What to Know About Pelvic Pain

What should you do if you experience pelvic pain symptoms?

Pelvic pain is a common problem affecting women and men. Pain in the pelvic area typically stems from the reproductive, urinary, digestive or musculoskeletal systems. Patients often describe the pain as a stabbing or cramping sensation.

However, pelvic pain can be tricky to diagnose as the causes and symptoms of pelvic pain can vary widely.

“Pelvic pain can come in many shapes and forms,” says Mitchell Goldenberg, MD, a urologist with USC Urology, part of Keck Medicine of USC, who sees patients at USC Verdugo Hills Hospital. “We have to take more than just the characteristics of the pain into account when we’re deciding what’s going on.”

Pelvic pain during pregnancy

Dr. Goldenberg says it’s normal to experience pelvic pain during pregnancy. “Ligaments become stretchy, and there is pressure being put on them,” he explains, “and the bones are changing in structure as the body prepares to deliver the child.”

Pelvic pain during pregnancy is often centered in the middle front of the pelvis and can stretch to the hips and back. Dr. Goldenberg says people who are pregnant should avoid heavy physical activity if they’re having pelvic pain, but that gentle exercises like walking and yoga are safe.

To ease pubic bone pain, he recommends that people who are pregnant sleep on their side with a pillow between their legs and rest whenever possible.

Pelvic pain causes and treatments

For people who are not expecting a baby, Dr. Goldenberg explains other possible causes of pelvic pain:

• A urinary tract infection is a common explanation for pelvic pain, he says. “It’s often accompanied by other symptoms, like a fever, going to the bathroom more often or lower abdominal pain.” Urinary tract infections are typically treated with antibiotics.
• Chronic constipation is another common cause of pelvic pain. Dr. Goldenberg says he may recommend dietary changes and fiber supplements, or laxatives in more severe cases.
• It’s possible to strain the pelvic floor muscles. “People may feel pain with sitting, while urinating or during sex,” Dr. Goldenberg says. “I almost always recommend pelvic floor physical therapy for pelvic pain because even if the muscles aren’t the underlying problem, they’ll tighten over time because of the discomfort. Therefore, physical therapy is useful in most cases.”
• If vaginal pressure or bulge accompanies the pelvic pain, then it may be a uterine or bladder prolapse. Pelvic floor physical therapy can be used, but often placing a device called a “pessary” is needed, or surgery in some cases.
• Interstitial cystitis affects the lining of the bladder, and resulting inflammation can lead to pelvic pain. Treatments include oral medications, bladder training and sometimes surgery.
• Clinicians may explore neurological conditions once other causes have been ruled out, says Dr. Goldenberg. “The pain may be related to the nerves and how the brain is perceiving sensations from pelvic organs.”

Urologists may use additional diagnostic techniques to determine the root cause of pelvic pain, such as an ultrasound or a CT scan of the pelvis, or a cystoscopy to view the inside of the bladder and urethra.

“A patient may be diagnosed with chronic pelvic pain syndrome,” Dr. Goldenberg says, “when there’s no clear and readily treatable cause. We’ll then focus on how best to manage symptoms and restore the patient’s quality of life.”

When to call your doctor for pelvic pain

Consult with a doctor if pelvic pain is accompanied by blood in the urine, urinary incontinence or recurrent urinary tract infections. Pelvic pain that is progressively worsening is also a signal to see a doctor as soon as possible.

Dr. Goldenberg warns that men who experience a urinary tract infection need to see a specialist because it could indicate a serious bladder or prostate issue. “Because of our anatomical differences, men shouldn’t be getting urinary tract infections.”

He adds that patients shouldn’t feel ashamed or embarrassed if they do experience pelvic pain. “Pelvic pain is rarely caused by anything you’ve done,” assures Dr. Goldenberg.

“Don’t suffer in silence,” Dr. Goldenberg says. “Pain is an important symptom that tells us something is wrong. Pelvic pain isn’t something you necessarily need to call 911 about, but you don’t want to ignore it, either.”

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