The "pelvis" refers to your hip bones and all of the organs contained within them. Women have pelvic pain symptoms more often than men. Learn more.
9 most common cause(s)
Symptoms of pelvic pain
The "pelvis" refers to your hip bones and all of the organs and structures contained within them. This includes your reproductive and urinary tracts; your large and small intestines; and the muscles, tendons, and ligaments inside your pelvic area.
Pain and other symptoms can arise from any of those locations, which can make it challenging to precisely identify the root cause of your pelvic problems. To make the diagnosis, all of your symptoms will be carefully examined and ruled out one at a time to determine the true cause. Pelvic pain is also called pelvic girdle pain.
Common characteristics of pelvic pain
If you're experiencing pelvic pain, it can likely be described by the following.
- The pain can fit almost any description: Dull, cramping, sharp, on-and-off, constant, mild, or severe problems.
- Pain location: It may be localized to one spot or seem to exist throughout your pelvic area.
- Genitourinary discharge: There may be a discharge from your urinary tract or your sexual organs.
- Pain that spreads: The pain may also spread, or radiate, into your back or legs.
Who is most often affected by pelvic pain symptoms?
Women have pelvic pain more often than men. This is because the female pelvic area is complex and designed for rapid change during pregnancy.
When are pelvic pain symptoms most likely to occur?
Pelvic pain is more likely to occur:
- During urination
- During a bowel movement
- After ejaculation in men
- During sex in women
- Before or during menstruation
- During pregnancy and in the weeks of recovery that follow: Even with a normal pregnancy, some pelvic pain and discomfort are common due to hormones that relax the ligaments for birth.
Are pelvic pain symptoms serious?
The severity of your pelvic pain symptoms is ultimately dependent on the cause.
- Not serious: Some pelvic discomfort during pregnancy is quite common and not abnormal.
- Moderately serious: Any ongoing pain, whether there are other symptoms or not, is something that should be treated by your medical provider.
- Serious: Any severe pelvic pain symptoms can be a sign of serious illness, especially if there are other symptoms with it.
Causes of pelvic pain
Most common causes in women
- Ovulation: Women may experience a mild tearing sensation in the pelvic region around the time of ovulation.
- Cramping: Cramping ranging from mild to severe, is very common during a menstrual period.
- Abnormalities: Abnormal growth of uterine tissue on other reproductive structures in the abdomen and pelvis can cause pain.
- Uterine growths: Benign growths lodged within the muscular wall of the uterus cause pain whenever the uterus contracts.
- Complications of pregnancy: A pregnancy that has begun to grow in a fallopian tube instead of the uterus will cause pelvic pain. Miscarriage is another possible cause, which is labor and delivery of a stillborn infant.
Other inflammatory and infectious causes
Other causes of inflammation of the structures of the pelvis may be related to disease or infection.
- Infection throughout the female reproductive organs: This is almost always from the bacteria that cause one or more of the sexually transmitted diseases.
- In men: Sexually transmitted diseases will cause a discharge from the penis as well as pelvic pain symptoms during urination and sexual activity. Inflammation of the prostate gland in men causes pain and burning during urination, along with pain throughout the reproductive organs.
- Bacterial infection of the urethra and bladder: This causes burning pain and cramping in both men and women.
- Kidney stones: These are crystallized deposits that may travel down from the kidneys in both men and women, causing severe pain while trying to exit the system.
Inflammation of abdominal organs
If the abdominal organs are impaired due to normal processes or illness, this can result in pelvic pain.
- Infection and inflammation of the appendix
- Constipation and gas
- Intestinal contractions: The intestines may be contracting too strongly or too slowly, causing pain and discomfort either way.
- Inflammation of the large or small intestine
- A blockage or obstruction within the intestine
- A protrusion of fatty tissue: Or, a loop of intestine, has been forced out of place within the pelvis
Musculoskeletal pelvic pain causes
Musculoskeletal causes of pelvic pain may include the following.
- Scar tissue following surgery or disease
- Injuries: Such as hip fracture, dislocation, or bursitis, as well as muscle or tendon strain, or ligament sprain.
- Arthritis: Any of several forms of arthritis, which is the wearing away of the cartilage protecting bones.
- Joint inflammation: Particularly inflammation of the joint at the front of the pelvic girdle. This is usually caused by the stresses of pregnancy and childbirth.
Other pelvic pain causes
Other causes of pelvic pain may include the following.
- Sexual abuse: Anyone, male or female, who has experienced any sort of sexual abuse is more likely to suffer from chronic pelvic pain.
- Tumors: Tumors can grow on almost any of the structures within the pelvis, causing pain.
This list does not constitute medical advice and may not accurately represent what you have.
Normal abdominal pain
The complaint of nonspecific abdominal pain and discomfort, with no apparent cause, is one of the most common in medicine. It is a primary reason for patients to visit a medical provider or the emergency room.
