Pelvic pain is pain that is localized below the navel and above the beginning of the thighs. They can be associated with different conditions. Sometimes pelvic pain does not pose any danger and goes away on its own after some time, sometimes it indicates certain diseases, and in some cases it signals that you need to urgently go to the hospital.
Sexually transmitted infections
Characteristic signs of sexually transmitted infections (STIs): pain during urination, vaginal discharge, vaginal bleeding between periods. The most common types of STIs are gonorrhea and chlamydia. The final diagnosis can be made by a doctor after laboratory tests. If you are diagnosed with a sexually transmitted disease, your partner should also be tested.
Treatment
Help before diagnosis
For abdominal pain associated with menstruation, non-drug methods are sufficient. Herbal teas with chamomile and mint are effective. You can put a warm (not hot!) heating pad on your lower abdomen and lie with it in the “fetal position”, pulling your knees towards your body. To reduce menstrual cramps, it is advisable to give up strong tea and coffee, spicy and smoked foods. A woman’s psychological mood, the ability to calm down and relax are very important.
For minor pain that occurs in pregnant women, doctors recommend avoiding physical activity and heavy lifting and getting plenty of rest. It is necessary to exclude from the diet foods that increase gas formation, since flatulence is one of the main causes of abdominal pain during gestation. If pain intensifies, protective tension in the abdominal muscles appears, and bloody discharge from the vagina occurs, you should seek medical help as soon as possible.
Conservative therapy
Treatment of women experiencing pain in the lower abdomen should be etiopathogenetic, so drugs are prescribed only after identifying the root causes of the pain syndrome. Drug therapy is supplemented with a gentle regimen, if indicated - bed or half-bed, a fortified diet with an adequate amount of fluid. Treatment regimens may include the following groups of medications:
- Painkillers
. Taking antispasmodics and analgesics is effective for all types of inflammatory diseases of the genitourinary system and algomenorrhea, accompanied by severe pain. Non-steroidal anti-inflammatory drugs are also used for inflammation. - Antibacterial drugs
. Antibiotics are indicated for adnexitis, endometritis, cystitis, intestinal infections, etc. More often drugs from the group of cephalosporins, fluoroquinolones, and macrolides are used. For uncomplicated urinary tract infections, uroseptics are appropriate. - Hormones
. For the treatment of severe algomenorrhea, combined oral contraceptives or natural progestins are recommended. A similar treatment regimen is selected for women suffering from endometriosis. - Sedatives
. Medicines are effective for chronic pelvic pain, algomenorrhea, especially if they are combined with severe neuropsychic symptoms.
Surgery
A number of obstetric pathologies require urgent surgical intervention. In case of an ectopic pregnancy, an operation is performed to remove the fallopian tube along with the fertilized egg (tubectomy), and in case of an uncomplicated pregnancy, an organ-preserving operation - tubotomy - is possible. Complete premature placental abruption is an indication for cesarean section, regardless of gestational age.
Gynecological diseases (ovarian apoplexy and torsion of the tumor stalk) are treated surgically by oophorectomy, adnexectomy, wedge resection of the ovary. In severe forms of endometriosis, endometrioid lesions are excised. Surgical treatment is also required for abdominal pathologies: appendicitis (appendectomy), hernias (hernioplasty).
Ovarian cyst
The ovaries contain follicles - sacs in which eggs mature. A mature follicle ruptures during ovulation and releases an egg. If this does not happen, it turns into a cyst. Such ovarian cysts are usually harmless and can go away on their own, but they can cause pain and an enlarged abdomen. When the cyst is torsioned, a threatening condition occurs - severe acute pain should force you to immediately consult a doctor. Ovarian cysts are detected during a gynecological examination and ultrasound.
Diagnostics
Establishing the root cause of pain in the lower abdomen in women is difficult even for an experienced doctor, since it is necessary to differentiate diseases of the reproductive, digestive, and urinary systems. The patient is examined by an obstetrician-gynecologist and a gastroenterologist, and other specialists are involved if necessary. The diagnostic plan includes laboratory and instrumental methods:
- Examination on the chair.
