Dr Dulcy gives health advice

BE INFORMED: THERE ARE MANY DIFFERENT CAUSES OF THIS

A urine infection is a common cause.

The pelvis is the lowest part of your abdomen. Organs in your pelvis include your bowel, bladder, womb (uterus) and ovaries. Pelvic pain usually means pain that starts from one of these organs.

In some cases the pain comes from your pelvic bones or from nearby muscles, nerves, blood vessels or joints. Pelvic pain is more common in women.

If you are confident that you know the cause or the pain – for example, period pain – you could try taking a painkiller, such as paracetamol or ibuprofen. If you are not sure of the cause of the pain or if the pain is severe, you should see a doctor.

Some causes are emergencies – for example, an ectopic pregnancy. Seek medical help urgently if you suspect this. You may also want to see a doctor if the pain keeps coming back. For many of the conditions listed below, there are treatments available.

CAUSES OF PELVIC PAIN

Pelvic pain can be acute or chronic. Acute means that it is the first time you have had this type of pain. Chronic means that pain has been a problem for a long time.

There are many different causes of pain in your pelvis. For easy diagnosis separate them by when they tend to happen, if you are pregnant and if they are accompanied by other symptoms, such as vaginal bleeding.

The most common causes are discussed here. Most will improve with painkillers.

Problems associated with pregnancy

Miscarriage: Miscarriage is the loss of a pregnancy at any time up to the 24th week. Seven or eight miscarriages out of 10 occur before 13 weeks of pregnancy. The

usual symptoms of miscarriage are vaginal bleeding and lower tummy or pelvic cramps.

You may then pass some tissue from the vagina, which often looks like a blood clot.

Ectopic pregnancy: an ectopic pregnancy is a pregnancy that tries to develop outside the womb (uterus). It occurs in about one in 100 pregnancies. Usual symptoms include pain on one side of the lower abdomen or pelvis.

Vaginal bleeding can occur. It is often darker-coloured than the bleeding of a period.

Rupture of corpus luteum cyst: a corpus luteum makes hormones that help keep you pregnant, until other organs, such as the placenta, take over. It forms after the release of the egg at ovulation.

They are often found, by chance, when you have an ultrasound scan for whatever reason. They often clear up without treatment. Sometimes it can become too swollen and may burst. This may cause sharp pain.

Premature labour: normally labour starts after 37 completed weeks of pregnancy. Normal labour usually starts as cramps felt across the lower abdomen.

If you have a gush of fluid from the vagina, your waters may have broken. You should contact your doctor immediately.

Placental abruption: About six times in every 1 000 deliveries, the placenta detaches from the wall of the womb. Before 24 weeks of pregnancy this is a miscarriage; but after 24 weeks it is called an abruption. It is an emergency because the baby relies on the placenta for food and oxygen.

Gynaecological problems

Ovulation: Ovulation means producing an egg from your ovary. Some women develop a sharp pain when an egg is released.

The pain usually occurs mid-cycle. The pain may be on a different side each month, depending on which ovary releases the egg. This pain only lasts a few hours.

Period pains (dysmenorrhoea): Most women have some pain during their periods. The pain is often mild but, in about one in 10 women, the pain is severe enough to affect day-to-day activities. Doctors may call period pain dysmenorrhoea.

Pelvic inflammatory disease (PID): PID is an infection of your womb. Bacteria that cause the infection usually travel into your womb from your vagina or cervix.

Most cases are caused by chlamydia or gonorrhoea. Symptoms include pain in your lower abdomen or pelvis, fever, abnormal vaginal bleeding and a discharge.

Rupture or torsion of ovarian cyst: An ovarian cyst is a fluid-filled sac which develops in an ovary. Most ovarian cysts are non-cancerous (benign) and cause no symptoms. Some cause problems such as pain and irregular bleeding. Pain may happen when they burst (rupture) or twist (called torsion).

No treatment may be needed for certain types of ovarian cysts. Others may require surgery.

Degenerative changes in a fibroid: Fibroids are non-cancerous growths in the womb.

They usually cause no symptoms but can cause heavy periods, abdominal swelling and urinary problems. Rarely, the fibroid outgrows its blood supply. This can make it shrink (degenerate), which can be very painful.

Endometriosis: This is a condition found in women between the ages of 13 and 50. It is most commonly diagnosed in women in their thirties.

It is more common in women who are having trouble conceiving and can be found in one out of five of them. It causes pain around the time of your period. It may also cause pain when you have sex.

Chronic pelvic pain: this is the term used when a woman has had pain for at least six months. Chronic pelvic pain can occur in around one in six women.

Keeping a symptom diary is helpful. This may identify a pattern to the pain and triggers in your life that may be responsible.

Depression, chronic stress or a past history of sexual or physical abuse increases your risk of developing chronic pelvic pain. In addition, any emotional distress often makes pain worse.

Your doctor will often consider psychological treatments to help with the pain.

Cancers: cervical, ovarian or uterine cancer may also present with lower abdominal or pelvic pain, occasionally associated with abnormal bleeding or discharge. The pain may or may not be associated with sexual intercourse.

Bowel or bladder problems

Appendicitis: appendicitis means inflammation of your appendix. The appendix is a small pouch that comes off the gut wall. Appendicitis is common.

Typical symptoms include abdominal pain and being sick (vomiting) that gradually get worse over 6-24 hours. Some people have less typical symptoms. An operation to remove the inflamed appendix is usually done.

Irritable bowel syndrome

(IBS): IBS is a common bowel disorder. The cause is not known. Symptoms can be quite variable and include abdominal pain, bloating, and sometimes bouts of diarrhoea and/or constipation. Symptoms tend to come and go.

There is no cure for IBS but symptoms can often be eased with treatment.

Cystitis: this is a urine infection in the bladder. It is common in women. A short course of antibiotic medication is a common treatment.

It may improve spontaneously without the need for antibiotics. Cystitis clears quickly without complications in most cases.

DIAGNOSING PELVIC PAIN

Consult your doctor for a full history and physical examination. A urine infection is a very common cause of pelvic pain and your doctor may ask for a urine sample. If they think there is a risk of an infection, they may ask to take a sample (swab). They may provide

Adhesions: adhesions may happen after surgery. As your body tries to heal after surgery, the tissues become sticky.

The stickiness may accidentally cause tissues to stick together. The most common organ affected is the bowel. This may cause pain.

Strangulated hernia: a hernia occurs where there is a weakness in the wall of the abdomen. As a result, some of the contents within the abdomen can then push through (bulge) under the skin. You can then feel a soft lump or swelling under the skin. There is a small chance that the hernia might strangulate.

A hernia strangulates when too much bowel has come through the gap in the muscle or ligament and then becomes squeezed. This can cut off the blood supply to the portion of intestine in the hernia.

This can lead to severe pain and some damage to the part of the intestines in the hernia.

Muscle and bone problems: Problems with your lower back, bones in your pelvis and nearby joints such as your hip joints can cause pain.

Often it is clear where the pain is coming from. However, in some cases, the pain can feel like it is in your pelvis and it can be difficult to pinpoint its origin. an urgent ultrasound if miscarriage or ectopic pregnancy is suspected. A routine ultrasound scan can also be done. A pap smear will also be done if cervical pathology is suspected. Laparoscopy is commonly undertaken by gynaecologists. In this procedure, a telescope is put through a small cut in your belly button. This allows the doctor to see inside your pelvis. The lower bowel (rectum and colon) are looked at by colonoscopy.