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Causes
By Mayo Clinic staffSeveral gynecologic problems may be the source of chronic pelvic pain. However, other diseases can cause pelvic pain, such as irritable bowel syndrome and interstitial cystitis. In addition, psychological factors may contribute to your pain.
Some causes of chronic pelvic pain include:
- Endometriosis. This is a condition in which tissue from your uterine lining grows outside your uterus. These deposits of tissue respond to your menstrual cycle, just as your uterine lining does — thickening, breaking down and bleeding each month as your hormone levels rise and fall. Because it's happening outside your uterus, the blood and tissue can't exit your body through your vagina. Instead, they remain in your abdomen, where they may lead to painful cysts and fibrous bands of scar tissue (adhesions).
- Tension in your pelvic floor muscles. Spasms or tension of the pelvic floor muscles can lead to recurring pelvic pain.
- Chronic pelvic inflammatory disease. This can occur if a long-term infection, often sexually transmitted, causes scarring involving your pelvic organs.
- Pelvic congestion syndrome. Some doctors believe enlarged, varicose-type veins around your uterus and ovaries may result in pelvic pain. However, doctors don't agree on pelvic congestion syndrome as a cause of pelvic pain because most women with enlarged veins in the pelvis have no associated pain.
- Ovarian remnant. During a complete hysterectomy — surgical removal of the uterus, ovaries and fallopian tubes — a small piece of ovary may be left inside and later develop painful cysts.
- Fibroids. These noncancerous uterine growths may cause pressure or a feeling of heaviness in your lower abdomen. They rarely cause sharp pain unless they become deprived of nutrients and begin to die (degenerate).
- Irritable bowel syndrome. Symptoms associated with irritable bowel syndrome — bloating, constipation or diarrhea — can be a source of uncomfortable pelvic pain and pressure.
- Interstitial cystitis. Chronic inflammation of your bladder and a frequent need to urinate characterize interstitial cystitis. You may experience pelvic pain as your bladder fills, which may improve temporarily after you empty your bladder.
- Psychological factors. Depression, chronic stress or a history of sexual or physical abuse may increase your risk of chronic pelvic pain. Emotional distress makes pain worse, and living with chronic pain contributes to emotional distress. These two factors frequently get locked into a vicious cycle.
References
- Hoffman BL. Pelvic pain. In: Schorge JO, et al. Williams Gynecology. New York, N.Y.: McGraw-Hill Medical; 2008. http://www.accessmedicine.com/content.aspx?aID=3154265. Accessed Jan. 18, 2011.
- Lentz GM. Differential diagnosis of major gynecologic problems by age group: Vaginal bleeding, pelvic pain, pelvic mass. In: Katz VL, et al. Comprehensive Gynecology. 5th ed. Philadelphia, Pa.: Mosby Elsevier; 2007. http://www.mdconsult.com/das/book/body/208746819-4/0/1524/0.html. Accessed Jan. 10, 2011.
- Chronic pelvic pain. American Congress of Obstetricians and Gynecologists. http://www.acog.org/publications/patient_education/bp099.cfm. Accessed Jan. 18, 2011.
- Howard F. Evaluation of chronic pelvic pain in women. http://www.uptodate.com/home/index.html. Accessed Jan. 18, 2011.
- ACOG Committee on Practice Bulletins - Gynecology. Chronic pelvic pain. Obstetrics & Gynecology. 2004;103:589.
- Howard F. Treatment of chronic pelvic pain in women. http://www.uptodate.com/home/index.html. Accessed Jan. 18, 2011.
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