Pelvic pain is defined as pain located in the lower region of the abdomen, below the navel, between both iliac crests. We consider it chronic when it persists beyond 6 months.
“This pain can have different characteristics, it can appear as a continuous pain or colic type, it can be intense or mild, it can present as cramps, or as a sensation of pressure,” Dr. Ana Vegas Carrillo emphasizes in an interview with Infosalus Bathrobe
In addition, according to the specialist, pelvic pain has been associated with different triggers such as sexual intercourse, the menstrual cycle, pelvic varicose veins, infections, bowel movements, urination, body movements, or certain postures.
Although the exact prevalence of pelvic pain is not known, according to the expert of the Gynecology and Obstetrics Team of Dr. Jiménez Magyc of the Ruber International Hospital in Madrid, some studies estimate that it is around 15%, being somewhat more frequent in women than in men.
In the case of women, he points out that pelvic pain is a very frequent reason for gynecology, since all the organs of the female reproductive system are in the pelvis. “It is important to keep in mind that the origin of pelvic pain is not always gynecological. In the pelvis, in addition to the uterus and the ovaries, we have vascular, nervous and musculoskeletal structures, and other organs such as the bladder or intestine,” warns the Quirónsalud expert.
Therefore, and before a patient with pelvic pain, a multidisciplinary approach is essential, which may require the participation of the gastroenterologist, gynecologist, urologist, anesthesiologist, or even the neurologist to perform the necessary studies to identify the cause of this pain and determine the treatment.
In the specific case of women, and among the possible causes of pelvic pain, the most frequent is dysmenorrhea, or pain associated with menstruation. “This type of pain is characterized by being cyclic, it begins with menstruation, it is more intense at the beginning and disappears with the passing of days,” says Dr. Vegas Carrillo de Albornoz.
He also argues that other gynecological causes such as endometriosis can be found, which can cause pain associated with the menstrual cycle or independent of it, pelvic inflammatory disease, which usually appears secondary to an infectious process and ovarian or uterine tumors, whether benign or malignant, that by compression can cause pain.
Another possible cause of pelvic pain, which is important to rule out, is vascular origin, since the presence of pelvic varicose veins around the uterus and ovaries can cause pain, associated or not with the menstrual cycle.
In addition to ruling out a possible gynecological origin, the expert considers it important to also study possible gastrointestinal causes such as irritable bowel syndrome, diverticulosis, inflammatory bowel diseases or food intolerances. “In general, pelvic pain of gastrointestinal origin is usually accompanied by changes in bowel habit,” he clarifies.
It is also frequent, as he assesses, that pelvic pain has its origin in urological disorders and the main causes are cystitis, urethritis, or prostatitis in men. “In these cases it is common that we find it associated with alterations in urination, such as increased frequency or a sense of urgency,” the doctor appreciates.
The presence of adhesions between the pelvic organs, whether they are of post-surgical or infectious origin also constitutes a possible cause of pelvic pain, he argues, while remembering that pelvic pain can also have a neurological origin and appear as a consequence of entrapment or the inflammation of a nerve, or an musculoskeletal origin and trigger secondary to trauma, or as a result of bad postural habits, or lack of physical exercise.
As explained by the American National Institute of Child Health and Human Development, if you are a woman, you can feel this pelvic pain during the menstrual period, or when you have sex. “Pelvic pain may be a sign that there is a problem with one of the organs in the pelvic region, such as the uterus, ovaries, fallopian tubes, cervix, or vagina,” he appreciates.
If you are a man, it says it may be due to a prostate problem. In men and women it can also be a symptom of infection, or problems in the urinary tract, intestine, rectum, muscles, or bones. In fact, he warns that some women may have more than one cause of pelvic pain at the same time. “Perhaps you should undergo laboratory tests, imaging or other medical tests to find the cause of pain. The treatment will depend on the cause, intensity and frequency of pain,” remarks the scientific entity.
WHAT TO DO IN EACH CASE
Meanwhile, the expert of the Gynecology and Obstetrics Team of Dr. Jiménez Magyc of the Ruber International Hospital in Madrid therefore maintains that there are “multiple” causes that can produce a picture of pelvic pain, and to identify them is the realization of a good story clinic, the proper description of the characteristics of this pain and its accompanying clinic. “All this will help us determine the origin and will help us establish the treatment,” says Dr. Vegas Carrillo de Albornoz.
Depending on the underlying cause, this gynecologist emphasizes that the pain can be acute and self-limited in time, or if the cause persists it can be considered chronic until the pathology is resolved. “In the face of severe acute pelvic pain that associates another symptomatology, such as fever or vomiting, it is important to consult the doctor to rule out possible urgent causes that require short-term treatment, such as appendicitis or ovarian torsion,” Apostille
When we are facing a chronic pelvic pain of several weeks of evolution it is recommended to consult before the persistence of the symptoms, or in case another associated clinic appears. “In the case of pelvic pain in women, the main cause is of gynecological origin, so it is recommended to go first to the gynecology office, where we will perform a clinical history and a complete history, a thorough examination and complementary tests such as a gynecological ultrasound and, if deemed necessary, other studies will be requested, such as an MRI. If the gynecological origin is ruled out, it will be referred to other specialists for the study of other possible causes, “he says.