From ovarian cysts and endometriosis to conditions like urinary tract infections, your pelvic pain should not be ignored

Story by: Norton Healthcare; Reviewed by Kerry W. Curtiss, APRN on June 13, 2024

Pelvic pain can be caused by a variety of issues that lead to discomfort, and understanding some of the most common causes of pelvic pain is necessary to help you find appropriate treatment and relief. From gynecologic issues like ovarian cysts and endometriosis to conditions such as urinary tract infections, your health care provider can help determine the cause of your pelvic pain, effectively manage symptoms and treat various conditions. 

“Some of the most common causes of chronic pelvic pain among women in their childbearing years includes endometriosis, ovarian cysts, scar tissue or other issues involving the bladder, intestines or pelvic floor muscles,” said Kerry W. Curtiss, APRN, a nurse practitioner with Norton Urogynecology Center, a part of Norton Women’s Care. “If you have any concerns with your pelvic health, you should bring these concerns to your healthcare provider.”

8 common causes of pelvic pain

1) Endometriosis
Endometriosis is a condition where tissue similar to the lining of the uterus grows outside the uterus, which can cause pelvic pain. This tissue can be found on the ovaries, fallopian tubes or other pelvic structures. Endometriosis can lead to inflammation, scarring and the formation of adhesions within the pelvic area, resulting in chronic pelvic pain. Endometriosis can cause pain that feels like severe menstrual cramps, lower back pain, painful urination and discomfort during sexual intercourse.

Endometriosis also can contribute to pelvic pain through the development of endometriomas, a type of ovarian cyst that forms when endometrial tissue grows within the ovaries and becomes filled with old blood, leading to sharp pelvic pain and discomfort. Scar tissue caused by pelvic adhesions can form from endometriosis, which can cause some pelvic organs to stick together. This can cause pelvic organ prolapse or pelvic floor dysfunction, both of which can make pelvic pain worse. Advanced endometriosis may be treated through minimally invasive gynecologic surgery.

2) Ovarian cysts

Ovarian cysts are fluid-filled sacs that can develop on the surface of the ovaries. These cysts can vary in size and may form as a result of the normal monthly ovulation process, when they are known as functional cysts, or due to other underlying conditions. Ovarian cysts can cause pelvic discomfort when they grow large, rupture, bleed or twist the ovary, leading to sudden and sharp pain in the lower abdomen. The sudden onset of severe pelvic pain sometimes may be an indication of a ruptured ovarian cyst, which requires immediate medical attention to prevent further complications.

3) PCOS
Polycystic ovary syndrome (PCOS) is a complex hormonal disorder that often leads to the formation of multiple small cysts on the ovaries, along with other symptoms such as irregular menstrual periods, excessive hair growth and hormonal imbalances. The hormonal imbalances characteristic of PCOS can disrupt the normal menstrual cycle and result in irregular or missed periods. Additionally, the hormonal fluctuations in PCOS can trigger inflammation in the pelvic region, increasing symptoms of pain or discomfort.

4) Pelvic floor myalgia

Pelvic floor myalgia refers to the chronic contraction and spasm of the muscles in the pelvic floor, which can lead to ongoing pain and discomfort in the pelvic region. These persistent muscle contractions can result from various factors such as stress, trauma or repetitive strain, causing the muscles to become tense and inflamed over time.

Chronic tightness or spasms in the pelvic floor muscles can irritate nearby nerves and cause pain. This condition can cause chronic pelvic pain by impairing the normal function of the pelvic floor muscles, which support proper function of the pelvic organs, including bladder and bowel control, and sexual intercourse.

Physical therapy can help treat pelvic floor conditions by focusing on strengthening and relaxing the muscles in the pelvic area. Through tailored exercises and techniques, a pelvic floor physical therapist can help you improve your pelvic floor muscle function and relieve pain. Additionally, physical therapists can provide education on proper body mechanics and lifestyle modifications to help you manage symptoms effectively.

5) Uterine fibroids

Uterine fibroids are noncancerous growths that develop in the uterus. When these fibroids enlarge or press on surrounding organs, they can cause pelvic pain. Fibroids that grow large can press on nearby pelvic muscles or structures that resulting in chronic pelvic pain, extreme menstrual cramps or pain during intercourse. In some cases, the location and size of the fibroids also can contribute to lower back pain or abdominal pain.

6) Pelvic inflammatory disease

Pelvic inflammatory disease is an infection of the female reproductive organs, often caused by sexually transmitted infections, such as chlamydia or gonorrhea. When left untreated, it can lead to inflammation and infection of the uterus, fallopian tubes and ovaries, resulting in chronic pelvic pain. 
 

7) Urinary tract infection

A urinary tract infection (UTI) or interstitial cystitis are common causes of pelvic pain in women. UTIs occur when bacteria enter the urinary tract and cause infection, leading to symptoms such as pelvic pain, frequent urination and a painful or burning sensation during urination. Treatment for UTIs typically involves antibiotics to clear the bacterial infection, which in turn alleviates the pelvic pain. Drinking plenty of water and maintaining good hygiene practices can help prevent UTIs. 

8) Interstitial cystitis

Interstitial cystitis is a chronic condition characterized by bladder pain and urinary urgency. The inflammation of the bladder wall in interstitial cystitis can result in pelvic pain that is often described as a constant, dull ache in the lower abdomen and pelvic region. Managing interstitial cystitis may involve a combination of dietary changes, bladder training, physical therapy and medications to help reduce inflammation and alleviate symptoms of pelvic pain.

Other causes of pelvic pain 

Not all causes of pelvic pain are due to an underlying gynecologic health condition. For example, some women may experience normal cramping during their period or ovulation. More causes of pelvic pain involve other organs, muscles, diseases or conditions.

Treating pelvic pain

It is important to work with your health care provider to discuss any symptoms of pelvic pain that you are experiencing. They can help detect or rule out any underlying causes of your pelvic pain, diagnose conditions and help treat your symptoms effectively. 

Treatment options can vary, depending on a patient’s unique condition, including age, a desire to get pregnant, preexisting conditions or health concerns. Treatments also can vary based on a patients’ diagnosis, and may include medications (including hormonal medications, such as birth control, for some conditions), physical therapy or minimally invasive gynecologic surgery (MIGS).

A MIGS procedure may be considered for patients with certain complex conditions. Patients should speak to their provider about a referral for a MIGS evaluation for the following conditions: 

• Advanced endometriosis (affecting bladder, gastrointestinal tract, diaphragm, etc.)
• Chronic pelvic pain without apparent cause
• Frozen pelvis
• Severe scar tissue
• Large leiomyomas (fibroids)
• Large ovarian cysts
• Conditions that may make surgery more complicated, such as obesity, diabetes, chronic anticoagulation, circulatory issues, etc.

Norton Women’s Care Pelvic Health Program specializes in caring for patients with pelvic health conditions.