A female is said to have chronic pelvic pain when she has persistent pain around the pelvic region which has continued unabated for about six months’ duration. In many such cases, there is no direct etiology found for it and they are referred to as complex regional pain syndrome or somatic pain syndrome. At times, pelvic pain in females can be caused due to medical conditions like irritable bowel syndrome and even posttraumatic stress disorder. Depression is also linked at times to a female having persistent pelvic pain. The diagnosis for the pain is mainly identified depending on the history and physical examination findings along with pelvic examination with ultrasound.
In case of severe pelvic pain, conditions like endometriosis are believed to be the cause and tests are done to that in or out. A definitive treatment for pelvic pain depends on the underlying cause. There are many cases where cure does not occur and the patient is left with some pain. However, researchers recommend a psychosocial approach towards management of pelvic pain in females especially if they are caused due to mental health disorders.
Medications given for relief of pelvic pain in females include gabapentin, NSAIDs, and even in some cases hormonal therapy. Physical therapy to strengthen the pelvic floor muscles is also recommended to treat pelvic pain in females. In rare cases, where the ovaries are involved in the cause of pelvic pain then hysterectomy may have to be done but this procedure is reserved as a last resort.
A patient-centered approach is considered to be the best when it comes to treating pelvic pain in females. At times, common conditions like menstrual cramps or ovulation may also result in a female having pelvic pain. Food allergies are also considered to be a causative factor in many cases of pelvic pain in females. At times, pelvic pain is considered to be a sign of a dysfunctional reproductive system which may require immediate treatment. This article highlights 10 causes of pelvic pain in females.[1,2]
10 Causes of Pelvic Pain in Females
The causes of pelvic pain in females include:
Menstrual Cramps: This is the most common cause for a female to have pelvic pain. In fact, this is the most common symptom that is experienced by females during menstruation according to a data released by American College of Obstetrics and Gynecologists. The data suggests that 50% of female having menses will tend to have pelvic pain on at least two days of their cycle.
Cramping and pelvic pain are one of the first signs that a female is about to have her periods. It usually starts a couple of days before the actual period starts. This is when the uterus sheds the lining and there is contraction of the uterus. The pain severity may be acute and sharp. This is best treated by putting on a warm pad or taking over-the-counter pain medication. If the pain becomes unbearable, the female can visit the physician and get stronger medications.
Ovulation: This is yet another common cause of pelvic pain in females. This usually occurs in the middle of the menstrual cycle. During ovulation, the ovaries release an egg in anticipation of it being fertilized. The egg travels through the fallopian tube in to the uterus.
The additional fluid that is released by the ovaries along with the egg gets accumulated in the pelvic region at times causing pain. The pain may last for about an hour in duration and can radiate from one side to the other. This pain eases off and completely fades away in a couple of days. Thus it requires no treatment.
Interstitial Cystitis: Inflammation of the bladder is yet another cause for pelvic pain in females. If there is no known cause for this inflammation then it is termed as interstitial cystitis. The cause for this condition is not well understood; however, it causes pelvic pain along with pain with urination. Increased urinary urgency and dyspareunia are also one of the symptoms of this condition. There is no definite cure for this condition and treatment is aimed at controlling the symptoms.
Pelvic Inflammatory Disease: This is an inflammatory and infectious condition seen in the upper genital area of a female. This usually involves the uterus, fallopian tubes , and adjoining structures which constitutes the pelvic region. The inflammation at times can spread to the entire abdominal area. Females who have multiple sex partners are most at risk for developing this condition.
It usually occurs when bacteria enters the genital tract of a female through the vagina. The primary symptom of this condition is severe pelvic pain. Abnormal vaginal discharge and abnormal bleeding are some of the other symptoms that a female may experience along with pelvic pain in cases of a pelvic inflammatory disease. This condition may render a female infertile where she may not be able to conceive.[2,3]
Studies suggest that 1 out 10 females with pelvic inflammatory disorder are not able to conceive or have problems with it. Treatment usually involves antibiotic administration. However, if this condition causes scarring then it makes treatment that much more complex. This calls for early diagnosis and treatment of pelvic inflammatory disease.[2,3]
Endometriosis: This is another condition that tends to cause pelvic pain in females. This condition occurs when the lining of the uterus which usually grows inside it starts growing on the outer part of it. This results in the female having severe pelvic pain.
