At NYU Langone, our specialists concentrate on determining the source of pelvic pain in women, which occurs in the lowest part of the abdomen. Many different conditions can cause pelvic pain, and more than one may be responsible for your discomfort.
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Knowing what’s causing the pain can help your doctor make a diagnosis and choose the right strengthening exercise, medication, or surgery for your condition.
Adenomyosis occurs when the tissue that lines the uterus, called the endometrium, is found inside the muscular wall of the uterus itself. It can cause severe menstrual cramps with heavy, prolonged bleeding.
Some women with adenomyosis feel pain between periods, during sexual activity, or with bowel movements or urination. Pain may feel like a lower backache or radiate down one or both legs.
Endometriosis occurs when the endometrial tissue lining the inside of the uterus grows outside of the uterus and attaches to other organs or structures in the body, such as the fallopian tubes or the ovaries. These abnormal growths are called endometrial implants, and along with adhesions—scar tissue that can cause internal organs to bind together—can inflame surrounding tissues.
Endometriosis does not need to cover extensive areas of the pelvic organs to cause pain; even microscopic implants can cause aching or stabbing pain. The pain may occur only during menstruation or at various times throughout the menstrual cycle. Many women with endometriosis also have adenomyosis.
Fibroids are typically benign, or noncancerous, masses of tissue that grow on the inner or outer wall of the uterus. Most fibroids don’t cause pelvic pain unless they’re large and press against other organs or nerves.
For some women, fibroids cause discomfort or pain between periods, as well as during menstruation, urination, bowel movements, or sexual activity. The condition can also lead to heavy periods or abnormal vaginal bleeding.
Interstitial cystitis is a chronic bladder condition that causes frequent urination and mild to severe pain in the bladder and the surrounding area. It can cause discomfort with sexual activity or urination, an urgent need to urinate, and pressure and tenderness in the pelvis. Symptoms may be mistaken for a urinary tract infection and can vary with diet.
Ovarian cysts are fluid-filled sacs or other benign (noncancerous) growths that can form in or on the ovaries. They may cause pain in the pelvis, especially if they bleed or rupture, or in the low back. Pain may strike suddenly or be ongoing; it may feel like a dull ache or a lingering pressure as the cyst pushes on another pelvic organ, such as the bladder. Exercise, urination, sexual activity, or menstruation may make the pain worse.
Some ovarian cysts go away without treatment, but some may require surgery, especially those related to endometriosis or other conditions. Large ovarian cysts may cause the ovary to twist, cutting off its blood supply, possibly requiring emergency surgery to save the ovary.
Pelvic congestion syndrome results from pelvic varicose veins, which are abnormally enlarged veins in the pelvis, similar to varicose veins that occur in the legs. They start in the ovarian veins, the deep veins of the pelvis, or sometimes both. The cause of this enlargement is not always known, but is associated with prior pregnancy, pelvic surgery, and estrogen replacement therapy.
Symptoms of pelvic congestion syndrome include chronic pelvic pain, often described as dull or aching, that is worst when sitting or standing and improves when lying down. Other symptoms include pain after intercourse, fatigue, backache, bloating, nausea, and leg fullness. Some women may have visible varicose veins of the vulva, buttocks, and upper thighs.
Pelvic inflammatory disease, sometimes called PID, is a complex infection that affects a woman’s reproductive organs—the cervix, uterus, fallopian tubes, and ovaries. It’s often the result of an untreated sexually transmitted infection, such as chlamydia. Without treatment, pelvic inflammatory disease can cause irreversible scarring to the pelvic organs and lead to infertility.
Women with pelvic inflammatory disease may experience fever, a dull ache in the pelvis, pain with urination or sexual activity, and a heavy yellow or green vaginal discharge with an unpleasant odor, though some women have no symptoms.
Pelvic organ prolapse occurs when the ligaments and muscles supporting the organs in the pelvis weaken or stretch. This can cause the bladder, bowel, rectum, urethra, uterus, or vagina to prolapse, or slip out of place. More than one organ can prolapse at the same time.
It may be a result of childbirth, genetics, or chronic stress on the pelvis straining during bowel movements when constipated, among other causes.
Women with pelvic organ prolapse may experience pelvic pain during sex or between periods. They may feel low-back pain or pressure caused by one or more of the pelvic organs pressing against the vaginal wall.
Other causes of pelvic pain in women may include irritable bowel syndrome, a condition of the large intestine that may involve cramping and bloating, or vulvodynia, a constant or intermittent pain in the opening to the vagina and surrounding area.
Your NYU Langone doctor can perform an exam and conduct other diagnostic tests to determine the cause of your pelvic pain.
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