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Pelvic Pain

Most women experience pelvic pain at some or the other time during their live time.  Mostly it is just the normal functioning of the reproductive or other organs, but at other times it may indicate a serious problem that needs urgent treatment. 

CAUSES OF PELVIC PAIN

Many organs, including the uterus, ovaries, fallopian tubes are located in the pelvis. The bladder and intestine, and appendix are also found next to the reproductive organs, and sensations from these organs can feel like pain from the uterus or ovaries.  That is not all, pain from the kidney and pain from muscles and from the abdominal wall can also seem to come from the pelvis. 

PELVIC PAIN FALLS INTO THREE CLASSIFICATIONS

  • Pelvic pain that indicates a serious problem and that needs urgent surgery or hospitalization.  Examples of this type of pelvic pain would be a ruptured tubal pregnancy or appendicitis.
  • Pelvic pain that indicates a problem that may need treatment, but not on an urgent basis.   Examples of this would include pain from endometriosis, or a growing fibroid tumor.   Chronic pelvic pain also falls into this category.
  • Pelvic pain that is caused in the course of normal functioning of the reproductive organs, and will probably resolve without treatment.  This pain can be severe, but is self-limited.  A frequent cause of this is pain during ovulation and a "functional" ovarian cyst.

PELVIC PAIN: THE TRUE EMERGENCIES

  • A True Emergency is one that if not treated urgently will cause serious harm or death.  One of the causes is ruptured tubal (ectopic) pregnancy.  Many women with a tubal pregnancy will continue to have menstrual-like bleeding, so they do not consider this possibility. The only way for a doctor to be sure not to miss this diagnosis is to presume every woman, in the reproductive age, is pregnant, until proved otherwise! 
  • What else could prove dangerous? Most ovarian cysts do not need to be (and should not be) treated urgently. Occasionally, an ovarian cysts will twist (undergo torsion) and cut off the blood supply to the ovary. Fortunately, only a very small percentage of ruptured cysts need any treatment at all.
  • Pelvic infection (Pelvic inflammatory disease, or PID) caused by chlamydia or gonorrhea needs to be treated without delay. These infections often cause diffuse lower abdominal pain, and may or may not cause a fever.  Unfortunately, the diagnosis of PID is used to explain any pain whose cause is not obvious.  Laparoscopy, a procedure in which a little telescope actually examines the tubes and ovaries, may be necessary for an accurate diagnosis.
  • Non-gynecologic emergencies should also be kept in mind.  Pain from appendicitis often starts out near the navel, and then moves to the right lower side.   Inflammation of the colon can cause severe pain, as can kidney stones.
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