Pelvic Pain

Indentifying Conditions that Cause Pelvic Pain,
to Find a Solution

Most women experience pelvic pain of some type at some point in their lives, and a very long list of conditions can cause such pain.  Many of these conditions, though, can cause severe or longer-term pelvic pain, including uterine fibroids; endometriosis; cancer; menstrual conditions; ovarian cysts; gastrointestinal conditions; ectopic pregnancy; and urologic conditions, such as interstitial cystitis – to name just some.  

Two other general terms refer to conditions that can also cause pelvic pain:

Pelvic inflammatory disease.  In this infectious condition, bacteria or other infectious organisms have crossed the cervical barrier and irritated and affected the uterus, fallopian tubes, or adjacent pelvic structures.  The result can be persistent inflammation or long-term scarring.  Pelvic inflammatory disease can also encompass symptoms from sexually transmitted diseases, vaginal infections, or urinary infections.

Adhesions.  Abnormal physical connections between the surface of organs and structures in the pelvis, usually caused by connective tissue such as scar tissue, can form after injury to tissue in the area due to surgery, infection, or chronic conditions such as endometriosis.  These connections can cause pulling, pressure, or stiffness that results in pelvic pain.

 Significant, chronic pelvic pain is not normal.  Women should make the prudent decision to find out the cause, because effective treatment is often available.

Pelvic pain may be acute (sharp and with rapid onset), intermittent, or constant.  Every woman's tolerance for pelvic pain is different, but certainly when such pain begins to interfere with activities, to affect other aspects of physical health, or to cause distress, it should be evaluated.  

With so many potential causes of pelvic pain, isolating the basis of a woman's discomfort may take time and patience.  The staff at our Center for Gynecology & Women's Health may use a variety of different steps to determine the cause of pelvic pain.  These include:

• taking a medical history;

• physical examination (both standing and prone);

• and a number of different lab and imaging studies.

Ultrasound conducted externally on the pelvis or with a probe introduced through the vagina may be useful.  In addition, our specialists may perform a diagnostic hysteroscopy to view the interior of the uterus or laparoscopy to view the interior of the pelvis.  CT and MR imaging, as well as other radiologic, urologic, and gastroenterologic tests may also be employed.

Our women's center can offer treatment or refer for treatment for conditions underlying pelvic pain, including psychological factors that may exacerbate the experience of pelvic pain.  Treatment can include medications (including analgesics, anti-inflammatories, hormone therapy, muscle relaxants, or antidepressants), heat therapy, nerve blocks, physical therapy (relaxation techniques), minimally invasive surgery using hysteroscopy or laparoscopy, or major surgery (such as hysterectomy).

Pelvic Congestive Syndrome

Pelvic congestive syndrome is a diagnostic term and a condition that has received renewed attention in recent years, as understanding of the phenomenon, and ability to diagnose it accurately and treat it properly, have improved.  The syndrome is thought to cause chronic pelvic pain as a result of varicosing of veins that drain blood from the ovaries.  (Indeed, pelvic congestive syndrome occurs more often in women who have varicose veins of the legs as well.  Pregnancy, ovarian cysts, and hormonal dysfunction may also be risk factors for this condition.)  The valves that prevent the reverse flow of blood in the venous system are defective in such veins.  For this reason, blood pools in these vessels.  The result is swollen, distorted, misshapen veins that, in the pelvis, cause pressure and pain due to their enlargement.  In the course of a day, the resulting discomfort can be get worse, the longer women with the condition remain in the upright position. 

The ovarian veins are susceptible to such expansion and congestion as a result of their anatomy and their relatively unsupported position along the pelvic sidewall.  Varicose veins in the pelvis are a common condition, though they do not always cause symptoms.  Recent data, however, indicates that pelvic congestive syndrome may be a very common cause of chronic pelvic pain. 

Thus, pelvic congestive syndrome is increasingly recognized as a potential basis of otherwise unexplained, long-term pelvic pain in women.  Many specialists consider it significantly underdiagnosed and undertreated.  The condition has been associated with other symptoms such as menstrual irregularities; sexual problems; abdominal distension; irritable bladder; varicose veins in the vulva, buttocks, or thigh; and sometimes serious discomfort before, during, and after menstruation. 

Varicosities of one or more of the ovarian veins may be difficult to detect.  If other conditions are ruled out, our staff may order a venogram (performed in a partly vertical position), to create an image of the vessels that may be varicosed.  Gynecologic surgeons may also diagnose the syndrome by conducting a special type of laparoscopy using only local anesthesia and minimal sedation, in which they touch different pelvic structures with a probe to identify the source of the patient's pain.

Drug treatment can be effective, using over-the-counter analgesics or prescription anti-inflammatories, or through hormonal suppression including with birth control pills.  Other options include surgical ligation of the vein, or surgical removal of the uterus and ovaries.  (Hysterectomy alone is not considered effective.)  In a newer approach, though, Aria's interventional radiologists can also embolize these veins.  This treatment plugs the blood vessels, causing them to shrink and disappear.  This approach spares women from having to undergo surgery, is effective in reducing pain, and preserves ovarian function.  Learn more.