts, period pain, infection, bowel disorders and bladder problems are all common, which is why a careful history comes before any test.

Details that help a provider

A few specifics narrow the possibilities quickly. Note which side hurts, whether it is steady or comes in waves, and whether it gets worse with your period, with sex, with urination or with a bowel movement. Write down any fever, discharge, bleeding or nausea. Mention any chance of pregnancy. A simple diary for two weeks often tells more than memory does. The abdominal pain guide describes the same approach for belly pain in general.

Gynecologic causes

Ovarian cysts, endometriosis, fibroids, pelvic infection and period pain are among the reasons for pelvic pain in women, with the first two described in the ovarian cyst guide and the endometriosis guide. Infections spread through sex can also cause pain, and the STI testing guide explains testing. Bleeding with the pain is covered in the abnormal uterine bleeding guide. Pelvic exams and gynecologic imaging are done by referral.

Urinary and bowel causes

Not every pelvic pain is gynecologic. Burning with urination, urgency and a low ache can come from a bladder infection, as the urinary tract infection page describes, and constipation, irritable bowel and diverticulitis can all cause cramping low in the belly. The constipation guide and the irritable bowel syndrome guide describe those patterns. A urine test is often the first step because it is quick and can separate infection from other causes.

Tests a provider may order

MedlinePlus says you might need lab, imaging or other tests to find the cause, and that treatment depends on the cause, how bad the pain is and how often it occurs. The practice lists blood work, and urine testing is part of routine visits, while pelvic ultrasound, CT, MRI and laparoscopy are arranged by referral. A provider uses the history and exam to decide how far to go. If the findings suggest a gynecologic cause, a referral to a women's health specialist is the usual step.

Warning signs that need urgent care

Go to the emergency room or call 911 for sudden, severe pelvic pain, particularly with fever, vomiting, fainting, heavy vaginal bleeding or a possible pregnancy. Pain with a missed period can mean a pregnancy outside the uterus, which is dangerous. Pain with a rigid belly, or pain that began after an injury, also needs urgent evaluation. The appendicitis warning signs guide describes another cause of sudden lower belly pain that should not wait.

Sources

• MedlinePlus: Pelvic Pain (health topic)
• MedlinePlus: Ovarian cysts (encyclopedia)