In a classic two-manual examination, the doctor assesses the size and consistency of the uterus, and identifies tenderness or enlargement of its appendages. A vaginal examination using speculum is needed to examine the mucous membrane of the vagina, cervix, and determine prolapse of the internal reproductive organs in women. - Ultrasonography.
An ultrasound scan examines the condition of the uterus and appendages, detecting signs of pregnancy, space-occupying formations, and an inflammatory process. Abdominal sonography is necessary to exclude appendicitis and pathology of the distal intestine. An ultrasound of the bladder is performed after preliminary preparation. - Endoscopic methods.
Hysteroscopy is necessary to examine the uterine cavity, find benign and malignant neoplasms, and chronic inflammation. In case of possible Crohn's disease or UC, the gastroenterologist prescribes a colonoscopy, which, if indicated, is supplemented with a biopsy. - X-ray diagnostics.
Hysterosalpingography is a method for assessing the patency of the fallopian tubes and identifying sclerotic changes in women that are specific to chronic adnexitis. To confirm or exclude pathology of the urinary organs, excretory urography is used. Irrigoscopy is used to visualize the intestinal mucosa. - Laboratory methods.
If algomenorrhea is suspected, it is necessary to determine the levels of estrogen and progesterone; for early diagnosis of pregnancy, the content of human chorionic gonadotropin is measured. If there are signs of inflammation, smears are taken from the urethra and vagina, in which the causative agent of the infection is determined using a microbiological method.
For pain in the lower abdomen, a woman should consult a gynecologist
Pelvic organ prolapse
With age or during pregnancy and childbirth, the pelvic floor muscles may weaken, causing the uterus, vagina and bladder to move downwards. This is not a dangerous condition, but it leads to a feeling of discomfort and makes sexual intercourse painful. Special Kegel exercises help strengthen the pelvic floor muscles.
Varicose veins of the pelvic veins
Varicose veins can occur not only on the legs. Dilatation of the pelvic veins leads to pain, which intensifies when the woman sits or stands. When lying down, symptoms decrease or disappear. Varicose veins of the pelvic veins are treated surgically.
Causes of lower abdominal pain in women
Physiological changes during pregnancy
During normal gestation, women experience short-term, mild pain in the lower abdomen. They are caused by an increase in the size of the uterus and overstretching of the ligaments that support it. In the second and third trimesters, the enlarged uterus puts pressure on neighboring organs, which also causes discomfort in the expectant mother. Pain can occur with bloating, which is often observed in pregnant women.
Pathologies of pregnancy
During gestation, acute pain in the lower abdomen indicates the development of complications. When spontaneous abortion occurs, women experience sharp, paroxysmal pain in the suprapubic and sacral area. It appears suddenly and can be triggered by a blow to the stomach, heavy lifting, or a stressful situation. The pain syndrome is accompanied by bloody discharge from the genital tract, which indicates an abortion in progress.
Severe paroxysmal or aching dull pain in the lower abdomen, combined with bleeding, may indicate premature placental abruption. The lower abdomen becomes hard and tense, and when palpating this area, the pain increases. Sometimes the pain syndrome is so intense that some women lose consciousness. The condition mainly develops after the 20th week of pregnancy.
Aching pain in the lower abdomen on the right or left occurs in women with an ectopic pregnancy. They may be accompanied by engorgement of the mammary glands, changes in appetite, and delayed menstruation. An interrupted tubal pregnancy is characterized by sharp pain in the lower abdominal cavity, which radiates to the perineum, lower back, and thigh. Bloody or brown spotting from the vagina is common.
Algomenorrhea
It is the most common cause of lower abdominal pain in women of reproductive age. Soreness appears 12-24 hours before the start of menstruation. For most women, the pain is nagging or aching in nature, of moderate intensity, and is eliminated with the help of conventional analgesics or antispasmodics. The most intense cramps are observed on the first day of menstruation, then they decrease. For 3-4 days you may feel slight discomfort in the lower abdomen.
