Most women experience pelvic pain at some time during their lives. Many times pelvic pain is just the normal functioning of the reproductive tract or other organs. Other times pelvic pain may indicate a more serious problem that needs urgent treatment. Here we will discuss some common causes of pelvic pain and potential treatment options.
Some “normal” events can cause severe pain. Pain with ovulation is called “mittleschmirtz” and can at times be severe. Functional ovarian cysts are fluid filled structures that if left alone will go away without any treatment.
Dysmenorrhea. This means pain with menstrual period. Some cramping with the menstrual period is normal, but it is not normal to have pain that interferes with a woman’s normal activities. Prostaglandins are compounds in menstrual blood that cause the uterus to contract, and cause cramping. Common medicines used to treat dysmenorrhea, such as aspirin, ibuprofen, or naproxen sodium help by interfering with the production of prostaglandin. Hormonal therapy with birth control pills can also be very effective.
Endometriosis. Endometriosis is a condition in which the type of tissue that lines the uterus implants in locations outside the uterus. This typically causes pelvic pain around the time of the menstrual period, but can cause pain at other times in the cycle as well as pain with intercourse. Treatment includes hormonal therapy +/- surgical therapy, including laparoscopy and hysterectomy.
Fibroids. Fibroids are benign growths in the muscle of the uterus. Fibroids are very common, and usually are not painful. Some fibroids can cause pelvic pressure, pain and excessively heavy menstrual bleeding (menorrhagia). If symptoms are severe enough, hysterectomy may be necessary. In fact, fibroids are the most common indication for hysterectomy in the United States.
Infection. Most pelvic infections that cause pain are caused by Chlamydia and/or Gonorrhea. Infections can also be caused by other bacteria. Infection of the lining of the uterus (the endometrium) is called endometritis. Infection of the fallopian tubes is called salpingitis. Often pelvic infection is given the term Pelvic Inflammatory Disease, or PID. Sometimes pelvic infections can cause severe pelvic pain and fever, but a chlamydia infection may not cause any pain at all. If a pelvic infection is suspected, it is important to be treated with antibiotics, since severe damage to the tubes and ovaries can result if treatment is delayed.
Pelvic Adhesions. An adhesion is where intra-abdominal organs stick together. This is often caused by pelvic infection (PID), endometriosis, or previous surgery. Pelvic pain can occur when adhesions are stretched. For example, if an ovary is stuck to the intestine, ovulation may stretch these adhesions and cause pain. On the other hand, many adhesions cause no pain at all.
Unless adhesions cause the intestines to be blocked (a bowel obstruction), they usually cannot be diagnosed without doing laparoscopy and actually looking inside the abdomen. Most adhesions can be freed during laparoscopy, but they can reform. Freeing the adhesions may or may not relieve pain.
Pain from other organs
The colon sits next to the uterus and ovary. Pain from irritable bowel syndrome can seem like it is coming from the ovary. Usually this is a crampy pain. Constipation and inflammation of the intestine, such as diverticulitis can also cause pelvic pain. As endometriosis can involve the intestines, evaluation of the intestinal tract and laparoscopy may be necessary to determine whether the pain is coming from the intestines or a gynecologic problem.
Bladder. Inflammation of the bladder is felt in the lower abdomen. A bladder infection usually causes burning with urination and urinary frequency. Interstitial cystitis is an inflammation of the bladder not caused by infection, but can cause severe symptoms. Kidney stones also can also cause pelvic pain.
Abdominal wall pain. Nerves in the abdominal wall can be trapped, and cause severe pain. Often this is near a previous surgical incision. It is important to distinguish pain from the abdominal wall from problems inside the abdomen. Often this can be done by numbing areas of the abdominal wall with local anesthetics, which will eliminate pain coming from the wall, but not from internal organs.
As noted above, many of the common causes of pelvic pain will resolve with observation or with simple medical treatment including anti-inflammatory medications, antibiotics, or hormonal therapy. If the pain remains persistent or seems to be gradually worsening, many times a diagnostic laparoscopy may be necessary. This involves placement of a 10 mm camera into the abdominal cavity and inflation of the cavity with carbon dioxide. Looking into the pelvis, different causes of pelvic pain can be diagnosed and treated including endometriosis, pelvic adhesions, and ovarian cyst formation. If laparoscopy alone cannot relieve the pain, or if there are coexisting problems, hysterectomy, with or without removal of the tubes and ovaries, many times becomes the definitive management.
By: Oliver E. Carlota, M. D.
Oliver E. Carlota, M.D. has been in private practice in Athens, Alabama since 1998. He has recently been joined by his wife Amy Carlota, CRNP who completed her Master’s degree as a family nurse practitioner in 2009. He has been in practice with Roberta Ress, CNM, a certified nurse midwife, for a number of years. The goal of their practice is to provide comprehensive, compassionate, and competent women’s health care in a timely fashion. Carlota OB/GYN, P.C. has recently moved to Suite 17 of Athens Professional Plaza. Their beautiful, new office has been renovated and redecorated in a contemporary fashion in order to provide a soothing and comfortable atmosphere for their patients. To schedule an appointment, contact Carlota OB/GYN, P.C. at (256) 233-3100.