Pelvic pain can originate from different sources and it can be acute or chronic. Regardless, there are contributing factors to consider. Some are very treatable and others can be more difficult to manage. Acute pelvic pain is a warning sign that comes on suddenly lasting a few minutes to a few days depending on the cause. Chronic pelvic pain can be constant or come in flares and symptoms can vary in character and intensity. Knowing what and when to report any unusual symptoms to your doctor is important, because some causes of pelvic pain when left untreated can cause permanent damage that could be avoided when we know what to do.
Critical Elements of the Pelvis: A Bowl, Really?
Before we can truly understand pelvic pain, we should know about the pelvis. Pelvic bones are shaped like a bowl without a bottom. Because of how the pelvic bones are formed, it takes multiple layers of muscles to provide a protective environment. A mesh-like framework of muscle layers at the bottom of the pelvic bowl provides security. Connective tissue provides a hammock that suspends organs and prevents gravity from pulling the organs down into the bowl in one big mass like a bag of melted candy. This unique suspension is important to proper function. Those who have experienced a twisted bowel, prolapsed genital organs, or prolapsed bladder understand the importance of muscles and connective tissue in the pelvis.
Because everything is in close proximity and the organs of the pelvis are connected in one way or another, the source of pelvic pain can sometimes be difficult to pinpoint. When one structure is malfunctioning, pain can occur in other areas. If we understand the pelvic floor muscles, connective tissue, and their job, it is easier to understand why this happens.
Principle Causes of Pain Down Under
- Prostatitis – inflammation of the male prostate gland, which can be benign with no known cause (suggestive of pelvic trigger points), bacterial infection, or cancer.)
- Sexually transmitted diseases
- Interstitial cystitis also known as painful bladder syndrome
- Reproductive organ pain, such as painful menstrual periods, uterine fibroids, pain with ovulation, ovarian cysts, uterine tissue abnormalities, fallopian tube or ovary abnormalities, testicular or prostate abnormalities (including congenital non-descending testicle), cancer, or pregnancy related problems
- Pelvic inflammatory disease
- Vaginitis (inflammation of the vagina, usually due to a bacterial infection)
- Uretheritis (inflammation of the tube that carries urine out of the bladder when you urinate)
- Orchitis (Inflammation of one or both testicles)
- Genital ulcers
Contributors to Pelvic Pain
Pelvic Pain can also occur when surrounding organs or supportive muscles and connective tissue are having a problem. These include:
- Pelvic congestion syndrome
- Vasculitis (inflammation of blood vessels in the pelvis)
- Inguinal hernia
- Broken pelvis
- Adhesions or scarring from pelvic inflammatory disease, ruptured ovarian cysts or surgery
- Bowel problems, such as ulcerative colitis, Crohn’s disease, bowel obstruction, irritable bowel syndrome, chronic constipation, appendicitis, or diverticulitis.
- Radiation treatment
- Neurological disorders, such as shingles, or nerve entrapment
- Kidney or bladder stones
- Cancer in abdominal or pelvic organs
- Myofascial pain syndrome causing pelvic floor muscle spasms
When Pelvic Pain Becomes Chronic
Chronic pelvic pain affects both men and women. Pain can vary from mild to severe, constant to intermittent and last at least three to six months. It isn’t isolated to just the pelvis; it can cause lower back pain, pain in the tailbone, hip or groin, pain in the area over the pubic bone (the front on the pelvic bowl) and can radiate pain to other parts of the body.
It is believed that the presence of trigger points in the muscles of the pelvic floor and those surrounding them can contribute to chronic pelvic pain. These knotted up pieces of muscle fiber can develop because of sitting too long, surgical trauma and scarring or anatomical deformity, or result from a primary acute pelvic problem. Trigger points can cause everything from rectal pain, urethral pain, painful urination, hesitancy, and incomplete emptying of the bladder (Pub Med) to painful intercourse, or vaginal atrophy in women. They can also cause painful ejaculation, penis and testicular pain, or erectile dysfunction in men.
Men and women experience the same bias regarding pelvic pain because we don’t always know the cause. There is evidence of biological involvement in chronic pelvic pain, so if your needs are not being met, keep working at finding the right doctor, one who understands the complexity of pelvic pain, so you can be as comfortable as possible.
Expect your doctor to do a thorough physical exam and order blood tests, scans, laparoscopy, ultrasound or other procedures to find the underlying cause of your pain.
Learn more about the role of the myofascia in chronic pelvic pain, diagnosing and treating, and finding the right doctor, nurse, or therapist in posts coming soon.
International Pelvic Pain Society
Interstitial Cystitis Network
American Sexual Health Association