Chronic pelvic pain

Overview

Chronic pelvic pain is pain in the area below the bellybutton and between the hips that lasts six months or longer.

Chronic pelvic pain can have more than one cause. It may be a symptom of another disease, or it can be a condition in its own right.

If chronic pelvic pain seems to be caused by another health condition, treating that problem may get rid of the pain.

But tests may not be able to find a cause for chronic pelvic pain. In that case, the goal of treatment is to ease pain and other symptoms. That could make your quality of life better.

Symptoms

You may feel chronic pelvic pain in different parts of your pelvic area, rather than in just one spot. You might describe the pain in one or more of the following ways:

• Serious and steady.
• Pain that comes and goes.
• Dull aching.
• Sharp pains or cramping.
• Pressure or heaviness deep within the pelvis.

The pain also may happen:

• During sex.
• While having a bowel movement or urinating.
• When you sit or stand for a long time.

Chronic pelvic pain may be mild. Or it may be so intense that you miss work and can't sleep or exercise.

Other symptoms can include:

• An urgent or frequent need to urinate.
• Bloating.
• Upset stomach.
• Constipation or diarrhea.

When to see a doctor

In general, see your healthcare professional if the pain disrupts your daily life or if your symptoms seem to get worse.

Causes

Chronic pelvic pain is a complex health problem. Sometimes, tests may find that a single disease is the cause. In other cases, the pain may stem from more than one medical condition. For example, you might have endometriosis and interstitial cystitis, both of which play a role in chronic pelvic pain.

Some causes of chronic pelvic pain include:

• Endometriosis. This is a disease where tissue that's like the lining of the uterus grows outside the uterus. It may cause pain or infertility.
• Muscle and bone problems. Health issues that affect bones, joints and connective tissues can lead to pelvic pain that keeps coming back. These problems include fibromyalgia, tension in pelvic floor muscles, swelling of the pubic joint or a hernia.
• Nerve injury. Injured or trapped nerves in the pelvis or lower stomach area can lead to ongoing pelvic pain. Nerve problems might happen after surgery in the lower stomach area, such as having a C-section. Or lasting pain could result after injury to a nerve in the pelvis called the pudendal nerve from repetitive activities such as cycling, riding horses or sitting for long periods of time. This condition is called pudendal neuralgia.
• Chronic pelvic inflammatory disease. This can happen if a long-term infection, often spread through sex, causes scarring that involves the pelvic organs.
• Ovarian remnant. After surgery to remove one or both ovaries, a small piece of ovary may be left inside by mistake. Later, this leftover tissue may form painful cysts.
• Fibroids. These growths inside, on or attached to the uterus aren't cancer. But they may cause pressure or a feeling of heaviness in the lower stomach area or lower back. Rarely, they cause sharp pain.
• Irritable bowel syndrome. Symptoms linked with irritable bowel syndrome — bloating, constipation or diarrhea — can be a source of pelvic pain and pressure.
• Painful bladder syndrome. This also is called interstitial cystitis. It's linked with pain in the bladder that keeps coming back. It's also tied to a frequent need to urinate. You may have pelvic pain as your bladder fills. The pain may get better for a while after you empty your bladder.
• Pelvic congestion syndrome. Enlarged, varicose-type veins around the uterus and ovaries can lead to pelvic pain.
• Mental health risk factors. Depression, long-term stress, or a history of sexual or physical abuse may raise your risk of chronic pelvic pain. Emotional distress can make pain worse. And long-term pain can fuel distress. These two factors often become a vicious cycle.

Risk factors

Many conditions are linked to chronic pelvic pain. Having more than one condition that causes pelvic pain, such as endometriosis and fibroids, raises the risk. A history of sexual or physical abuse also may raise the risk.