The cause of abdominal pain can be difficult to find, because it can come from many different sources: the digestive tract, the urinary tract, the pancreas, the gall bladder, or the gynecologic organs.
The pain may simply be caused by overly sensitive nerves in the gut. This hypersensitivity can occur after repeated abdominal injury and/or it may have an emotional cause due to fear of the pain itself.
Diagnosis is made through physical examination, patient history, and simply ruling out any other condition. CT scan is often requested, but can rarely find a specific cause. The benefits must be weighed against the risks of radiation.
Treatment first involves making any needed lifestyle improvements regarding diet, exercise, work, and sleep, in order to reduce stress and irritation. In some cases, counseling, hypnosis, mild pain relievers, and antidepressants are helpful.
Rarity: Common
Top Symptoms: abdominal pain (stomach ache), vaginal discharge, fever, nausea
Symptoms that always occur with normal abdominal pain: abdominal pain (stomach ache)
Symptoms that never occur with normal abdominal pain: fever, vomiting, diarrhea, nausea, severe abdominal pain, unintentional weight loss, vaginal discharge
Urgency: Self-treatment
Normal variation of constipation
Constipation means bowel movements that have become infrequent and/or hardened and difficult to pass.
There is wide variation in what is thought "normal" when it comes to the frequency of bowel movements. Anywhere from three times a day to three times a week is considered normal.
As long as stools are easy to pass, laxatives should not be used in an effort to force the body to a more frequent schedule.
Constipation is usually caused by lack of fiber in the diet; not drinking enough water; insufficient exercise; and often suppressing the urge to have a bowel movement.
A number of medications and remedies, especially narcotic pain relievers, can cause constipation.
Women are often affected, due to pregnancy and other hormonal changes. Young children who demand low-fiber or "junk food" diets are also susceptible.
Constipation is a condition, not a disease, and most of the time is easily corrected. If simple adjustments in diet, exercise, and bowel habits don't help, a doctor can be consulted to rule out a more serious cause.
Rarity: Common
Top Symptoms: abdominal pain (stomach ache), nausea, stomach bloating, constipation, constipation
Symptoms that always occur with normal variation of constipation: constipation
Symptoms that never occur with normal variation of constipation: vomiting
Urgency: Self-treatment
Urinary tract infection
A urinary tract infection, or UTI, can involve any or all parts of the urinary system but most often affects the bladder and urethra.
Bacteria from the gastrointestinal tract – especially Escherichia coli (E. coli) – are the most common cause of UTIs. These bacteria spread from the anus and rectum to the urethra. Sexual activity can do this, but a UTI is not considered a sexually transmitted disease.
Women are more at risk for UTI than men. Due to female anatomy, the urethral opening is a short distance from the anus and rectum. Anyone who uses catheters to urinate is also prone to UTIs.
Common symptoms of less-serious UTIs include lower abdominal discomfort and pressure; burning or discomfort on urination; and cloudy or discolored urine.
Left untreated, the infection could spread to the kidneys and cause a medical emergency.
Diagnosis is made by having the patient describe the symptoms and by testing a urine sample for bacteria.
UTIs are caused by bacteria and so can be treated with antibiotics.
Prevention involves good hygiene and drinking plenty of water.
Polycystic ovary syndrome
Polycystic ovary syndrome, or PCOS, is a condition in which a woman's ovaries do not correctly release one egg cell per month (ovulate) as is normal. Instead, the egg cells remain on the surface of the ovary and fluid-filled cysts form around them.
The cause is not entirely known, but PCOS can be caused by significant weight gain because that brings about hormonal imbalance and insulin resistance. There may also be hereditary factors.
Symptoms include very irregular and abnormal menstrual periods. There may be signs of excess male hormones such as acne, facial and body hair, or even male pattern baldness.
Untreated PCOS can lead to infertility, complications of pregnancy, abnormal uterine bleeding, depression, and endometrial cancer.
Diagnosis is made through symptoms, pelvic examination, blood tests, and ultrasound.
PCOS is often treated with birth control pills, which suppress ovulation, regulate the monthly cycle, and decrease male hormone production. Maintaining normal body weight can often help the condition.
Pelvic inflammatory disease
Pelvic inflammatory disease, or PID, is the general term for a bacterial infection of a woman's reproductive organs.
PID is most often a complication of a sexually transmitted disease (STD) such as gonorrhea or chlamydia. However, it is possible to get PID from other causes.
Any woman can be affected. It is most often found in sexually active women under age 25, especially those who have had PID before, have multiple partners, and/or douche frequently.
Symptoms include fever, lower abdominal pain, foul-smelling vaginal discharge, pain and/or bleeding during sex, and pain on urination.
