Pelvic pain

Pelvic pain

Many women experience pelvic pain at some point, which can significantly impact their quality of life.

Pelvic pain can present in many ways. Sometimes, it can be a dull, heavy ache; it may also be sharp, burning or stabbing in nature, and some women describe having twisting or cramping-type pain. For others, it may present itself as pain when having sex (known as dyspareunia) or when peeing (dysuria).

There can be many causes of pelvic pain, and not all of them are gynaecological.

Common pelvic pain causes include:

  • Bowel problems, such as constipation, IBS, inflammatory bowel diseases (e.g. ulcerative colitis and Crohn’s disease), and appendicitis.

  • Urinary tract problems, such as kidney and ureteric stones and UTIs (urine infections).

  • Gynaecological infections, such as STIs (sexually transmitted infections, including chlamydia and gonorrhoea) and pelvic inflammatory disease.

  • Ovarian conditions such as ovarian cysts, ovarian torsion, and ovarian cancer.
  • Fibroids (which are muscle growths within the uterus).
  • Adhesions (scarring) caused by previous surgery.

  • Endometriosis is a condition where tissue that is similar to the lining of the womb grows outside of the uterus, often onto the ovaries, fallopian tubes and bowels.

  • Pelvic congestion syndrome (which is pain due to enlarged varicose-like veins in the pelvis).

  • Musculoskeletal problems, such as a hernia, hip arthritis, and tension problems in the pelvic floor.

It is important to exclude pregnancy, as pelvic pain can be associated with miscarriage or ectopic pregnancy, which can be a medical emergency.

Pain after sex

Pain after sex or pain during sex (known as dyspareunia) can be immensely distressing, and there can be many causes. Infections (including STIs and pelvic inflammatory disease), endometriosis, and fibroids are common causes, and some women hold back from seeing a specialist because they feel embarrassed or uncomfortable talking about it. 3 out of 4 women experience painful sex at some point in their lives, and sex shouldn’t be painful, so do book an appointment if you’re experiencing pain.

When should you worry about pelvic pain?

It’s essential to have a gynaecological assessment if you have pelvic pain that’s not going away, pain that is severe or that’s associated with bloating, pain after sex, blood in your urine, or an unusual discharge or bleeding from your vagina.

When you come to the clinic, I’ll listen carefully to your symptoms and concerns and ask questions to clarify what is going on. I will want to know where exactly the pain is located, when it started, and the type of pain (including if it comes and goes or is constant). We’ll identify if any related factors make it worse or better, and we’ll talk about your menstrual, obstetric and contraceptive history, as well as other medical conditions, past surgeries, and family history you may have.

I will then examine your tummy carefully and carry out a pelvic exam, which may also include looking inside the vagina with a speculum. If infection is suspected, I may take some swabs to be analysed. I may also need to take blood tests for inflammation and onco-markers if indicated.

What tests may be needed?

Based on your symptoms and the examination findings, after discussion, we may consider:

  • Pelvic ultrasound to examine organs for masses or abnormalities.
  • Laparoscopy for better visualisation if endometriosis or scar tissue adhesions are suspected. Not everyone will require laparoscopy.
  • CT scan or MRI for suspected digestive or urinary conditions contributing to pain.
  • Blood tests to check for infections or inflammatory markers.

  • Swab tests to exclude infection.

Thorough assessment and testing allow me to make the correct diagnosis by identifying the underlying issue so that appropriate, tailored treatment can begin, whether that involves surgery, antibiotics, hormone therapy, or specialist pelvic physio.

Laparoscopy

Laparoscopy is a minimally invasive surgical procedure that allows visualisation of the organs inside your pelvis and abdomen using a tiny camera and instruments inserted into the tummy via small incisions. It’s both a diagnostic procedure, and the treatment of some conditions can be carried out there and then. It’s a handy tool for helping to get to the underlying cause of pelvic pain, particularly if endometriosis is suspected or if we’re investigating infertility issues.

Because the incisions are small, the procedure can be done as a day case, under general anaesthesia, and the recovery time is much quicker than for surgery involving a significant abdominal incision.

During the procedure, 2 or 3 small incisions are made in the abdomen (one is typically placed in the belly button area), and gas is pumped into the tummy to lift the abdominal wall away from the pelvic organs. A laparoscope, a thin tube with a light and camera, will be gently guided into your abdomen, and this projects images on a screen, allowing me to thoroughly inspect organs like the uterus, ovaries, and fallopian tubes for abnormalities. I may take tiny tissue samples (biopsies) of areas that appear unusual. For some conditions like endometriosis, I can remove any problematic tissue or lesions right away.

After the procedure, you will gently wake up in the recovery area, and you’ll spend a few hours in the hospital before you go home at the end of the day. You will have a shower-proof dressing over the incision sites, and you should keep these on for five days. The stitches are dissolvable and don’t need to be removed. It is usual to feel some mild pain in the area of the incision sites, and you’ll be given painkillers to ensure your comfort. You may also experience some tummy swelling for a few days, and gas in the abdomen can also cause discomfort in the shoulders and chest. This is gradually absorbed by the body and settles swiftly.

Most women can return to work within a week of the procedure. You can return to swimming 2-3 after the laparoscopy, and you should be back to total activity by 4-6 weeks.

Laparoscopy risks

Laparoscopy is a very safe procedure, although it’s not possible to eliminate complications. Around 3 out of 1000 women may have a complication, which can include:

  • Bleeding and blood clots
  • Injury to organs and blood vessels
  • Bowel perforation
  • Infection
  • Problems related to general anaesthesia

Many women wait years to get a proper diagnosis and suffer on, needlessly. If you are suffering from pelvic pain, do come to see me. I’m here to help.