Pelvic Pain: Causes, Diagnosis and Treatment

Pelvic pain can be felt in the lower abdomen, pelvis, lower back or around the hips, and its cause needs clinical assessment.

Pelvic pain may feel cramping, aching, sharp, burning, pressure-like or tender. It can be constant or come and go, and may be linked with periods, sex, urination, bowel movements or movement. Some people feel it centrally behind the pubic bone; others notice it more on one side, in the lower back or near the hips.

Seek urgent medical help for sudden severe pain, faintness, marked weakness, heavy bleeding, fever with worsening pain, repeated vomiting or a rigid or very swollen abdomen. If pregnancy is possible, pain with bleeding, shoulder-tip pain, dizziness or collapse needs prompt assessment because an ectopic pregnancy can be dangerous. Sudden one-sided pain with nausea also needs urgent review.

The causes below are listed alphabetically, not by likelihood. Adenomyosis can cause painful, heavy periods and pelvic aching. Chronic pelvic pain can involve overlapping muscle, nerve, bladder, bowel or reproductive factors. Ectopic pregnancy causes pain when a pregnancy develops outside the uterus. Endometriosis may cause period-related pain, pain with sex or bowel symptoms. Interstitial cystitis may cause bladder pressure and frequent urination. Ovarian cysts can cause pressure or pain, while ovarian torsion causes abrupt one-sided pain. Pelvic inflammatory disease may cause lower abdominal pain with discharge or fever. Uterine fibroids may cause pressure, cramps or heavy bleeding.

A clinician will ask when the pain began, where it is, what triggers it, how it relates to periods, sex, urination and bowel movements, and whether pregnancy is possible. They may examine the abdomen and pelvis, and request urine or pregnancy testing, blood tests, infection testing or an ultrasound. Further imaging or specialist assessment depends on the examination and the pattern of symptoms. Keeping a short pain and cycle diary can make changes easier to describe.

Care is tailored to the diagnosis and to whether you are planning a pregnancy. Infection may need antibiotic treatment for pelvic infection. Medicines that alter hormone activity may be considered for conditions such as endometriosis, adenomyosis or fibroids, including GnRH analogue therapy in selected situations. Procedures can include laparoscopic excision of endometriosis, myomectomy or uterine artery embolisation. Hysterectomy is a major option for some uterine conditions when other approaches are unsuitable. Pain, bladder and pelvic-floor symptoms may also need separate treatment.

Not every cause can be prevented, but tracking symptoms can help you obtain earlier assessment. Use condoms or other barrier protection when appropriate, attend recommended sexual-health checks, and seek care for unusual discharge, fever or pain after sex. Avoid repeatedly taking leftover antibiotics. Gentle activity, sleep, hydration and treatment of constipation may reduce strain for some people, but persistent or recurring pain still deserves a medical review.

Pelvic pain may occur alongside heavy or irregular bleeding, painful periods, pain during sex, unusual vaginal discharge, urinary urgency, constipation, diarrhoea, bloating, nausea or lower-back pain. The combination and timing matter more than any single symptom.

Evaluation may identify a treatable infection, a uterine or ovarian condition, bladder inflammation, endometriosis or a combination of factors. If initial tests do not explain the pain, follow-up can focus on pelvic-floor muscles, nerves, bowel function and pain management rather than dismissing the symptom.