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Pelvic Pain Causes, Diagnosis, and Treatment Options

Men and women can both have pelvic pain, though it's more common with people designated female at birth. This pain isn't always due to gynecological issues. Pelvic pain can also have causes related to muscles and joints.

The physiatrists at the Department of Physical Medicine and Rehabilitation (PM&R) diagnose and treat pelvic pain using a holistic approach. This means we draw on many specialties to treat people with pelvic pain.

What Is Pelvic Pain?

Pelvic pain is pain in the pelvic area. You may have pelvic pain in your lower abdomen, though it can spread to your back and upper thighs.

Pelvic pain is common during and after pregnancy but isn't always linked to pregnancy. It can happen to people at different times and ages.

Pelvic pain can range from mild to severe and often varies. Doctors define chronic pelvic pain as pain that lasts for more than six months, without getting better.

Chronic pelvic pain may affect as many as 15% of women of childbearing age in the U.S. Pelvic pain linked to prostate inflammation affects 10 to 15% of men. People with pelvic pain may miss work because their pain is so severe.

What Causes Pelvic Pain?

Often, pelvic pain stems from an underlying issue in the pelvic muscles or your urinary, digestive, or reproductive system. Causes of pelvic pain include:

  • Pregnancy-related problems.
  • Gynecological issues (such as endometriosis, painful menstrual cramps, or ovarian cysts).
  • Sexually transmitted infections.
  • Pelvic inflammatory disease.
  • Inflammation of the prostate gland (in men).
  • Abdominal surgeries.
  • Bladder issues (such as IBS, urinary tract infections, or kidney stones).
  • Muscle and bone structure issues (such as fractured pelvic bones).
  • Nerve problems.
  • Psychological issues, including stress or past trauma.

Several things can contribute at once to pelvic pain.

For example, a person may have a gynecological issue, like endometriosis, and a digestive issue, like irritable bowel syndrome. They may also have anxiety or depression because of these issues. All of that together can make pelvic pain worse.

Contact the Department of Physical Medicine and Rehabilitation

Appointments and Referrals

Call 1-412-692-4400 or 1-800-533-8762 to make an appointment with, or refer people to, a doctor from the Department of Physical Medicine and Rehabilitation (PM&R).

What Are the Risk Factors and Complications of Pelvic Pain?

The biggest risk factor for pelvic pain is gender, with people designated female at birth being most at risk. Pregnancy is also a risk factor.

Having sacroiliac (SI) joint pain also puts people at risk for pelvic pain, because the two often occur together. This is especially true in pregnancy.

Other risk factors include:

  • Drug and alcohol abuse.
  • Sexual trauma.
  • Having had a miscarriage or C-section birth.
  • Having a heavy menstrual flow.

Some causes of pelvic pain can lead to long-term issues. Pelvic inflammatory disease (PID), an infection of the female reproductive organs, can cause infertility and ectopic pregnancy.

Many people don't know they have PID until they have pelvic pain. This is why people with pelvic pain that doesn't go away should see their doctor.

Another complication of pelvic pain is worsening mental health. Chronic pelvic pain can cause depression and may lead to relationship stress and problems with sleep, sex, and work.

How Do I Prevent Pelvic Pain?

Pelvic pain can be hard to prevent, since many factors that cause it are out of your control. Researchers have looked at whether exercise can help, especially with pregnancy-related pelvic pain. But the evidence isn't clear that it can prevent pelvic pain. Exercise can help with things like anxiety and mood, so it may help in ways we don't yet know. One of the most important steps you can take to prevent pelvic pain is to see your doctor regularly. Tell them about any pain you have and can't explain in your abdomen or low back. You may be able to treat an underlying cause before it turns into chronic pelvic pain.

What Are the Symptoms of Pelvic Pain?

Symptoms of pelvic pain can include:

  • Bleeding.
  • Pain during sex.
  • Bloating, gas, or constipation.
  • Pain in the groin or hip.
  • Rectal pain.

The pain can come on all of a sudden and feel sharp and stabbing. Or it can be dull and more spread out. People often describe pelvic pain with words like aching, cramping, tender, sickening, or hot and burning.

Some people also have sacroiliac (SI) joint pain. SI joint pain is pain in the very low back or butt. It can be hard to tell the two apart since they can exist together.

How Do You Diagnose Pelvic Pain?

Your physiatrist will work to figure out the root of your pain. They'll start by taking a history and doing a physical exam. Then, they may order imaging and other tests to try to rule out gynecological issues.

These tests can include:

  • Lab tests, like a urine test or blood sample.
  • Pelvic ultrasound.
  • MRI of the pelvic area or low back.
  • X-ray of the abdomen.
  • Colonoscopy, if your doctor thinks you may have bowel problems.
  • Cystoscopy, which helps doctors see into the bladder.

If your doctor can rule out gynecologic, bowel, or bladder issues, they can look for muscle or joint problems. Some types of pelvic pain are myofascial. This is pain in the tissues that support your muscles.

Learn more about treatment for pelvic pain and other women's health issues at the UPMC Rehabilitation Institute.

Treating Pelvic Pain

Once your physiatrist learns the cause of your pain, they will work with you to manage your type of pain.

Treatments may include:

  • Medicine. Doctors prescribe drugs to help manage pelvic pain symptoms or treat the underlying causes. These can include pain relievers, muscle relaxers, antidepressants, pain injections, and hormone-related medicine.
  • Nerve blocks. Nerve blocks target specific nerves and pathways involved in pain transmission, with the aim of interrupting these nerve pathways. They may be performed for diagnosis, pain relief, or both.
  • Pelvic floor therapy. Your pelvic floor includes the muscles and nerves near your lower back and abdomen, especially those with reproductive function. Our pelvic floor physical therapy program treats pain with techniques like deep tissue massage and exercises to tighten and relax certain muscles.
  • Surgery. Surgery may be a treatment for an underlying cause of pelvic pain, like endometriosis.
  • Counseling. Talk therapy can improve pain, especially when people combine it with other therapies.

With training in areas relating to pelvic health and wellness, physiatrists at the Department of Physical Medicine and Rehabilitation are also able to:

  • Address biomechanical issues.
  • Treat pain.
  • Do interventional techniques, when needed.
  • Coordinate care with physical therapists and other experts to address factors that lead to pain, like mood disturbances and life situations.

For more information about health problems associated with pregnancy and postpartum care, visit UPMC Magee-Women's Hospital.

Make an Appointment

Call 1-800-533-8762 to make an appointment with a doctor from the Department of Physical Medicine and Rehabilitation.