Lower Abdominal Pain - Pelvic Pain in Females

Overview, Causes, & Risk Factors

A woman's pelvis contains the uterus, fallopian tubes, ovaries, vagina, bladder, and rectum. Pelvic pain refers to any pain or discomfort in this area of the body.

What is going on in the body?

Pelvic pain is a common symptom in women. It is frequently, but not always, related to the reproductive system. Other causes of pelvic pain are related to the intestines or urinary tract. Psychological factors can make the pain seem worse, or even cause a sensation of pain where no physical problem exists.

Pelvic pain can range from mild discomfort or cramping, to severe, intense pain. This pain may be acute, when it occurs suddenly, or chronic, when the pain lasts for a long period of time.

What are the causes and risks of the condition?

Pelvic pain in females has many causes including:

  • pelvic adhesions, which are fibrous bands holding parts together that are usually separate
  • endometriosis, a disorder in which patches of endometrial tissue (normally found only in the lining of the uterus) grow outside the uterus
  • peritonitis, an inflammation usually caused by an infection of the lining of the abdomen
  • urinary tract infection
  • hernia, or a bulging of internal organs or tissues through an abnormal opening in the muscle wall
  • menstrual cramping
  • Mittelschmerz, which is pain in the middle of the menstrual cycle caused by ovulation
  • ectopic pregnancy, a pregnancy in which the fetus develops outside of the uterus
  • twisted ovary
  • miscarriage
  • ovarian cysts
  • uterine fibroid, a noncancerous growth that occurs in the wall of the uterus
  • colon cancer or ovarian cancer
  • diverticulosis, a saclike protrusion of any part of the digestive tract, usually in the large intestine
  • irritable bowel syndrome
  • gastroenteritis, a general term for a group of conditions caused by infection in the digestive tract
  • kidney stones
  • abscess, or an accumulation of pus usually caused by a bacterial infection
  • pelvic inflammatory disease (PID), an infection of the uterus, fallopian tubes, and adjacent pelvic structures. PID is commonly caused by a sexually transmitted disease that is not treated quickly and effectively.
  • appendicitis, or inflammation of the appendix
  • musculoskeletal disorders, such as a misalignment or shifting of the pelvic bones
  • psychological factors, such as stress

    • Other causes are also possible. In some cases, the cause is never found.

    Symptoms & Signs

    What are the signs and symptoms of the condition?

    When a woman has pelvic pain, the healthcare provider will want more information. Questions may be asked about the pain, including:

  • When did the pain start?
  • How long has the pain existed? When does it stop? How often does it occur?
  • What type of pain is it? Dull, sharp, steady, or crampy?
  • Where is the pain located?
  • When was the last menstrual period? Was it a normal period?
  • Is there any vaginal bleeding or drainage?
  • Does anything decrease the pain or make the pain worse?
  • Are there any other symptoms, such as fever, fatigue, malaise, nausea, vomiting, change in bowel movements, or trouble urinating?
  • Is the woman sexually active? Does she use protection?
  • What medications, drugs, or herbs does the person take, if any?
  • Is there a history of any other medical problems or surgery?

    • Other questions may also be asked in some cases.

    Diagnosis & Tests

    How is the condition diagnosed?

    Diagnosis of pelvic pain begins with a history and physical exam. The healthcare provider may order tests, including:

  • a urinalysis and a urine culture to rule out any kidney or bladder disorders, such as an infection or kidney stones
  • blood tests, which may include a complete blood count or CBC, to check for infection
  • a pregnancy test
  • a pelvic exam to help determine which organs are affected and whether an infection is present
  • other types of x-ray tests, such as ultrasound, CT scans, or MRI scans

    • Prevention & Expectations

    What can be done to prevent the condition?

    Prevention of pelvic pain may or may not be possible, depending on the cause. Some ways to decrease the risk of pelvic pain include:

  • practicing safer sex to decrease the risk of sexually transmitted disease and secondary PID
  • seeking early treatment for infections of the genital tract, such as PID
  • oral contraceptives, which may reduce the risk of pelvic pain associated with painful ovulation
  • drinking plenty of fluids every day and avoiding dehydration to prevent kidney stones

    • Many of the causes of pelvic pain cannot be prevented.

    What are the long-term effects of the condition?

    Long-term effects are related to the cause of the pelvic pain. For example, irritable bowel syndrome may make a person uncomfortable and even depressed, but poses no serious long-term health risks. A small kidney stone may pass by itself and have no long-term effects. A large kidney stone may require surgery to remove. Cancer may lead to death if treatment is unsuccessful. A woman with an ectopic pregnancy may need surgery, and in some cases, may have to have the fallopian tube removed.

    What are the risks to others?

    Pelvic pain itself is not contagious and poses no risk to others. However, if the pain is caused by a sexually transmitted disease, that infection is contagious.

    Treatment & Monitoring

    What are the treatments for the condition?

    Specific treatment for pelvic pain depends on the cause of the pain. Treatment may include:

  • antibiotics
  • nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen
  • pain medication
  • oral contraceptives to stop pain caused by ovulation
  • surgery
  • relaxation exercises
  • physical therapy

    • What are the side effects of the treatments?

    Side effects to treatment will depend on the treatment used. There may be stomach upset, diarrhea, or allergic reaction to antibiotics. There may be stomach upset, ulcers and bleeding, or allergic reaction to NSAIDs. NSAIDs may also affect the liver and kidneys. Treatments that require surgery pose a risk of bleeding, infection, and allergic reaction to anesthesia.

    What happens after treatment for the condition?

    What happens after treatment depends on the success of the treatment and the cause of the pain. For example, those who pass a kidney stone on their own or have it removed may not need any further treatment. Those with cancer may need long-term treatment for the cancer and may die if treatment is unsuccessful.

    How is the condition monitored?

    Any new or worsening symptoms should be reported to the healthcare provider.

    Attribution

    Author:Gail Hendrickson, RN, BS
    Date Written:
    Editor:Smith, Mary Ellen, BS
    Edit Date:10/10/00
    Reviewer:Eileen McLaughlin, RN, BSN
    Date Reviewed:07/05/01

    Sources

    Harrison's Principles of Internal Medicine, 1998, Fauci et al.

    The Merck Manual of Medical Information, 1997

    Professional Guide to Diseases: 6th edition, 1998