This usually happens during menstrual periods when the tissues growing outside the uterus starts to respond to hormonal changes causing inflammation of the pelvis resulting in pain. Endometriosis can make conceiving in a female difficult and the affected female may have to undergo various treatments depending on the severity of the condition.
Ectopic Pregnancy: This is a condition that at times tends to cause pelvic pain. A female is said to have ectopic pregnancy when the embryo is present outside of the uterus and starts growing. The female will experience sharp pelvic pain localized to one side of the body. She may also have abnormal bleeding, dizziness, and nausea. This is an emergent medical condition and requires immediate treatment to prevent potentially serious complications.
Pelvic Adhesions: An adhesion develops when there is formation of a scar tissue that connects two separate tissues. This often at times results in pain. If this occurs in the pelvic region then it causes pelvic pain. It may be caused due to conditions like endometriosis or an infection.
The female may also experience other symptoms depending on the location of the scar tissue. The treatments for pelvic adhesions are usually minimally invasive procedures to remove the adhesion and get the tissues separated again and provide symptom relief.
Ovarian Cysts: A cyst in the ovary develops when the ovaries are not able to release an egg during ovulation. This may happen due to the follicle containing the egg not being able to open completely for the egg to come out. This may also be possible due to the follicle being clogged with fluid. This results in a cyst to form at the area around the follicle. This is what results in the female experiencing pelvic pain along with bloating and pressure around the pelvic region.
Majority of ovarian cysts are benign and pose no threat. In fact, they resolve spontaneously requiring no treatment. However, there are cases where a cyst ruptures. This requires immediate treatment as the female will experience unrelenting excruciating pelvic pain. The cyst can easily be diagnosed through ultrasound and depending on the severity treatment can be formulated which include observation or surgery.
Uterine Fibroids: A female is said to have uterine fibroids when she develops lumps of muscle and fibrous tissues in the uterus. These lumps are benign and are generally asymptomatic but at times they may cause pelvic pain. At times, they may also lead to dyspareunia. A female with uterine fibroids may have abnormal and heavy bleeding during periods.
While many cases of uterine fibroids do not require any treatment, physicians may prescribe some medications in case the patient finds the pain unbearable. In some cases surgery may have to be done to remove the fibroids.
Tumors: This is one of the rare causes for pelvic pain. The tumor may grow anywhere in the reproductive system, urinary tract, or the GI system of a female. The presence of the tumor at times causes pelvic pain in females. Depending on the type of the tumor and its location there may be other symptoms experienced by the patient.
If tumor is suspected to be the cause of pelvic pain in a female, then a thorough evaluation will have to be done and biopsies taken of the tumor to check whether the tumor is malignant or benign. This will help the physician formulate a detailed treatment plan for the patient.
In majority of the cases, there is no need for a patient to see a physician for pelvic pain. If the pain is unrelenting and is present along with other symptoms like abnormal bleeding, weight loss, or vaginal discharge then a visit to a physician becomes mandatory. This will help the patient known the cause of the symptoms and get treated promptly.
In conclusion, in most cases pelvic pain in females is due to a harmless cause like pain due to ovulation or cramping due to menstruation. However, there are more serious causes such as an ectopic pregnancy or uterine fibroids that may also cause pelvic pain in females. These conditions will always be accompanied by other symptoms as well.
Thus the patient with pelvic pain should look out for any additional symptoms for which an evaluation may be required. A thorough evaluation and checkup is necessary to come to a definitive diagnosis in such situations. Once a cause is identified then it becomes easier for the physician top formulate a treatment plan that best suits the patient. It will also help the patient get rid of the symptoms of pelvic pain.
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