Pelvic Pain

Pelvic pain is pain anywhere in the lower belly, below the navel. It can be sharp, dull, cramping, or constant. It can come from the gynaecological organs, the urinary system, bowel, nerves, muscles, or the pelvic floor. Finding the cause often takes step-by-step evaluation — and persistence.

Acute pelvic pain — red flags

• Sudden severe pelvic pain — especially with fainting, fast heartbeat, pale/sweating: possible ectopic pregnancy rupture, ovarian torsion, or bleeding — dial 112.
• Pain with fever, abnormal discharge — possible pelvic inflammatory disease.
• Pain with heavy vaginal bleeding or with a missed period — needs urgent pregnancy-related evaluation.
• Pain with severe urinary symptoms — possible obstruction or severe infection.

Common causes of chronic pelvic pain (over 6 months)

• Endometriosis and adenomyosis.
• Fibroids, ovarian cysts.
• Pelvic inflammatory disease, its after-effects.
• Chronic interstitial cystitis (bladder pain syndrome).
• Irritable bowel syndrome — overlaps with pelvic pain.
• Pelvic floor muscle tightness — under-recognised and highly treatable with pelvic physiotherapy.
• Pudendal neuralgia and other nerve causes.
• Tuberculosis of the pelvis — specifically relevant in India.
• Previous sexual or physical trauma — can contribute; trauma-informed care helps.

Evaluation

• Detailed history — pattern, timing with cycle, sex, urination, bowel habit.
• Pelvic examination.
• Pregnancy test, urine test, STI screen.
• Pelvic ultrasound.
• Further tests as needed — MRI, laparoscopy, cystoscopy, colonoscopy, TB work-up.

Approach

Chronic pelvic pain rarely has a single cause or a single fix. The most helpful teams combine a gynaecologist, a pelvic-floor physiotherapist, sometimes a pain specialist and a mental-health professional. Progress usually comes from several small gains, not one cure. You are not imagining the pain. You deserve persistence from your Health Expert.