With moderate and severe algomenorrhea, women experience severe cramps in the lower abdomen with irradiation to the lumbar region. The pain becomes more severe when turning and bending the body, coughing and sneezing, and straining. Severe pain affects the ability to work and activity of women. In addition to pain, psycho-emotional instability, weakness and dizziness, nausea and stool disorder are noted.
Pain in the lower abdomen in women
Inflammatory diseases of the reproductive system
Pain above the pubis and in the lateral abdomen is characteristic of endometritis and adnexitis. In acute inflammation, women are bothered by intense constant or paroxysmal pain, which is more pronounced on the side of inflammation. Acute endometritis is characterized by pain in the lower abdomen without clear localization. Against the background of pain, body temperature rises, general weakness increases, and various vaginal discharges are possible.
In the chronic form of adnexitis, moderate aching pain in the lower abdomen is observed, and short-term cramps occasionally occur. The pain intensifies after hypothermia, under stress, and with concomitant viral or bacterial processes. With chronic endometritis, nagging pain is felt, accompanied by menstrual irregularities. A pathognomonic sign is a sharp increase in pain during sexual intercourse.
Endometriosis
Depending on the location of endometriosis, pain in the lower abdomen has different characteristics. Most women complain of vague pulling or aching sensations in the pelvis, which intensify before menstruation. The pain syndrome reaches its maximum intensity in the first 2-3 days of menstruation. Often, pain in the pubic area intensifies during intimate relationships.
Neoplasms
The most common tumor formation of the genitals in women is uterine fibroids. Interstitial and subserous fibroids are characterized by constant dull pain in the pelvic cavity. With submucous fibroids, women suddenly feel severe cramps. It is typical to change the intensity of the pain syndrome in different phases of the monthly cycle. The pain is accompanied by menorrhagia and acyclic uterine bleeding.
Malignant tumors of the uterus are characterized by constant pain in the lower abdomen, which worsens as the tumor grows. Sometimes the pain radiates to the lower back, sacrum, and rectum. With cancer of the uterus, cramping painful sensations occur for no apparent reason. After a painful attack, as a rule, bloody or bloody vaginal discharge appears.
Chronic pelvic pain syndrome
With CPPS, women complain of painful sensations of varying strength and nature that bother the patient for at least 6 months. The pain is localized in the lower abdomen, perineal and pubic area. They may irradiate to the hip joints and buttocks. The pain syndrome intensifies with physical exertion and hypothermia. Pain in the lower abdomen also appears during sexual intercourse and vaginal examination.
Diseases of the urinary system
A common cause of lower abdominal pain in women is cystitis. In acute inflammation, patients constantly experience pain in the suprapubic region, which varies in intensity - from slight discomfort to unbearable pain. There is a frequent imperative urge to urinate, urine leakage is accompanied by increased pain in the lower abdomen. Sometimes women notice a strong unpleasant odor and cloudy urine.
Dull pain above the pubis, intensifying at the end of urination, is typical for bladder polyps. With a malignant process in the bladder, there is constant severe pain above the pubis. Sometimes pain in the lower abdomen occurs with pyelonephritis or ureteritis. For these diseases, pain in the lower back is more typical, however, when urinating, a woman may feel discomfort in the suprapubic area.
Intestinal infections
Paroxysmal pain in the lower abdomen is typical for infections that occur with colitis syndrome. These include escherichiosis, shigellosis, yersiniosis and campylobacteriosis. Women are bothered by severe cutting pains, accompanied by a painful urge to defecate. After bowel movement, the pain subsides for a short time. Diarrhea develops 10 or more times a day, stool contains a large amount of mucus, and sometimes streaks of blood.
Hernias
Pain in the lower abdomen is observed in women with inguinal hernias, hernias of the white or Spigelian lines. Pain occurs when straining or squeezing the abdominal organs with tight clothing or a belt. Over time, due to the increase in hernial protrusion, the pain becomes permanent. Acute pain in the area of the hernial sac and the inability to reduce it into the abdominal cavity indicate a strangulated hernia.
