Pelvic Pain Explained

Pelvic Pain Explained

What Is Pelvic Pain?

Pelvic pain refers to discomfort felt in the lower abdomen — the area below the belly button and between the hips. It can be:

  • Acute pelvic pain: sudden, intense pain lasting hours to days
  • Chronic pelvic pain: recurring or continuous pain lasting 3 months or more

Men and women experience pelvic pain differently because of differences in reproductive anatomy. In all cases, pelvic pain is a symptom, not a diagnosis — and understanding its cause is key to effective treatment.

 

Common Causes of Pelvic Pain

Pelvic pain has many possible sources. Below are the main categories doctors consider when investigating symptoms.

1. Gynaecological Causes

Pelvic pain in women is frequently linked to the reproductive system. Common causes include:

  • Endometriosis: tissue similar to the uterine lining grows outside the womb, causing severe pain
  • Ovarian cysts: fluid-filled sacs on the ovaries that may twist or rupture
  • Fibroids: benign growths that can cause pressure and heavy periods
  • Adenomyosis: uterine tissue grows into the muscle wall
  • Pelvic inflammatory disease (PID): infection often caused by untreated STIs

These conditions can cause cramping, deep pelvic aching, painful intercourse, and irregular bleeding.

2. Urological Causes

Pain coming from the urinary system includes:

  • Urinary tract infections (UTIs)
  • Bladder inflammation (cystitis)
  • Kidney stones
  • Interstitial cystitis (chronic bladder pain)

Symptoms often involve burning urination, urgency, frequency, or flank pain.

3. Gastrointestinal Causes

Problems in the digestive system can mimic pelvic pain:

  • Irritable bowel syndrome (IBS)
  • Constipation or bloating
  • Appendicitis
  • Inflammatory bowel disease (IBD)

Pain is often accompanied by bowel habit changes, nausea, or abdominal swelling.

4. Musculoskeletal Causes

Pain originating from muscles, joints, or nerves in the pelvis and lower back may include:

  • Pelvic floor dysfunction
  • Sacroiliac joint dysfunction
  • Lower back degeneration
  • Nerve entrapments (e.g., pudendal neuralgia)

This pain can worsen with movement, sitting, or posture changes.

5. Sexually Transmitted Infections (STIs)

STIs such as chlamydia or gonorrhoea can cause pelvic inflammation and deep aching — especially if untreated.

 

Recognising the Symptoms

Pelvic pain varies depending on the underlying cause. Symptoms that often accompany pelvic discomfort include:

  • Sharp, stabbing, or cramping pain
  • Pain during intercourse
  • Irregular or heavy menstrual bleeding
  • Nausea or vomiting
  • Fever or chills
  • Urinary burning, urgency, or frequency
  • Bloating or constipation
  • Deep ache in the lower back
  • Pain that worsens with sitting or standing
  • Vaginal discharge or odour
  • Pain radiating into the thighs or groin

Symptom patterns — such as pain linked to your menstrual cycle, urination, bowel movements, or sexual activity — provide important diagnostic clues.

 

When Should You Seek Medical Help?

Seek medical attention urgently if you experience:

  • Severe pelvic or abdominal pain
  • Fever with pelvic pain
  • Fainting or dizziness
  • Heavy vaginal bleeding
  • Pain after positive pregnancy test (risk of ectopic pregnancy)
  • Pain with vomiting
  • Sudden sharp pain after exercise or intercourse
  • Inability to pass urine or stool

These may indicate emergencies such as appendicitis, ovarian torsion, ruptured cysts, or ectopic pregnancy — conditions that require prompt care.

For chronic pelvic pain, seek help if:

  • Pain persists longer than 3 months
  • Symptoms disrupt daily activities
  • Over-the-counter pain relief is ineffective
  • Pain affects sleep, mood, or sexual health

 

Diagnosis and Testing

Diagnosing pelvic pain requires a structured approach.

