Causes and symptoms of chronic pelvic pain

Many different conditions can cause chronic pelvic pain. You may have one or more of them. All can have similar symptoms and that often makes it hard to work out the source of the pain. The main symptom is pain that lasts for more than six months, but there are usually other symptoms as well. Understanding your symptoms can help you and your doctor begin to pinpoint the cause or causes of your chronic pelvic pain.

Here are some of the causes and the related symptoms:

Endometriosis

With endometriosis, cells that normally line the inside of the uterus (the endometrium) grow inappropriately outside on organs such as the ovaries, bladder or rectum.

Symptoms you may have:

• Pelvic pain or cramps before or during your period
• Pain during or after sex
• Pain when you ovulate
• Painful bowel movements
• Rectal bleeding during your period
• Pain when you urinate
• Lower back pain
• Infertility
• Spotting between periods
• Bloating in your abdomen

Adenomyosis

This condition is similar to endometriosis. Cells that normally line your uterus (the endometrium) invade the muscle tissue of the uterus wall (the myometrium). Many women with adenomyosis don't have any symptoms.

• Symptoms you may have:
• Pain during your period
• Feeling of pressure on your bladder or rectum
• Heavy periods
• Periods that last longer than usual
• Spotting between periods

Interstitial cystitis

Women with interstitial cystitis have an inflamed bladder. The inflammation is not caused by an infection. This condition tends to affect women in their 30s and 40s.

• Symptoms you may have:
• Needing to urinate very often
• Often feeling an urgent need to urinate
• Discomfort when you urinate
• Pain during sex

Urinary tract infection

Bacteria are usually the cause of urinary tract infections. Infections can involve any part of the urinary tract, including the kidneys, bladder and urethra. Urinary tract infections are much more common in women than in men.

Symptoms you may have:

• Feeling pressure in your lower pelvis
• Pain or a burning sensation when you urinate
• Needing to urinate often
• Often feeling an urgent need to urinate
• Needing to get up at night to urinate
• Cloudy urine
• Blood in urine
• Urine has strong or bad smell
• Only a trickle of urine comes out
• Lower back pain

Pelvic inflammatory disease

This is an infection of the uterus, fallopian tubes or ovaries that causes them to become inflamed and infected. Most often it is a sexually transmitted bacterial infection, like gonorrhoea or chlamydia. These organisms go from the vaginal canal up through the cervix, into the uterus, out the fallopian tubes and into the surrounding pelvic organs including the ovaries. Very occasionally these bacteria can infect these organs in other ways, such as through vaginal irrigation. Scars left by the infection may cause long-term chronic pelvic pain, but more usually the pain is acute and short-lived.

Symptoms you may have:

• Vaginal discharge having an unusual colour, texture or odour
• Abdominal or pelvic pain in a specific area or more widespread
• Pain during sex
• Irregular or missed periods
• Menstrual cramps that are worse than usual
• Frequent need to urinate
• Pain when you urinate
• Pain when you ovulate
• Pain when you press on certain areas of your pelvis
• Lower back pain
• Fatigue
• Fever
• Nausea