Friday, January 27, 2012

Pain in the pelvis

Sunday January 8, 2012
Pain in the pelvis

The concluding article on pelvic pain, which can be caused by a wide range of conditions, some of which are easily treated, while others require more urgent medical attention.

IN my last article, I shared with readers a list of conditions that could possibly account for symptoms of pelvic or lower abdomen pain.

Some of these conditions are related to the reproductive system, while others may be related to the digestive or urinary system.

Not all causes of pelvic pain are medical emergencies – nonetheless, it is always better to see your doctor when you experience such symptoms, as there could be any number of causes.

In this article, I will continue to elaborate on more of these potential causes of pelvic pain.

Kidney stones are minerals that form in the kidney. They can be as small as a grain of sand or as big as a golf ball, so you can imagine what pain it can cause.


When endometrial cells grow outside the uterus and form implants (growths) on the ovaries, bowel, rectum, bladder, and on the lining of the pelvic area, this is called endometriosis.

Pain is the most significant symptom of endometriosis. The pain could be in the lower abdomen or the lower back, before, during or after menstruation. You may also experience cramps, pain during or after sexual intercourse, or pain with bowel movements.

Unfortunately, there is no way to reverse the scarring caused by endometriosis. However, there are treatments that can stop the disease from getting worse.

In severe cases, surgery can be carried out to remove all endometrial implants and scar tissue, or more drastically, to remove your uterus, fallopian tubes and ovaries.

Vulvar pain

In some cases, the pain may originate lower down the pelvis, namely at the vaginal area. Chronic pain around the opening of the vagina is a condition called vulvodynia, where no cause is known.

The pain could be a burning, stinging, or experienced as a throbbing sensation, and it may be there constantly or come and go. Certain activities like sexual intercourse or riding a bicycle may make the pain worse.

Since there is no known cause of vulvodynia, there is no way to treat the source of the pain. However, medications and physical therapy may help to relieve the symptoms.

Interstitial cystitis

There is a condition called interstitial cystitis (IC), which is related to long-term inflammation of the bladder wall.

The pain is felt during urination and sex, as well as a sensation of pressure above the pubic area. You may also feel the need to urinate multiple times every hour throughout the course of the day.

IC also has no known cause. You should work with your doctor to try out treatments that can relieve the symptoms.

Pelvic organ prolapse

A prolapsed pelvic organ is when the organ, such as the bladder or uterus, slips out of its normal place and drops into a lower position. This happens when the ligaments or muscles supporting the organs weaken, which is usually due to age.

Prolapse can cause some form of pain or pressure in the groin or lower back and against the vaginal wall. You may also have a feeling of “fullness” in the lower belly and pain during intercourse.

Treating prolapsed organs usually requires some form of surgery, although there are now minimally invasive techniques that result in faster recovery.

Irritable Bowel Syndrome (IBS)

If you have constantly recurring stomach pain that comes with cramps, bloating and diarrhoea or constipation, you could have IBS.

IBS describes the presence of these symptoms together without any known cause. It is strongly believed that stress in your life has a lot to do with IBS, as these symptoms tend to flare up in people when they go through highly stressful or demanding periods in their life.

Lifestyle changes like modifying your diet and managing your stress can help to keep the symptoms of IBS under control.

Urinary tract infection (UTI)

Have you ever experienced pain while urinating, along with a frequent urge to urinate? You could have a urinary tract infection, which is caused by bacteria getting into the urinary tract and causing infection to the urethra, bladder, ureters or the kidneys. You may also have the feeling of pressure in your lower pelvis.

If you suspect that you have a UTI, you should see a doctor and get it treated with some simple antibiotics.

Don’t let it progress to kidney infection, which is characterised by symptoms like fever, nausea, vomiting and pain on one side of the lower back.

Kidney stones

If you see your urine turning pink or red, and you have a sudden sharp pain in the stomach or pelvic area, you may have kidney stones.

Kidney stones are minerals that form in the kidney and move to the bladder. They can be as small as a grain of sand or as big as a golf ball, so you can imagine what pain it can cause.

Your doctor can recommend treatments to remove the kidney stones, if they cannot pass out through the urine on their own.

Pelvic congestion syndrome

You’ve probably heard of varicose veins, which is when veins become swollen, twisted and filled with blood. Although varicose veins commonly occur in the legs, they can also develop in the pelvis, causing pelvic congestion syndrome.

The pelvic veins become swollen and painful, causing pain especially when you sit or stand. You may find that lying down eases the pain.

This condition is not easily diagnosed because the pelvic veins are not visible from outside the body. Your doctor will need to rule out other possible conditions.

Ask your doctor about minimally invasive surgical procedures to treat this condition.

Scar tissue or adhesions

Have you had surgery in your pelvic or lower abdominal region before? It could be surgery to remove your appendix or uterus, or a C-section for delivery.

These surgical procedures can cause scar tissue to form between organs or structures in the pelvic area, causing them to stick or adhere to each other. In normal situations, these organs should have a slippery surface, allowing them to shift easily as the body moves.

These adhesions can cause long-term abdominal or pelvic pain in some people, and even blockage of the intestines. In these situations, surgery may be needed to break the adhesions, although doctors only resort to surgery if there is no other option.

As you can see, pelvic pain can be caused by a wide range of conditions, some of which can be easily treated and others that require more urgent medical attention.

The most important thing to remember when you experience pain in the pelvis or lower abdomen area is to take note of other symptoms and things occuring in your body. For instance, take note of what you are doing when the pain occurs, and whether certain activities make it worse.

Observe your menstrual periods, bleeding, urine and bowel movements, and whether you have nausea, vomiting or fever.

Knowing these details will help your doctor to make a more accurate diagnosis. Sometimes, even after a lot of testing, the cause of pelvic pain remains a mystery. But your doctor can still help you find ways to feel better and prescribe the appropriate treatment for you.

> Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician & gynaecologist (FRCOG, UK). For further information, visit The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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