Symptoms

When asked to locate your pain, you might sweep your hand over your entire pelvic area rather than point to a single spot. You might describe your chronic pelvic pain in one or more of the following ways:

• Severe and steady pain
• Pain that comes and goes (intermittent)
• Dull aching
• Sharp pains or cramping
• Pressure or heaviness deep within your pelvis

In addition, you may experience:

• Pain during intercourse
• Pain while having a bowel movement or urinating
• Pain when you sit for long periods of time

Your discomfort may intensify after standing for long periods and may be relieved when you lie down. The pain may be mild and annoying, or it may be so severe that you miss work, can’t sleep and can’t exercise.

When to see a doctor

With any chronic pain problem, it can be difficult to know when you should go to the doctor. In general, make an appointment with your doctor if your pelvic pain disrupts your daily life or if your symptoms seem to be getting worse.

Common causes for chronic pelvic pain

Chronic pelvic pain is a complex condition that can have multiple causes. Sometimes, a single disorder may be identified as the cause.

In other cases, however, pain may be the result of several medical conditions. For example, a woman might have endometriosis and interstitial cystitis, both of which contribute to chronic pelvic pain.

Some causes of chronic pelvic pain include:

• Endometriosis. This is a condition in which tissue from the lining of your womb (uterus) grows outside your uterus. These deposits of tissue respond to your menstrual cycle, just as your uterine lining does — thickening, breaking down and bleeding each month as your hormone levels rise and fall. Because it’s happening outside your uterus, the blood and tissue can’t exit your body through your vagina. Instead, they remain in your abdomen, where they may lead to painful cysts and fibrous bands of scar tissue (adhesions).
• Musculoskeletal problems. Conditions affecting your bones, joints and connective tissues (musculoskeletal system) — such as fibromyalgia, pelvic floor muscle tension, inflammation of the pubic joint (pubic symphysis) or hernia — can lead to recurring pelvic pain.
• Chronic pelvic inflammatory disease. This can occur if a long-term infection, often sexually transmitted, causes scarring that involves your pelvic organs.
• Ovarian remnant. After surgical removal of the uterus, ovaries and fallopian tubes, a small piece of ovary may accidentally be left inside and later develop painful cysts.
• Fibroids. These noncancerous uterine growths may cause pressure or a feeling of heaviness in your lower abdomen. They rarely cause sharp pain unless they become deprived of a blood supply and begin to die (degenerate).
• Irritable bowel syndrome. Symptoms associated with irritable bowel syndrome — bloating, constipation or diarrhea — can be a source of pelvic pain and pressure.
• Painful bladder syndrome (interstitial cystitis). This condition is associated with recurring pain in your bladder and a frequent need to urinate. You may experience pelvic pain as your bladder fills, which may improve temporarily after you empty your bladder.
• Pelvic congestion syndrome. Some doctors believe enlarged, varicose-type veins around your uterus and ovaries may result in pelvic pain. However, other doctors are much less certain that pelvic congestion syndrome is a cause of pelvic pain because most women with enlarged veins in the pelvis have no associated pain.
• Psychological factors. Depression, chronic stress or a history of sexual or physical abuse may increase your risk of chronic pelvic pain. Emotional distress makes pain worse, and living with chronic pain contributes to emotional distress. These two factors often become a vicious cycle.

Diagnosis

Figuring out what’s causing your chronic pelvic pain often involves a process of elimination because many different disorders can cause pelvic pain.

In addition to a detailed interview about your pain, your personal health history and your family history, your doctor may ask you to keep a journal of your pain and other symptoms.

Tests or exams your doctor might suggest include:

• Pelvic exam. This can reveal signs of infection, abnormal growths or tense pelvic floor muscles. Your doctor checks for areas of tenderness. Let your doctor know if you feel any discomfort during this exam, especially if the pain is similar to the pain you’ve been experiencing.
• Lab tests. During the pelvic exam, your doctor may order labs to check for infections, such as chlamydia or gonorrhea. Your doctor may also order bloodwork to check your blood cell counts and urinalysis to check for a urinary tract infection.
• Ultrasound. This test uses high-frequency sound waves to produce precise images of structures within your body. This procedure is especially useful for detecting masses or cysts in the ovaries, uterus or fallopian tubes.
• Other imaging tests. Your doctor may recommend abdominal X-rays, computerized tomography (CT) scans or magnetic resonance imaging (MRI) to help detect abnormal structures or growths.
• Laparoscopy. During this surgical procedure, your doctor makes a small incision in your abdomen and inserts a thin tube attached to a small camera (laparoscope). The laparoscope allows your doctor to view your pelvic organs and check for abnormal tissues or signs of infection. This procedure is especially useful in detecting endometriosis and chronic pelvic inflammatory disease.

Finding the underlying cause of chronic pelvic pain can be a long process, and in some cases, a clear explanation may never be found.

With patience and open communication, however, you and your doctor can develop a treatment plan that helps you live a full life with minimal discomfort.