Pelvic Pain

What is pelvic pain?

Pelvic pain is pain that occurs in the pelvic area. The pelvic area is the lower part of your abdomen below your belly button, above your legs, and between your hip bones. The pelvic area contains important organs such as your uterus (womb), ovaries, fallopian tubes, bowel, and bladder. This area can also refer to the lower back and upper thighs.

What kinds of pelvic pain are there?

There are many different types of pelvic pain. These include:

• Period pain
• Painful sex
• Pelvic muscle pain
• Vulval pain
• Bowel pain
• Bladder pain
• Chronic pelvic pain

What causes pelvic pain?

There are many different causes of pelvic pain. Sometimes there can be several causes, and sometimes the cause of the pain may not be known.

Pelvic pain can come from the nerves, the pelvic organs, the deep muscles, the bowel, the bladder, the skin, or from certain conditions such as endometriosis (end-oh-me-tree-oh-sis).

Period Pain 

Period pain is the most common type of pelvic pain. Period pain is called dysmenorrhoea (dis-men-oh-re-ah).

What is normal period pain?

Period pain varies a lot from person to person. Normal period pain is defined as pain that only occurs on day 1 or 2 of your period and goes away when you take pain relief. 

If your period pain lasts longer than 2 days, doesn’t go away if you take pain relief, and interferes with work, school, or your normal activities, it is not normal, and you need to see a doctor. 

Painful sex 

Painful sex is pain that happens during or after sex. It is also called dyspareunia (dis-par-roo-nia). There are many different kinds of painful sex including: 

• Vaginal pain when penetration with a penis, finger, or sex toy is attempted
• Pain on deep penetration
• Pain with orgasm
• Skin in the vulval area that is painful to touch

What causes painful sex?

Painful sex has many different causes. These include:

• Endometriosis
• Lack of lubrication 
• Pelvic floor muscle tightness
• Changes to the vulva and vagina after menopause
• Skin conditions, or
• No cause may be found

Is there treatment for painful sex?

The treatment for painful sex will depend on the cause of the pain. You will need to see a doctor with a special interest in this area to find out what is happening for you and what treatment and support might be most helpful for you. For more information about painful sex, see SHFPACT’s Painful Sex Factsheet.

Vaginismus

Vaginismus is an involuntary spasm of the vaginal muscles. It can cause pain and discomfort with sex. It can also make it very difficult to use tampons or have a vaginal examination. There is a lot that can be done to improve pelvic muscle tightness. To find out if this is happening for you and to access treatment and support you will need to see a doctor and/or a pelvic health physiotherapist. Some people also receive help from counselling support.

Bowel pain

Bowel pain usually occurs in the lower abdomen and can feel similar to other pain in the pelvic area. This can make it hard to tell what the pain is.

Bowel pain can take many forms, it can be stabbing, aching, cramping, dull, or gnawing. It can occur at any time or can just happen during or after you do a poo. 

Bowel pain can go together with bloating, constipation, or diarrhoea. Bowel pain can have many causes, including endometriosis. Bowel pain can often resolve on its own but if it doesn’t go away or gets worse it is important to see your GP. 

Bladder pain

Bladder pain is pain or sensitivity that happens in your bladder. If this is ongoing, and is not caused by an infection, it is called Bladder Pain Syndrome (BPS). BPS can cause frequency, urgency (needing to rush to the toilet), needing to get up to pass urine a lot at night, and pain that increases as your bladder fills up then is relieved when you empty your bladder. There are treatments that can help to improve your symptoms so it's important to see your GP to talk about.

What are the symptoms of endometriosis?

Symptoms of endometriosis vary from person to person and can include:

• Severe period pain
• Pain during or after sex
• Pelvic pain, leg pain, lower back pain, or tummy pain that gets worse over time
• Pain when you ovulate 
• Pain during or after you wee or do a poo
• Needing to pass urine often or difficulty holding on
• Bloating 
• Fatigue

What causes endometriosis?

We don’t know what causes endometriosis. There are some things make endometriosis more likely, including:

• If people in your family (such as your mum or a sister) have endometriosis
• If you got your periods when you were very young
• When your period blood flows back into the pelvic cavity instead of out the vagina
• If your periods are very painful, heavy, and frequent
• If you have low body weight

How can I find out if I have endometriosis?

You will need to see a doctor to find out if you have endometriosis.  The doctor will talk to you about your symptoms and may examine your pelvic area. Endometriosis is not always easy to diagnose.

It may sometimes be diagnosed with a specialised type of ultrasound, and some people will need a surgical examination called a laparoscopy to get a diagnosis. Your doctor can discuss this with you. 

How is endometriosis treated?

There are several different treatments for endometriosis, these include:

• Medical treatments (medications)
• Surgical treatments 
• Specialist physiotherapy
• Psychological support

Your doctor will discuss your individual situation and what treatment might be most suitable for you. For more details about treatments see; endometriosisaustralia

Chronic pelvic pain

Chronic pelvic pain is pain that is long term and present on most days. It may be caused by other conditions such as endometriosis, however sometimes the cause may be unknown. It can be burning, sharp and stabbing, or aching. 

When you have had pain for some time, the nerves, brain, and spinal cord become sensitised. It is a medical condition but is one that you can’t see.

Chronic pelvic pain is a condition that needs support and management by a doctor along with a pelvic health physiotherapist and a counsellor or pain psychologist. 

When should I see a doctor about my pelvic pain? 

You should see a doctor if:

• Your period pain lasts more than 2 days and does not go away when you take pain relief 
• You have pelvic pain that has gone on for 6 months or more
• You have pelvic pain that is getting worse
• You have pain during or after sex
• You have pain on most days
• Your pain is affecting your quality of life, including work, school, relationships, social life, and general wellbeing

Funding acknowledgement: This service is supported by funding from the ACT PHN through the Australian Government’s PHN Program.

References

• Endometriosis Australia
• Endozone
• Evans, Susan & Bush, Deborah. 2017 Pelvic Pain
• Healthdirect
• Jean Hailes
• Pelvic Pain Foundation of Australia