Untreated PID can cause infertility due to damaged tissue in the reproductive tract, as well as chronic pelvic and abdominal pain. Unprotected sex partners will be infected as well.
Diagnosis is made through symptoms, pelvic examination, vaginal and cervical swabs, and urine tests.
Treatment is with a course of antibiotics. Be sure to finish all of the medication as directed, even when you begin feeling better.
To prevent PID, have all partners (male or female) tested for STDs and avoid unprotected sexual contact.
Rarity: Common
Top Symptoms: fever, abdominal pain or unusual vaginal discharge, vaginal discharge, nausea or vomiting, vaginal bleeding, pelvic pain
Symptoms that always occur with pelvic inflammatory disease: fever, abdominal pain or unusual vaginal discharge
Urgency: In-person visit
Painful bladder syndrome (interstitial cystitis)
Painful bladder syndrome, also called interstitial cystitis or IC, is a chronic condition of pain and discomfort in the urinary system.
The cause is unknown. It may be an autoimmune disorder and is often found with fibromyalgia, irritable bowel syndrome, chronic fatigue syndrome, or vulvodynia (pain in the outer female organs.) Some researchers feel the condition may be linked to a history of abuse.
Painful bladder syndrome is more common in women than in men but can happen to anyone.
Symptoms vary and may include pressure and discomfort in the lower abdomen; pain during sexual intercourse; bladder pain; and a frequent urge to urinate.
A medical provider should be seen for these symptoms because painful bladder syndrome can interfere with quality of life and lead to depression.
Diagnosis is made through patient history; physical examination; blood and urine tests; and sometimes cystoscopy. Women may have a pelvic examination and men may have a digital rectal examination.
There is no cure specifically for painful bladder syndrome, so treatment involves addressing the symptoms and making lifestyle changes.
Rarity: Rare
Top Symptoms: fatigue, abdominal cramps (stomach cramps), depressed mood, pelvic pain, arthralgias or myalgias
Urgency: Primary care doctor
Ovulation pain (mittelschmerz) or midcycle spotting
Mittelschmerz is a German word that translates as "middle pain." It refers to the normal discomfort sometimes felt by women during ovulation, which is at the midpoint of the menstrual cycle.
Each month, one of the two ovaries forms a follicle that holds an egg cell. The pain occurs when the follicle ruptures and releases the egg.
This is a dull, cramping sensation that may begin suddenly in only one side of the lower abdomen. In a few cases, there may be vaginal spotting. Mittelschmerz occurs about 14 days before the start of the next menstrual period.
Actual Mittelschmerz is not associated with nausea, vomiting, fever, or severe pelvic pain. These symptoms should be evaluated by a medical provider since they can indicate a more serious condition.
Diagnosis is made through patient history.
Treatment requires only over-the-counter, nonsteroidal anti-inflammatory drugs to relieve the pain. An oral contraceptive will stop the symptoms since it also stops ovulation.
Rarity: Common
Top Symptoms: abdominal pain (stomach ache), last period approximately 2 weeks ago, vaginal bleeding, bloody vaginal discharge, pelvic pain
Symptoms that always occur with ovulation pain (mittelschmerz) or midcycle spotting: last period approximately 2 weeks ago
Urgency: Self-treatment
Menstrual cramps
Menstrual cramps, also called dysmenorrhea, are actually contractions of the uterus as it expels its lining during a woman's monthly period.
A certain amount of mild cramping is normal, triggered by hormone-like substances called prostaglandins. However, painful cramps may be caused by underlying conditions such as endometriosis, uterine fibroids, high prostaglandin levels, or pelvic inflammatory disease (PID.)
Severe cramping may be present, as well as nausea, headache, and dull pain that radiates to the low back and thighs. It is most common in women under age 30 who smoke, have heavy and irregular periods, and have never given birth.
An obstetrician/gynecologist (women's specialist) can do tests for underlying conditions such as those mentioned above. Women over age 25 who suddenly begin having severe cramps should see a doctor to rule out the sudden onset of a more serious concern.
Treatment of mild cramping can be done with heating pads to the abdomen and with over-the-counter pain relievers such as ibuprofen. Birth control pills, which regulate the menstrual cycle, are often effective in lessening cramps.
Rarity: Common
Top Symptoms: abdominal pain (stomach ache), abdominal cramps (stomach cramps), painful periods, lower back pain, abdominal pain that shoots to the back
Symptoms that always occur with menstrual cramps: abdominal pain (stomach ache)
Symptoms that never occur with menstrual cramps: being severely ill, disapearance of periods for over a year
Urgency: Self-treatment
Endometriosis
Endometriosis is a condition where the tissue that normally forms the lining of the uterus – the endometrium – also begins growing on the outside of the ovaries and fallopian tubes. This out-of-place endometrium still thickens and bleeds each month, causing pain, scar tissue, and adhesions.
