Pelvic Abdominal Pain

Pelvic pain is an unpleasant sensation that occurs in the lower area below the navel and above the scapula. Pelvic pain does not include pain outside the vulva area.  

Pain is considered chronic if it lasts for 4 to 6 months. 

This is also a common symptom for most women.  

Pelvic pain is a symptom that is caused by a disease of the genitals or pelvic organs. 

The pain sometimes comes on suddenly and goes away on its own. The pattern of pain can be intense, self-limiting or dull, continuous or a combination of patterns. The pain can gradually increase in intensity, sometimes occurring in waves. Pelvic pain may be related to the menstrual cycle, which occurs monthly, before or during menstruation, or between periods. 

Pain may also be accompanied by fever, nausea, vomiting, sweating, and dizziness. 

Often, with pain alone, it is difficult to determine the cause of pelvic pain.   

1/ Gynecological causes  

Gynecological causes may or may not be related to the menstrual cycle. The most common gynecological causes of pelvic pain include:  

• Dysmenorrhea (dysmenorrhea) 
•  Pain in the middle of the menstrual cycle (Mittelschmerz syndrome), which occurs during ovulation 
•  Endometriosis (the Unusual, ectopic, scattered endometrial fra).  
• Fibroidsbroids are noncancerous tumors made of muscle and fibrous tissue. Fibroids can cause pelvic pain if the fibroids are degenerating (ischemic) or causing bleeding such as menorrhagia bleeding.  

Most fibroids do not cause pain. Many other gynecological causes can cause pelvic pain:  

• Pelvic inflammatory disease  
• Pelvic adhesions due to sequelae of infection, previous surgery, or endometriosis.  
• Compression or damage to the pelvic nerves due to benign or malignant tumors. 
• Depression, especially postpartum depression.  

Psychological factors, especially stress and depression, can contribute to any type of pain, including pelvic pain, but are rare. 

Many women experience chronic pelvic pain as a result of physical, psychological, or sexual abuse. Adolescents and young girls who are sexually abused may experience pelvic pain. In such women and girls, psychological factors may contribute to the pain.  

Other common causes of pelvic pain include:  

• Gastrointestinal disorders : Gastritis, constipation, collection of pus (abscess) and tumors (which may or may not be cancerous), for example such as colon (large intestine) cancer.  
• Urinary disorders: Infection (cystitis), stones in the urinary tract (ureteral stones), and non-infectious cystitis (interstitial cystitis).  
• Musculoskeletal disorders: pelvic joint dilatation after childbirth, pelvic trauma. 
• Other common causes: Abscess in the pelvis and abdominal aortic aneurysm (a bulge in the wall of the aorta)  

2/ Evaluation of pelvic pain  

When a woman has acute, sudden, severe pain in the abdomen below, the doctor must quickly decide if urgent surgery is needed. Common causes of urgent surgery include 

•  Appendicitis  
• Perforated ectopic pregnancy (ectopic pregnancy – not in a normal position in the uterus) 
•  Ovarian torsion (twist of the appendage)  
• Perforated abscess in the pelvis 
•  Aneurysm Abdominal aorta  

3/ Warning signs  

In women with pelvic pain, there are several troubling accompanying symptoms: 

•  Dizziness, short-term sudden loss of consciousness (fainting), or dangerously low blood pressure (shock) . 
• Vaginal bleeding after menopause. 
•  Fever or chills.  
• Sudden, severe pain, especially accompanied by nausea, vomiting, profuse sweating, or agitation.

4/ When to see the doctor? 

 Women with most of the warning signs should see a doctor right away. With the only warning sign being vaginal bleeding after menopause, you can see your doctor within a week or make an appointment. 

 If it gets worse, you should see a doctor right away. If you have acute, intermittent, and not worse pain you can schedule an appointment, a delay of a few days is usually not harmful. 

 Recurrent or chronic pelvic pain should be evaluated by a doctor at some point.  

5/ What does the doctor do? 

Your doctor will ask you about your symptoms and medical history. During the examination, to find the cause, the doctor will order a few tests. After examination, causes requiring urgent surgery will be ruled out.  

6/ Test Routinely  

Performed Tests:  

• A urinalysis is a simple, rapid urinalysis that can rule out many common causes of pelvic pain such as bladder and kidney infections.  
• Urine tests to confirm pregnancy or not? 
•  If pregnancy is confirmed, an ultrasound will be performed to rule out an ectopic pregnancy. Gynecological ultrasounds are commonly performed to make it easier for doctors to find the cause.  
• If the ultrasound results are not clear, other tests, such as blood tests or laparoscopy 

Tests, depending on what cause is suspected, may also include:  

• Examination and culture of urine or secretions to check for infections that can cause pelvic pain 
•  Ultrasound , computed tomography (CT) or magnetic resonance imaging (MRI) of the abdomen and pelvis to check for a tumor 
•  If other tests fail to identify a cause, laparoscopy  

7/ What to look out for in older women 

In older women with age, common causes of pelvic pain can vary, especially after menopause.  

Common causes in older women include 

•  Bladder problems, including cystitis infections  
• Constipation  
• Pelvic organ prolapse 
• Genital cancer, such as endometrial cancer, ovarian cancer, and tubal cancer (rare). 

After menopause, estrogen levels drop, weakening many tissues, including bones, muscles (including bladder muscles), and tissues around the vagina and urethra. As a result, fractures and bladder infections became more common.  

Additionally, this weakens can contribute to pelvic organ prolapse, which can cause symptoms as a woman age.  

Older women are more likely to take many medications for medical conditions, which can cause constipation. 

In older women, the vaginal lining becomes thin and dry after menopause, due to a lack of the hormone estrogen. This condition (called atrophic vaginitis), can make sex uncomfortable and painful, and women may feel it like pelvic pain. 

To address the estrogen deficiency, the doctor examines and decides on hormone replacement therapy. 

Older women should see a doctor promptly if they have symptoms such as:  

• Sudden weight loss.  
• Sudden onset of indigestion, loss of appetite.  
• There is a sudden change in bowel movements; constipation or loose stools. to make sure it’s not ovarian cancer or endometrial cancer.  

Pelvic pain can be summed up as follows: 

•  Many women experience pelvic pain. 
• Many causes of genital or other nearby organs can cause pelvic pain.  
• Your doctor can determine the cause based on the nature of your pain, its relationship to your menstrual cycle, and the results of a physical exam.  
• If the woman is of reproductive age, a pregnancy test is always done.  
• Urinalysis and other tests, such as blood tests and pelvic ultrasound, are done to confirm the diagnosis. 
• Dysmenorrhea is a common cause of pelvic pain but is diagnosed only after other causes have been ruled out. 

Source: MSD 

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