Pelvic Pain In Women : Causes

Chronic pelvic pain may be defined as the pain occurring below the umbilicus that persists for at least six months. The condition is more commonly seen in reproductive-aged women, around 26-30 years of age.

Pelvic pain can be constant or intermittent. Constant pain is the outcome of a number of problems while intermittent pelvic pain is usually due to a specific cause.

The causes of chronic pelvic pain are numerous. An assortment of gynecological, gastrointestinal and urinary conditions can lead to the onset of pelvic pain.

(A) Gynecological Causes: Gynecological cause are believed to be the main cause of pelvic pain in about 20% of women. The important ones are as follows:

1. Endometriosis- Endometrium is the innermost lining of uterine cavity. The presence of endometrial tissue at some other place outside the uterine cavity is termed as endometriosis. The tissue may be attached to ovaries, fallopian tubes, bladder or intestines. Endometriosis causes intense pain in pelvic region especially during coitus or menstruation. Apart from pain it may also lead to abnormal bleeding or even infertility.

2. Pelvic Inflammatory Disease (PID)- PID is the infection resulting from sexually transmitted agent or organisms. It may affect uterus, ovaries and fallopian tubes. PID causes pain in the pelvic region and sometimes bleeding may be present.

3.Vulvodynia- The pain occurring in or around vulva is known as vulvodynia. It is described as stinging or even burning pain in external female genitalia.

4. Fibroids- Uterine fibroids are noncancerous benign outgrowths in the uterine cavity. They cause cramps or sharp acute pain. The pain is usually worse in the menstrual period and during sex.

5. Instability of Pelvic Joints- It is seen that during childbirth, ligaments stretch to facilitate fetal descent; as a result they tend to become loose and cause pain and discomfort in pelvic area.

6. Pelvic Adhesions- Usually due to previous surgery like Cesarean section or surgery on the uterus for its removal. These adhesions can sometimes cause excruciating pain in pelvic region.

7. Ovarian Cysts- During ovulation ovaries release egg, but sometimes it is seen that instead of releasing egg, the follicle becomes filled with fluid and cause irritation and pain in pelvic area. This pain is localized in such conditions.

8. Dysmenorrhoea- Dysmenorrhoea or painful menses is a condition where pain with cramps is felt by females during menstruation. It can be relieved by administering antispasmodics and analgesics.

9. Ectopic Pregnancy- This condition does not cause chronic pelvic pain as it is more of an acute situation with pain in the pelvis. The pregnancy that occurs outside the uterus commonly in fallopian tubes is termed as ectopic pregnancy. It is a medical emergency and a life threatening condition and require active medical intervention. Usually pain starts on one side of the abdomen, after a missed period. It may be accompanied with slight spotting or bleeding. The tubes may burst and immediate medical help is required to save the patient’s life.

(B) Other Causes: The other important causes of pelvic pain are associated with urinary, gastrointestinal systems or with muscles and nerves of pelvic area.

1. Irritable Bowel Syndrome- It is an important gastrointestinal cause of pelvic pain. Irritable Bowel Syndrome or IBS is the abdominal pain occurring as a result of deranged bowel habit e.g. loose stools and increased bowel movements. Pain usually subsides with defecation.

2. Interstitial Cystitis or Painful Bladder Syndrome- Bladder pain without any associated infection is termed as Painful Bladder Syndrome or Interstitial Cystitis (PBS/IC). The symptoms are increased frequency and urgency of micturition. Females suffering from PBS also experience lower abdominal discomfort and pelvic pain.

3.Diverticulitis- A sac like protrusion is sometimes found in the colonic muscular wall. This is called diverticulum.. The inflammation of diverticula is termed as diverticulitis. It’s important symptoms include pelvic pain, diarrhea, nausea and vomiting. It is an important cause of digestive system amounting to pelvic pain and discomfort.

4. Fibromyalgia- The muscles of pelvic floor or pelvic diaphragm includes levator ani, coccygeus and connective tissues of pelvic area. The connective tissue, muscles and ligaments of pelvic floor are affected in fibromyalgia. Apart from pain, the affected females also experience generalized fatigue, headache and even mood disturbances.

5. Neuropathy (Pelvic Nerve Pain)- Pelvic nerve pain is also an important cause of pelvic pain occurring in females.

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