Pelvic pain in women or anyone with a uterus can come from your digestive, reproductive, or urinary system. Several diagnoses share pelvic pain as a symptom. This pain could be caused by
- period cramps
- pelvic inflammatory disease
- kidney stones
- some STDs
- ovarian cysts
- ectopic pregnancy
People may also experience pelvic pain during pregnancy and after childbirth. Since labor and delivery is a traumatic experience, it can lead to pelvic pain after birth as well. This can sometimes be described as pelvic girdle pain which refers to any pain felt around the pelvis, lower back, hips, and thighs.
Your OBGYN will combine your health history with a physical exam to determine if more testing is needed. They may order lab work such as blood tests and urinalysis, ultrasound, or other diagnostic testing to determine your condition. Some conditions can also benefit from physical therapy. A physical therapist who treats pelvic conditions can help address incontinence, pelvic floor dysfunction, muscle spasm, weakness or provide pain relief.
The first step in getting treatment is finding your diagnosis. Keep reading to learn more about 20 common causes of pelvic pain among people with a uterus.
1. Pelvic muscle disorders (e.g. spasms, tightness)
Pelvic floor dysfunction (PFD) describes a variety of anatomic and functional changes to the muscles of the pelvic floor. The pelvic floor is made up of muscles and ligaments that serve to support the internal organs. Increased or decreased activation of these muscles or stretching of the ligaments can lead to a variety of conditions. Some of the conditions associated with PFD include:
- difficult urination
- painful intercourse
- prolapse (of several different organs)
- pelvic pain
2. Menstrual cramps
Menstrual cramps seem to be caused by the release of unique compounds in your body called prostaglandins. More prostaglandin release seems to be associated with more severe cramping or contractions. These contractions are how your uterus sheds its lining if you are not pregnant.
3. Irritable bowel syndrome (IBS)
Symptoms are often triggered by food, medication, or stress. The diagnostic criteria for IBS are:
- abominable pain at least one day a week for 12 weeks;
- a change in the frequency of stool;
- a change in the form/appearance of stool.
4. Urinary tract infections (UTI)
Another very common cause of pelvic pain is a urinary tract infection. The urinary system is made up of the kidneys, ureters, bladder and urethra; most infections are in the lower urinary tract- namely the bladder and the urethra.
Symptoms of a UTI may include burning during urination, cloudy or bloody urine, strong smelling urine, an urge to urinate that doesn’t go away or pelvic pain.
Older adults who develop sudden changes in behavior—including aggression, delirium, anxiety, confusion, depression, hallucinators, and paranoia—should be screened for UTI as a cognitive impairment since it can be associated with the infection.
If you have pelvic pain, it’s important to rule out appendicitis (and other life-threatening conditions) before continuing to investigate the cause of your pain. Appendicitis can cause acute pelvic pain and is the most common cause of nongynecologic pain.
Symptoms of appendicitis include:
- sudden, intense pain on the lower right side of the abdomen
- pain that worsens with coughing or movement
- nausea and vomiting
- decreased appetite
- low-grade fever that worsens as the inflammation progresses
6. Sexually transmitted disease (STD)
Sexually transmitted infections can cause pelvic inflammatory disease (PID) and the associated pelvic pain. PID is an infection of the upper genital organs in women (uterus, fallopian tubes, and ovaries) and is more common in young women who have multiple partners.
- lower abdominal pain
- vaginal discharge
- abnormal uterine bleeding.
Several different bacteria can cause these infections so it’s critical that you undergo testing to determine what type of bacteria is present to ensure the proper antibiotic is used for treatment.
7. Diverticulitis or colitis
Pain in the left lower quadrant can be difficult to diagnose. Notably in that region, discerning between diverticulitis and colitis has important treatment implications. Both of these conditions are problems in the large intestine.
Shared symptoms are abdominal pain, abdominal cramping, and blood stool. If you have diverticulitis, or infection of the diverticula (the lining of the colon), you may also have constipation or diarrhea.
Ulcerative colitis, an inflammatory bowel disease, causes ulcers in the large intestine, is accompanied by fecal incontinence, fever, exhaustion, diarrhea, and weight loss.
8. Kidney stones
Historically, kidney stones have occurred more often in men than women, but this gender gap seems to be closing. Your diet and lifestyle can affect how likely you get kidney stones.
To prevent this painful condition, the National Kidney Foundation recommends that you
- drink plenty of fluids (water, coffee, lemonade)
- avoid extra calcium supplements, high doses of vitamin C, and high salt intake.
