"I’ve been having pelvic pain for a while now. I’m concerned but I’m not sure where to go—my doctor? ObGyn? gastroenterologist? Or do I need to find some other expert?"
Most pelvic pain is not life threatening, but if any of these conditions apply to you, call 9-1-1 or head to the closest emergency room:
- Pain is sudden, sharp and severe
- You are pregnant or there’s any possibility you were pregnant in the past 6 months
- Pain is in the lower right pelvic area or behind the belly button and moving
- You can’t stand upright
- You are bleeding or have blood in your stool or urine
- You have a fever
Setting emergency-level pain aside, there are many potential causes of pelvic pain. After all, a woman’s pelvis houses the reproductive organs, bladder, intestines, rectum, and many nerves, blood vessels and connective tissue. Pain could be coming from one of these or radiating to the pelvis from another region, like the chest or spine.
With so many potential causes, how do you know where to go for help? The best course is to make appointments with both your primary doctor and your ObGyn. The order doesn’t matter – go see whoever can get you in faster, first. Both are likely to ask questions and perform basic tests that can narrow down the cause. And if your first stop is only to rule out a cause, you’ll already have the other appointment in place.
If you don’t have a physician, or just want some advice, our free Nurses on Call line can help (1-800-386-9355). Available 24 hours a day, 7 days per week, this free service lets you talk to a registered nurse or can help you find a physician. You can also use our online physician finder.
Keeping a Pain Diary
When you do see a doctor for your pelvic pain, you’ll be asked about your personal and family medical history and then asked to describe your pain. This sounds simple enough but can be hard to do if you’re not feeling the pain at that moment. So, take some time to jot down notes about your pain any time it occurs. This is sometimes called a pain journal or pain diary, but it doesn’t have to be formal. Here are some things you’ll want to note:
- What the pain feels like. There’s no right or wrong way to describe pain – achy, cramping, stabbing, gnawing, heavy, sharp, burning, sickening – just write the words that come to mind.
- Where you felt the pain. Don’t worry if you can’t nail it down to a specific spot – just note whether it’s in one spot or spread out. Whether it moves and in what direction is also important.
- How long the pain lasts. Maybe it comes and goes for an hour then stops or it could be constant for 15 minutes.
- What makes the pain better or worse. Does lying down help? Does eating make it worse? If so, jot it down. How limited are your activities when you have pain?
- How often the pain occurs and potential triggers. Each time the pain occurs, jot down how long it lasts and anything that might have triggered it – food, activity, relationship to your menstrual cycle, stress, sexual activity, etc.
Bring your pain diary with you to your doctor appointments – even if you haven’t been able to record much so far. Your doctor may suggest other things to record in it moving forward and that you get into the habit of taking it everywhere.
Diagnosing Pelvic Pain
Diagnosis of pelvic pain usually begins with a pelvic exam, blood tests and urine tests. Your doctor may also recommend one or more of the following:
- Pelvic ultrasound or transvaginal ultrasound—These send sound waves to produce images of the pelvic organs.
- Pelvic MRI (magnetic resonance imaging)—Uses magnets to produce detailed images of the pelvis.
- Cystoscopy—Allow doctors to examine the lining of your bladder using a small tube that enters through the urethra. It may be done with or without a ureteroscopy, which examines the tubes that carry urine from your kidneys to your bladder.
- Colonoscopy—Allows doctors to examine the internal lining of your colon and rectum as well as remove tissue samples or polyps. A tiny camera and light are attached to a thin, flexible tube that enters through the rectum while patients are under anesthesia.
Other tests may also be recommended based on your symptoms or the outcomes of other tests. Finding the cause of pelvic pain can take time and, in some cases, a definitive cause is never found. But that doesn’t mean that the pain isn’t real and treatable.
Chronic Pelvic Pain
Pelvic pain is chronic if it has been going on for more than 6 months and affects your quality of life. Treatment of chronic pelvic pain will vary for each patient and may include a combination of treatments such as:
- Medications—Including pain relievers, muscle relaxants or antidepressants (some of which have been found to help chronic pain conditions).
- Hormone treatments—If the pelvic pain has a menstruation-related cause, such as endometriosis or menopause, hormone medications may help.
- Physical therapy—Chronic pelvic pain that relates to the muscles or connective tissue can be treated with physical therapy techniques like stretching, strengthening, massage and/or learning to control pelvic muscles.
- Surgery—Ovarian cysts, uterine fibroids, endometriosis and other causes of pelvic pain can be treated surgically.
Counseling and lifestyle changes can also help some women with chronic pelvic pain. The most important thing is to seek help and don’t give up if a diagnosis is not quickly found. Remember that a registered nurse is just a phone call away to help with any questions along the way by calling 1-800-386-9355 (our free, 24/7, nurse help line.)
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