Risk factors include short menstrual cycles that begin at a young age, with menopause at an older age; never giving birth; uterine abnormalities; family history; and alcohol use.
Symptoms include severe pelvic pain, cramping, and excessive bleeding during menstruation. There may be pain during sexual intercourse and sometimes during bowel movements and urination. Diarrhea, constipation, nausea, and bloating are also common, as is difficulty becoming pregnant.
Endometriosis can be confused with other conditions, such as pelvic inflammatory disease or irritable bowel syndrome. Permanent infertility can occur with untreated endometriosis.
Diagnosis is made by pelvic examination, ultrasound, and sometimes laparoscopy.
Treatment involves over-the-counter pain relievers and hormone therapy, including contraceptives. Surgery may be done to remove endometriosis tissue. As a last resort, removal of the ovaries and the uterus may be recommended.
Rarity: Uncommon
Top Symptoms: vaginal discharge, abdominal pain (stomach ache), vaginal bleeding, pelvic pain, painful periods
Urgency: Primary care doctor
Constipation from not eating enough fiber
Constipation is defined as having stools which are large, hard, and difficult to pass. This leaves the person feeling bloated and uncomfortable. Many things can cause constipation, and a common one is lack of fiber in the diet.
To determine whether lack of fiber is causing the constipation, all other causes are first ruled out:
- Not drinking enough water, sometimes to the point of dehydration.
- Lack of exercise, which helps increase blood circulation and therefore motility (contraction and movement) of the bowel.
- A very low or no-fat diet.
- A need for probiotics, which replenish the "good" bacteria in the gut.
- Medications, or certain illnesses, which have a constipating effect.
- Constantly ignoring the feeling of needing to move the bowels, and delaying going to the toilet.
If fiber is needed, the best sources are fresh vegetables; fresh or dried fruits; and whole wheat and brown rice, because those include the fiber-rich bran. Over-the-counter fiber tablets can be tried, though laxatives should only be used if recommended by a medical provider.
Rarity: Common
Top Symptoms: constipation, constipation, pain in the lower left abdomen, pain when passing stools, feeling of needing to constantly pass stool
Symptoms that always occur with constipation from not eating enough fiber: constipation, constipation
Symptoms that never occur with constipation from not eating enough fiber: vomiting
Urgency: Self-treatment
Pelvic pain treatments and relief
When pelvic pain is an emergency
Seek immediate treatment in the emergency room or call 911 for pelvic pain if you are female and you have sudden, severe pelvic pain with dizziness or fainting. This may be an ectopic pregnancy, which is a life-threatening medical emergency.
When to see a doctor for pelvic pain
Schedule an appointment for:
- Treatment of any signs of infection and/or sexually transmitted disease: As described above.
- Physical therapy: You can receive a personalized exercise program to address any unstable structures or scar tissue within the pelvis.
At-home treatments for pelvic pain
Pelvic pain remedies that you can try at home:
- Improving general health: Make improvements to your diet, sleep, and exercise habits.
- Using over-the-counter pain relievers for minor pain
There are several over-the-counter (OTC) treatment options that might help alleviate your symptoms:
- Anti-inflammatory Pain Relievers: For general pelvic pain, especially if it feels crampy or inflammatory, ibuprofen or naproxen can provide relief. Remember not to exceed the recommended dose to avoid side effects.
- Heating Pads: Applying heat can help relax pelvic muscles and reduce pain, especially during menstrual cramps or ovulation pain.
- Phenazopyridine for Urinary Discomfort: If your pelvic pain is associated with urinary symptoms like burning or urgency, phenazopyridine can be used as a temporary measure to ease discomfort.
Questions your doctor may ask about pelvis pain
- Have you experienced any nausea?
- Any fever today or during the last week?
- How would you describe the nature of your abdominal pain?
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
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References
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- Pelvic Pain. NHS. Updated October 30, 2018. NHS Link.
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- Passavanti MB, Pota V, Pace MC, et al. Chronic Pelvic Pain: Assessment, Evaluation, and Objectivation. Pain Research and Treatment. 2017;2017:9472925. NCBI Link.
- Indman PD. Pelvic Pain. ModernMedicine Network. Published October 25, 2011. ModernMedicine Network Link.
- Verstraete EH, Vanderstraeten G, Parewijck W. Pelvic Girdle Pain During or After Pregnancy: A Review of Recent Evidence and a Clinical Care Path Proposal. Facts, Views & Vision in ObGyn. 2013;5(1):33-43. NCBI Link.
- Lampe A, Solder E, Ennemoser A, Schubert C, Rumpold G, Sollner W. Chronic Pelvic Pain and Previous Sexual Abuse. Obstetrics & Gynecology. 2000;96(6):929-933. NCBI Link.