Symptoms of kidney stones can involve pelvic pain as they cause pain when urinating as well as severe pain in the lower abdomen, groin, lower back, and flank.
Pain that stems from a hernia depends on the type of hernia and where it’s located. Hernia is a defect in the connective tissue (fascia) that holds muscles and other body structures in place.
Inguinal and abdominal hernias are most common, but the fascia of the pelvic floor may also be affected. It may take a long time for women with a hernia to get a diagnosis and initiate treatment because of their tendency to have pelvic pain and the lengthy process that may ensue when searching the cause of pain.
10. Pinched nerve
Your body is a vast network of nerves that connect your brain, spinal cord, and muscles. These nerves can get “pinched” as they travel through, around, and next to other structures.
In the pelvis, one source of pelvic pain in men and women is a pinched pudendal nerve. The pudendal nerve supplies the skin and muscles of the sex organs and genital region. Injury to the nerve can occur from prolonged sitting, cycling, riding horses or motorcycles, or long-term constipation. When injured, pain in the pelvic region occurs when sitting and is relieved by standing or lying down.
11. Bone and joint issues
Your pelvic pain may be musculoskeletal in nature. Some of the sources of musculoskeletal pain in the pelvis could be: bones, ligaments, muscles, or joints. Sprains, strains, and fractures can occur in this area of your body from motor vehicle accidents, falls, or other trauma.
If you’re actively being treated for cancer, you may also be more susceptible to fracture because chemotherapy and radiation are both associated with osteoporosis and increased risk of fracture.
12. Chronic stress or trauma
The link between chronic stress and pelvic pain was established nearly 25 years ago. Both chronic and acute stress exposure can cause pelvic pain with the latter being linked to increased severity of symptoms.
Chronic pelvic pain tends to occur in the absence of a known cause and is accompanied by several comorbidities. It’s believed that stress and anxiety can cause tightness in the pelvic floor muscles that creates pelvic pain in the same way that carrying stress in the muscles of your neck can cause neck pain and headaches.
13. Ectopic pregnancy
In normal pregnancy, the fertilized egg attaches itself to the lining of the uterus. An ectopic pregnancy describes a situation where the fertilized egg gets stuck on the way to the uterus.
The egg typically gets lodged in one of the fallopian tubes (called a tubal pregnancy), but it can get stuck in an ovary, the abdominal cavity, or the cervix. Ectopic pregnancy may cause severe, persistent pain and vaginal bleeding.
Other symptoms that have been associated with ectopic pregnancy include pain at the tip of the shoulder, syncope, and pain with neck motion.
14. Ovarian cysts
Ovarian cysts are fluid filled cysts located in or on an ovary. These cysts are common and may not be detected as they can be painless. Ordinary ovarian cysts do not cause harm and will disappear on their own.
These cysts can become problematic if they are large, twisted or rupture. Symptoms of an ovarian cyst problem include pelvic pain, bloating, and pressure or heaviness in your belly,
Severe pain just below the belly button accompanied by nausea and vomiting or pain may indicate a serious problem and should be checked by your physician.
15. Uterine fibroids
During your childbearing years, noncancerous growths called uterine fibroids can develop on the uterus. Most women have uterine fibroids at some point in their lifetime and don’t even know it because they’re small and non-painful.
You can have one fibroid or many and they can vary in size from tiny to large enough to distort the shape of the uterus. Uterine fibroids that are symptomatic may cause heavy menstrual bleeding, long periods, pelvic pain, frequent urination, and back or leg pain.
In women with endometriosis, tissues that are similar to the endometrium (the lining of the uterus) grow outside of the uterus. During the menstrual cycle, this endometrial-like tissue acts as normal endometrium would by thickening, breaking down, and bleeding.
Because this tissue is somewhere other than the uterus, it has no way to exit your body and gets stuck. This can cause the tissues around it to become irritated which may result in scarring or adhesions. Symptoms of endometriosis are pelvic pain, excessive bleeding, pain with intercourse, urination, or bowel movements, and excessive bleeding. People with endometriosis may also have difficulty becoming pregnant.
17. Pelvic inflammatory disease (PID)
Pelvic inflammatory disease is often linked to sexually transmitted infections such as chlamydia or gonorrhea, but can have other causes as well. In PID, the infection moves from the vagina or cervix to the upper portion of the genital tract. Normal bacteria can also travel into the genital tract and cause PID; the most common cause of this type of infection is douching which is generally not recommended by anyone in the medical community.