How doctors investigate pelvic pain:

  1. Medical history
    • Symptom patterns
    • Menstrual history
    • Sexual health history
    • Bowel and bladder symptoms
  2. Physical examination
  3. Diagnostic tools
    • Ultrasound
    • CT or MRI
    • Urine tests
    • STI screening
    • Pelvic floor assessment
    • Laparoscopy (in selected cases)

How The Pain Collective diagnoses pelvic pain

The Pain Collective uses a multidisciplinary approach that includes:

  • Specialist doctor evaluation
  • Detailed pain history and pattern analysis
  • Pelvic floor and musculoskeletal assessment
  • Ultrasound or nuclear medicine imaging when appropriate
  • Exclusion of red-flag medical conditions
  • Identification of nociceptive, neuropathic, or nociplastic pain drivers

This structured model ensures your treatment targets the true source of your symptoms.

 

Treatment Options

Pelvic pain treatment depends entirely on its cause.

Medical and Pharmacological Treatments

Condition

Common Treatment Options

Endometriosis

Hormonal therapy, NSAIDs, surgery (if needed)

UTIs

Antibiotics, increased fluids

Pelvic floor dysfunction

Physiotherapy, biofeedback

IBS

Dietary modification, antispasmodics

Interstitial cystitis

Bladder instillations, neuromodulation

Nerve pain

Neuropathic medications, nerve blocks, PRF

 

Interventional Options (Available at The Pain Collective)

The Pain Collective uses evidence-based procedures such as:

  • Pulsed Radiofrequency Neuromodulation (PRF) for pudendal neuralgia, sacral roots, sympathetic chain pain
  • Pelvic nerve blocks
  • Ilioinguinal and genitofemoral nerve treatments
  • Trigger point injections
  • Sacroiliac joint interventions

These treatments help reduce pain, calm sensitized nerves, and restore function.

Lifestyle and Physical Therapy Approaches

  • Pelvic floor physiotherapy
  • Diet modification (IBS, IBD, bladder pain)
  • Stress reduction
  • Hormonal regulation
  • Graded exercise programmes
  • Trauma-informed counselling

Chronic pelvic pain often responds best to a multimodal approach — combining medical, physical, and psychological care.

 

Living with Chronic Pelvic Pain

Chronic pelvic pain can affect sleep, mood, relationships, and mobility. A long-term management plan may include:

  • Physiotherapy
  • Occupational therapy
  • Counselling or cognitive behavioural therapy
  • Pelvic floor rehabilitation
  • Heat therapy
  • Movement retraining
  • Support groups and pain education
  • Avoiding known triggers

South African resources include endometriosis support groups, pelvic pain therapy networks, and chronic pain programmes like those at The Pain Collective.

 

Final Thoughts

Pelvic pain is common — but it is not something you should ignore or simply “live with.” Most causes are treatable once properly diagnosed, and early intervention can prevent complications.

Before your GP or specialist visit, note:

  • When the pain occurs
  • What makes it worse or better
  • Associated symptoms
  • Relation to menstrual cycle or bowel/bladder habits

With the right clinical support, relief is not only possible — it’s likely.

 

FAQs

1. What are the most common causes of pelvic pain in women?

Endometriosis, ovarian cysts, fibroids, UTIs, pelvic inflammatory disease, IBS, and pelvic floor dysfunction are the most frequent causes.

2. How can I tell if my pelvic pain is serious?

Seek urgent help if pain is severe, sudden, accompanied by fever or bleeding, or occurs during pregnancy. Persistent pain over 3 months also warrants evaluation.

3. What tests are used to diagnose pelvic pain in South Africa?

Ultrasound, urine tests, STI screening, pelvic exams, CT/MRI scans, and specialised nerve assessments. In rare cases, diagnostic laparoscopy may be recommended.

4. Is pelvic pain always related to gynaecological issues?

No. Pelvic pain may arise from urinary, digestive, musculoskeletal, or neurological causes — not only reproductive organs.

5. Can pelvic pain be managed without medication?

Yes. Physiotherapy, pelvic floor therapy, lifestyle modifications, counselling, and neuromodulation-based treatments often provide significant relief without chronic medication use.

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