Pelvic Pain

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 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, and chronic pain can also lead to depression.

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

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

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

• Imaging technology: Ultrasound, magnetic resonance imaging (MRI), computerized tomography (CT), or abdominal X-rays help physicians detect endometriosis or other abnormalities.
• 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.

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: Useful in a variety of chronic pain conditions, even if the patient isn't depressed. 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.

At Boston Children's Hospital, the Division of Gynecology can help young women determine the cause of the pelvic pain, and also provide testing to identify any potentially life-threatening condition.