18. Cervical cancer
The relatively new vaccines for the human papillomavirus (HPV) have been integral in reducing the incidence of cervical cancer, but the disease has not been eradicated.
Cervical cancer occurs in the cells of the lower part of the uterus that connects to the vagina- the cervix. This cancer can be difficult to find as the early stages are typically symptomless.
Signs of advanced cervical cancer include bleeding after intercourse, between periods, or after menopause as well as pelvic pain, painful intercourse, and vaginal discharge that is heavy and odorus.
19. Ovarian cancer
The signs and symptoms of ovarian cancer are common to several other cancers and even non-cancerous diseases. When these symptoms are caused by ovarian cancer, they tend to occur more often and are typically more severe.
If you have these symptoms more than a dozen times in 30 days, it’s time to seek medical attention:
- pelvic pain
- abdominal pain
- difficulty eating or quickly feeling full
- urinary urgency or frequency
Other symptoms of ovarian cancer may be extreme tiredness, back pain, painful intercourse, constipation, changes in your period, and abdominal swelling with weight loss.
20. Uterine cancer
Uterine cancer can be divided into endometrial cancer and uterine sarcoma. Cancer of the endometrium is a common gynecologic cancer whereas uterine sarcomas are quite rare.
The precise cause of uterine cancer is unknown. The symptoms of uterine cancer can include
- vagina bleeding between periods
- vaginal bleeding or spotting postmenopause
- lower abdominal/pelvic pain and cramping
- white or clear vaginal discharge postmenopause
- prolonged, heavy vaginal bleeding in women over age 40.
How is pelvic pain diagnosed?
The examination process to diagnose pelvic pain starts with you giving your health care practitioner a thorough health history. Describing your pain and symptoms is the first step in getting to what’s causing your problem.
After your health history is complete, the physician will perform a physical exam where they examine your abdomen and pelvis as well as the organs, muscles, and tissues in your pelvic region for pain or tenderness that might lead to a diagnosis.
Based on your exam, additional testing may be indicated. Your physician might send you for blood work, urinalysis, or more advanced testing, such as pelvic ultrasound or laparoscopy, MRI, cystoscopy (instrumented-assisted view of the bladder), or a colonoscopy (instrument-assisted view of the bowel).
It’s important to note that all of the body’s organs and systems interact with one another to create homeostasis so infection or dysfunction in one area can lead to seemingly unrelated problems in another area.
An example of this is the confusion that comes with a UTI in older adults. Remember that illness and infection are stressors to your body, and this stress can throw other systems or organs out of whack.
Behavior changes or difficulty with tasks that used to be easy could be a clue that something more serious is going on. Subtle changes in behavior, especially in older adults, should not be ignored.
Blood and urine tests
Laboratory testing can be used to detect elevated white blood cell counts, pregnancy, sexually transmitted infection, or a urinary tract infection.
CT scans can help your health care practitioner visualize masses or tumors that may be cancerous as well as fractures, intra-abdominal bleeding, obstructions, and appendicitis. CT can also detect signs of PID via thickened uterosacral ligaments and swollen lymph nodes.
Ultrasound is a helpful tool for looking at the pelvic organs. Ultrasound can be performed internally (transvaginal) or externally (transabdominal). While transvaginal ultrasound may be uncomfortable, the procedure should not be painful. Some of the conditions that ultrasound can help healthcare providers visualize are abnormalities in the uterus, tumors, PID, bleeding, and ectopic pregnancy.
Laparoscopy is a diagnostic procedure that is used to evaluate your abdominal organs. The laparoscope is a thin, lighted tube that has a video camera; the tube is inserted into a small incision in your belly and recovery is much faster than with traditional surgery. Laparoscopy allows your doctor to check for tumors, bleeding, infection, blockages, unexplained pain, and other conditions.
Hysteroscopy is performed using a flexible, thin, lighted tube called a hysteroscope. The hysteroscope is inserted through your vagina and can be used to take a biopsy (tissue sample), remove polyps or fibroid tumors, or to prevent bleeding through the use of electric current, freezing, heat, or chemical to destroy problematic tissue.
Because STIs are associated with PID, you may need a test to determine the presence of an infection. The most common infections associated with PID are chlamydia and gonorrhea. Bpth infections can be detected by the same test which can be performed at home or in a lab through a urine sample.
