KidsMD Health Topics

Pelvic Pain

  • Overview

    Adolescent girls and women frequently experience pain in the region below the belly button and between the hips, commonly called pelvic pain. Depending on the cause of the discomfort, pelvic pain and can either be short-lived or chronic.

    • Up to 33 percent of women will have pelvic pain during their lifetime.
    • Pelvic pain can range from mild and annoying to severe, and interfere with sleep, work and daily activities.
    • The cause of pelvic pain is often difficult to identify, but that doesn't mean the pain isn't real and treatable.

    Stress and depression can manifest as pelvic pain. Chronic pain can also lead to depression.

    Pelvic pain

    How Boston Children's Hospital approaches pelvic pain

    At Children's, the Gynecology Program can help young women determine the cause of the pelvic pain, and also provide testing to identify any potentially life-threatening condition. The Center for Young Women's Health provides information and support to young women who may be dealing with chronic pelvic pain.

    Boston Children's Hospital
    300 Longwood Avenue
    Boston MA 02115

  • In-Depth

    What are the symptoms of pelvic pain?

    The experience of pelvic pain can differ from patient to patient. A woman should seek medical help once the pain interferes with her daily schedule. Possible symptoms include:

    • severe pain in the pelvic region
    • pain that comes and goes
    • dull aching
    • sharp pains or cramping
    • pressure or heaviness deep within her pelvis
    • pain during sexual intercourse
    • pain while having a bowel movement
    • pain upon sitting down

    What causes pelvic pain?

    Pelvic pain can have many causes, gynecological, gastrointestinal or psychological. Common causes include:

    • endometriosis
    • tension in your pelvic floor muscles
    • chronic pelvic inflammatory disease
    • pelvic congestion syndrome
    • ovarian remnant
    • ovarian cysts
    • uterine fibroids
    • irritable bowel syndrome
    • painful bladder syndrome, also called interstitial cystitis
    • psychological factors, such as depression, stress or the effects of abuse

    What can my daughter do for herself before her appointment?

    Your daughter will most likely have tried over the counter pain medications to relieve pelvic pain. You can encourage her to try practicing relaxation, meditation or deep breathing techniques. It may seem hard to do while in pain, but it's important to try to reduce stress as it can increase the intensity of the symptoms.

  • Tests

    How does a doctor diagnose pelvic pain?

    A physician will take a complete medical history and pelvic exam, and may recommend:

    • imaging technology
    • cultures
      • Swabs taken from her vagina or cervix may detect infection or sexually transmitted diseases.
    • laparoscopy
      • A thin tube with a camera attached to its end provides an effective way for a gynecologist to check for endometriosis or pelvic inflammatory disease.
  • Pelvic pain treatment at Boston Children's Hospital

    Your daughter's specific treatment depends on the cause of her pelvic pain. If the physician finds a cause, her treatment will be tailored to her condition. If there is no identifiable cause, her treatment will be focused on pain management strategies. Possible treatments include:

    • antibiotics
    • pain relievers
      • Over the counter or prescription pain medications can partially relieve pelvic pain. Usually, pain relievers alone don't fully treat pelvic pain.
    • hormone treatments
      • If the pain is connected to the menstrual cycle, birth control pills or other hormonal treatments may be able to relieve the cyclical pain.
    • antidepressants
      • Anti-depressants are useful in a variety of chronic pain conditions, even if the patient isn'tdepressed. Certain antidepressants, such as amitriptyline and nortriptyline (Aventyl, Pamelor) among others have been found to relieve pain as well as depression.
    • counseling
      • Psychological stress can manifest as pelvic pain in women. Counseling should be a part of treatment if she is coping with a personality disorder, sexual abuse, depression or troubled relationships.
    • physical therapy
      • Stretching exercises, massage, heating or cooling pads or transcutaneous (TENS) nerve stimulation can help relieve pelvic pain.
    • trigger point injections
      • If the pain is coming from a specific spot, your physician may suggest a direct injection of a long-lasting local anesthetic to ease the pain.
    • nerve separation (ablation)
      • Sometimes a miscommunication within the pathways of the nervous system causes pelvic pain. Treatments for this include using heat or lasers to destroy certain nerves, surgery to remove them or injections of medication to block nerve function.
    • surgery
      • If endometriosis or pelvic adhesions are at the root of the pelvic pain, surgery to remove the problem could be the solution. During laparoscopic surgery, a physician makes small incisions in the abdomen with the help of a small camera attached to a tube.
      • A hysterectomy is a last resort to relieve pelvic pain.
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