Appendicitis
Inflammation of the appendix is characterized by pain on the right in the iliac region, but sometimes pain is felt above the pubis. The localization of pain depends on the location of the appendix in the abdominal cavity. With appendicitis, you experience severe constant pain, accompanied by muscle tension in the right iliac region. After the onset of pain, there may be one or two episodes of vomiting, diarrhea, or stool retention.
Rare causes
- Limited purulent inflammation
: pouch of Douglas abscess, tubo-ovarian abscess. - Inflammatory bowel disease
: nonspecific ulcerative colitis (UC), Crohn's disease. - Blunt abdominal trauma.
- Prolapse of the uterus and vagina.
- Emergency conditions in gynecology
: ovarian apoplexy, torsion of the pedicle of an ovarian tumor. - Vascular pathologies
: varicose veins of the small pelvis, inferior vena cava syndrome.
Myofascial pain syndrome (MPS)
Quite often, the source of pelvic pain is the muscles and ligaments. This condition is called myofascial pain syndrome and has the following causes:
- muscle and ligament sprains;
- bruises;
- frequent minor muscle injuries, for example, during heavy physical work or sports;
- overstrain of the pelvic muscles, when you have to maintain an uncomfortable position for a long time;
- Sometimes the cause is hypothermia and frequent stress.
There can be many causes of pelvic pain. Sometimes it is difficult for a doctor to determine the cause of this condition without additional examinations. If you are worried about pelvic pain, make an appointment with a gynecologist at ProfMedLab, our phone number: +7 (495) 120-08-07.
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Abdominal pain during pregnancy
An ectopic pregnancy is a pregnancy in which implantation of the embryo occurs outside the body of the uterus. The most common site of ectopic pregnancy is the fallopian (uterine) tube.
Risk factors for ectopic pregnancy include: in vitro fertilization, pelvic inflammatory disease and gynecological surgery.
To diagnose it, the level of human chorionic gonadotropin (hCG) is determined, ultrasound examination and laparoscopy are performed.
The main symptoms of an ectopic pregnancy include:
- delayed menstrual bleeding;
- irregular discharge mixed with blood from the uterus;
- severe pain in the abdominal cavity.
Types of ectopic pregnancies
Miscarriage
Miscarriage is the most common complication of pregnancy. This term refers to the expulsion of the fertilized egg from the uterus before 22 weeks of pregnancy. If three more miscarriages occur after the first one, this condition is called recurrent miscarriage.
The main symptoms of a miscarriage include bleeding and pain in the lower abdomen of varying severity. The most common causes are genetic, hormonal, anatomical and immunological pathologies. The risk of miscarriage is related to the age of the pregnant woman. Women who become pregnant after age 35 have a much higher risk of miscarriage.
Prostate diseases
Pain in the lower abdomen in men can occur as a result of prostate disease. Prostate diseases that cause pain in the lower abdomen include:
- inflammation of the prostate gland;
- prostate hypertrophy;
- prostate cancer.
Stages of prostate cancer
Inflammation (prostatitis) in the absence of treatment becomes chronic, possible development of abscess and fistulas of the prostate gland, cystitis and pyelonephritis, infertility due to the formation of autoimmune antibodies.
Our advantages
- Fast and high-quality diagnostics. In our hospital, the patient is examined using the latest equipment, which increases the efficiency of diagnosing the cause of pain in the lower abdomen.
- Doctors. The doctors of the gynecology department of the Yauza Clinical Hospital have extensive experience, scientific titles and degrees, the highest qualification category, and are proficient in all modern diagnostic methods, which allows them to quickly determine the cause of pain and provide effective and high-quality treatment.
- Complexity. Diagnosis and treatment of abdominal pain, including during pregnancy, is carried out jointly with other specialists.
- Equipped operating room. The presence of advanced equipment in the operating room allows, if necessary, to carry out surgical interventions as efficiently as possible (including minimally invasive - laparoscopic, hysteroscopy, transvaginal access, etc.).
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