There are two types of pregnancy tests- blood and urine. The urine tests are easy to find at your local pharmacy or drugstore. Blood tests are more accurate and can detect pregnancy sooner but need to be performed in your doctor’s office.
To find the source of your pelvic pain your doctor may press on specific areas in your abdomen to elicit pain in a particular organ in an effort to direct their diagnosis and treatment. They may also perform an internal exam to determine if the muscles of the are in spasm or if they are able to contract and relax normally.
Can I treat pelvic pain at home?
The suggested remedies for pelvic pain can vary based on your diagnosis. Some tried and true options are over-the-counter pain relievers, a warm bath or heating pad, meditation, massage, CBD oil, and rest.
Exercise may seem like the last thing you want to do when you are in pain, but the increase in blood flow coupled with the release of endorphins (a chemical response to exercise that makes you feel good) can provide an at-home pain relief option.
Dr. Alexandra “Alex” Hill, a physical therapist at UFHealth Jacksonville and the owner of OncoPelvic PT, LLC, suggests these home remedies and more. “The main thing to work on with pelvic pain is calming down the nervous system,” Hill said.
She encourages diaphragmatic breathing, which is the practice of taking slow, deep breaths in through the nose that fill your abdomen and chest and then breathing out slowly through your mouth. Diaphragmatic breathing can be done throughout the day and with any pain flares. Hill also recommends doing a “body check” throughout the day. To do this, scan your body from head to toe and learn which groups of muscles tend to hold tension.
“By learning to check in with your body and understanding how it responds to stress, you will better be able to relax your muscles,” she said. “Common muscle groups that tend to hold stress when pelvic pain is present include the jaw, abdomen, glutes, and pelvic floor.”
Most information sources will use the term exercises, but Hill really describes this more as gentle, daily movement. She advises that finding ways to get outside and get moving can be particularly helpful.
“This can include walking, yoga, or gardening; anything that gets you moving!” she said.
When should I see my doctor for pelvic pain?
As with most conditions, not all pelvic pain is created equal. Deciding when to see treatment can be a difficult decision to make. You should seek immediate treatment from the nearest emergency room if you have sudden pain that is sharp or severe, are or were recently pregnant, have bloody urine or stool, or can’t stand up because of the pain.
Less severe symptoms should still lead you to make an appointment with your physician or physical therapist to get relief. You’ll know it’s time to seek help if your pain lasts more than a few weeks, worsens during sexual intercourse, or affects your activities of daily living. Pain that doesn’t improve, comes and goes, or increases in frequency or intensity should be discussed with a healthcare practitioner.
“If pain is felt in the pelvic region (including the abdominal, vaginal, and/or rectal areas), an individual will benefit greatly from the assistance of a pelvic floor physical therapist as soon as possible,” said Dr. Lindsay Fader, a physical therapist and the founder and president of The Pelvic Advantage, a women’s health agency focused on the functional improvement in women’s bodies before, during, and after pregnancy and surgery.
She explains that it’s just as important to address the pelvic floor and related muscles as it is any other musculoskeletal injury.
“Most of the women I treat have hypertonic pelvic floor muscles and this increased tension is a key component of their pain,” Fader said. “It is important to be evaluated by a pelvic floor physical therapist to become aware of the state of the pelvic floor muscles and what each woman’s specific body needs to improve pelvic health and function without pain.”
Pelvic pain resources
Entropy Physiotherapy and Wellness, Chicago, Illinois
Evidence in Motion, San Antonio, Texas
Beyond the Kegel, Institute for Pelvic Health, Boston, Massachusetts
Integrative Approaches to Pelvic Pain in Women, Tucson, Arizona
Conquering Pelvic Pain: Fitness & Education to Empower Women, Princeton, New Jersey
Penny Goldberg, DPT, ATC
Penny Goldberg, DPT, ATC earned her doctorate in Physical Therapy from the University of Saint Augustine and completed a credentialed sports residency at the University of Florida. She is a Board Certified Clinical Specialist in Sports Physical Therapy.
Penny holds a B.S. in Kinesiology and a M.A. in Physical Education from San Diego State University. She has served as an Athletic Trainer at USD, CSUN, and Butler University.
She has presented on Kinesiophobia and differential diagnosis in complicated cases. Penny has published on returning to sports after ACL reconstruction and fear of movement and re-injury.
Outside of the clinic, Penny enjoys traveling, good cooking with great wine, concerts, working out and playing with her dogs.