Pelvic pain and lower abdominal pain (outside of pregnancy) is by far one of the most common reasons women see our providers for appointments. I thought it would be nice to write a series of blogs about the different gynecological etiologies of pelvic pain to add a resource for you to refer back to, were you to experience this type of discomfort in the future. This blog will serve as an introduction to pelvic pain and let you know how we think about the different causes and do a gynecological-specific workup.
Evaluating and diagnosing pelvic pain can be a frustrating experience for patients and their providers. And this is not the fault of either party. The body is not “wired” in a way for the brain to tell you what exactly is causing your pain. It does not tell you “hey friend, your left ovary is causing that pain this month yet again, you may want to get it checked out.” It is not like when you have a sore knee after your run and know your knee is what is hurting as opposed to your toes. So we have to take this into consideration when trying to figure out what is going on. Believe it or not, pelvic pain is not always your ovaries and is often nothing that is obviously gynecological at all. (MANY pelvic pain appointments are for a primary complaint of “pain in my ovary”.)
Women present with all different sorts of pelvic pain:
- Chronic vs Acute
- Severe vs mild or moderate
- Continuous vs intermittent
- Short lasting vs long lasting
- Cyclical vs erratic
- Unilateral vs bilateral vs midline
- Associated with sex or not affected by sex
- Insertion sex pain vs deep sex pain
- Pain with periods vs pain not associate with periods
- Pain with urination vs not
- Pain with bowel movements vs not
Pelvic pain can be described with more than one of the above items. And many of the above types of pain can be caused by the following:
- Uterus and anything in or on it
- Ovaries and their cysts
- Normal ovulation
- Endometriosis
- Intestines/Colon
- Bladder
- Muscles (pelvic floor)
- Hip joints
- Nerve pain
With an initial visit for pelvic pain we will ask many of the aforementioned questions to try to hone in on the more likely cause(s). We will hopefully determine if something is an absolute emergency requiring you to go to the hospital, or if it is something that can be evaluated outpatient. If you have not had recent imaging we will likely bring you back for an official pelvic sonogram (ultrasound) in our office to get a good look at your uterus and ovaries and discuss a more detailed plan of care after this imaging.
Even after the above evaluation, we often cannot tell you the cause of pain with 100% certainty. Sometimes management of the pain is as simple as, “We do not see anything dangerous on sonogram, it is very likely this pain will resolve on its own.” Other times we will start a treatment to see how that works. We may repeat imaging to follow larger cysts or uterine fibroids. Sometimes we will make referrals for further imaging or to see a specialist from gastroenterology or urology or a pelvic floor physical therapist.
Stay posted to our website blog section and/or our social media because in the coming months I will more specifically describe the different causes of pain and what can be done to help manage it.
