What's Causing Your Pelvic Pain?
Avoid Misdiagnosis

Causes and Symptoms of Chronic Pelvic Pain

WebMD Medical Reference

Many different conditions can cause chronic pelvic pain. You may have one or more of them. All can have similar symptoms, and that often makes it hard to figure out the source of the pain. The main symptom is pain that lasts for more than six months, but there are usually other symptoms as well. Understanding your symptoms can help you and your doctor begin to pinpoint the cause or causes of your chronic pelvic pain. Here are some of the causes and the related symptoms:

Endometriosis

In endometriosis, cells that normally line the inside of the uterus (the endometrium) grow inappropriately outside on organs such as the ovaries, bladder, or rectum.

Symptoms you may have:

• Pelvic pain or cramps before or during your period
• Pain during or after sex
• Pain when you ovulate
• Painful bowel movements
• Rectal bleeding during your period
• Pain when you urinate
• Lower back pain
• Infertility
• Spotting between periods
• Bloating in your abdomen

Adenomyosis

This condition is similar to endometriosis. Cells that normally line your uterus (the endometrium) invade the muscle tissue of the uterus wall (the myometrium). Many women with adenomyosis don't have any symptoms.

Symptoms you may have:

• Pain during your period
• Feeling of pressure on your bladder or rectum
• Heavy periods
• Periods that last longer than usual
• Spotting between periods

Interstitial Cystitis

Women with interstitial cystitis have an inflamed bladder. The inflammation is not caused by an infection. This condition tends to affect women in their 30s and 40s.

Symptoms you may have:

• You need to urinate very often
• Often feeling an urgent need to urinate
• Discomfort when you urinate
• Pain during sex

Urinary Tract Infection

Bacteria are usually the cause of urinary tract infections. Infections can involve any part of the urinary tract, including the kidneys, bladder, and urethra. Urinary tract infections are much more common in women than in men.

Symptoms you may have:

• Feeling pressure in your lower pelvis
• Pain or a burning sensation when you urinate
• Needing to urinate often
• Often feeling an urgent need to urinate
• Needing to get up at night to urinate
• Cloudy urine
• Blood in urine
• Urine has strong or bad smell
• Only a trickle of urine comes out
• Lower back pain

Pelvic Inflammatory Disease

This is an infection of the uterus, fallopian tubes, or ovaries that causes them to become inflamed and infected. Most often it is a sexually transmitted bacterial infection, like gonorrhea or chlamydia These organisms go from the vaginal canal up through the cervix, into the uterus, out the fallopian tubes, and into the surrounding pelvic organs including the ovaries. Rarely these bacteria can infect these organs in other ways, like through douching. Scars left by the infection may cause chronic pelvic pain; more commonly, the pain is acute.

Symptoms you may have:

• Vaginal discharge having an unusual color, texture, or odor
• Abdominal or pelvic pain in a specific area or more widespread
• Pain during sex
• Irregular or missed periods
• Menstrual cramps that are worse than usual
• Frequent need to urinate
• Pain when you urinate
• Pain when you ovulate
• It hurts when you press on certain areas of your pelvis
• Lower back pain
• Fatigue
• Fever
• Nausea

Pelvic Congestion Syndrome

Pelvic congestion is just like the varicose veins that some women have in their legs, but it affects the veins of the pelvis. Blood backs up in the veins, making them become enlarged and engorged. Pelvic congestion causes chronic pelvic pain in some women.

Symptoms you may have:

• Pain starts 7-10 days before your period
• Pelvic pain is worse when you sit or stand
• Lying down relieves pelvic pain
• Lower back pain
• Aches in your legs
• Pain during sex

Irritable Bowel Syndrome

Chronic pelvic pain sometimes isn't only due to problems with reproductive organs or the urinary tract; other organs the pelvic area, if "diseased," can present as pelvic pain. Irritable bowel syndrome, an intestinal condition that often causes pain, may be the cause.

Symptoms you may have:

• Diarrhea
• Constipation
• Incontinence
• Flatulence
• Bloating
• Pain relieved by a bowel movement

Uterine Fibroids

Fibroids are noncancerous tumors that grow in, and on, the wall of the uterus. Not all women who have them notice symptoms, but for some, fibroids can be painful.

Symptoms you may have:

• Heavy periods
• Feeling pressure or fullness in your abdomen
• Need to urinate frequently
• Pain or cramps during your period
• Constipation
• Hemorrhoids

Levator Syndrome

Sometimes spasms of a pelvic muscle called the "levator ani" cause pelvic pain.

Symptoms you may have:

• Pain is related to sitting
• Pain doesn't seem to be related to bowel movements
• You wake up at night in pain
• Pain usually lasts less than 20 minutes at a time

Pelvic Support Problems

Sometimes women have pelvic pain when the muscles and ligaments that hold organs in place weaken. This causes organs like the uterus, the bladder, or the rectum to move from their normal places and herniate into the vagina. The vagina may also change shape. Pregnancy and giving birth may cause these kinds of problems.

Symptoms you may have:

• Leaking urine
• Feeling like something is falling out of your vagina
• Difficulty with bowel movements
• Lower back pain
• Pain during sex
• Pelvic organs bulge into the vagina, or even stick out the vaginal opening, in severe cases

Vulvodynia

Vulvodynia is pain that affects the vulva for no apparent reason. The pain of vulvodynia may be constant or it may come and go.

Symptoms you may have:

• Burning or stinging sensations in the vulva
• Pain when something presses on the vulva, like during sex or when you straddle a seat
• Pain in your inner thighs

Psychological Causes

For some women, the root of pelvic pain is psychological. That's not to say that the pain isn't real. There just isn't an identifiable physical cause. Some people have emotional problems that only show up as physical symptoms. Women who have suffered sexual abuse or assault often have chronic pelvic pain afterward.

Symptoms you may have:

• Depression
• Anxiety
• Substance abuse
• Stress

Reviewed by Celia E. Dominguez, MD, September 14, 2007.

SOURCES: MedlinePlus Medical Encyclopedia, National Library of Medicine web site: "Endometriosis," "Interstitial cystitis (IC)," "Urinary tract infection," "Pelvic inflammatory disease (PID)," "Irritable bowel syndrome (functional bowel)," "Uterine fibroids," "Uterine prolapse." The Merck Manual of Diagnosis and Therapy, 17th Edition, Merck & Co., 1999. The Mayo Foundation for Medical Education and Research web site: "Endometriosis." WebMD Medical Reference from Healthwise: "Adenomyosis," "Varicose Veins." National Institute of Allergy and Infectious Diseases web site: "Pelvic Inflammatory Disease." National Uterine Fibroids Foundation web site: "Uterine Fibroids." American College of Obstetricians and Gynecologists: "Pelvic Support Problems." American College of Obstetricians and Gynecologists: "Practice Bulletin Number 51, March 2004."