What causes pelvic pain?

There are many possible causes of pelvic pain, and it may be difficult to figure out the specific cause or causes.¹ A woman's pain may result from multiple causes occurring all at the same time. And a woman with one chronic pain condition is at increased risk for other types of chronic pain.

In many cases, pelvic pain indicates a problem with one or more of the organs in the pelvic area, such as the uterus, vagina, intestine, or bladder. Problems may include infection, inflammation, or conditions such as endometriosis.

The intensity of a woman's pelvic pain may not relate to the severity of the problem or condition causing the pain. For example, a woman with only small areas of endometriosis may experience intense pain.

The following health problems can cause or contribute to pelvic pain:

Adhesions.^1,2 Adhesions are bands of scar tissue that form between internal tissues and organs. They can form as a result of surgery or infections, such as pelvic inflammatory disease. There is disagreement about whether adhesions can cause pain. It has been proposed that pain may occur when adhesions prevent normal movement of internal organs, such as the bowel.³

Endometriosis.^1,2 This condition (pronounced en-doh-mee-tree-OH-sis) occurs when tissues that normally grow inside the uterus grow somewhere else in the body, usually in other parts of the pelvis, such as on the outside of the uterus, ovaries, or fallopian tubes. The two most common symptoms of endometriosis are pain and infertility.

Interstitial cystitis/painful bladder syndrome.^1,2 This syndrome (pronounced IN-tur-STISH-uhl siss-TY-tiss) is associated with pain in the region of the bladder as well as the need to urinate frequently and urgently. This pain may be a burning or sharp pain in the bladder or at the opening where urine leaves the body (urethra), and it is often relieved by emptying the bladder.⁴

Irritable bowel syndrome.^1,2 This syndrome is a digestive problem that can cause pain, bloating, constipation, or diarrhea. Researchers have yet to find a specific cause for irritable bowel syndrome but stress or certain foods can trigger symptoms in some people.⁵

Pelvic floor disorders.^1,2 These disorders occur when the muscles and connective tissues that hold the pelvic organs in place weaken or are injured, such as may occur during childbirth. These organs include the uterus, bladder, and rectum. Pelvic floor disorders can cause discomfort as well as functional problems, such as the uncontrolled loss of urine (urinary incontinence) or stool (fecal incontinence). With pelvic floor disorders, pain may also be caused by spasms or an increase in pelvic floor muscle tone.

Uterine fibroids.^1,2 Uterine fibroids (pronounced YOO-ter-in FAHY-broidz) consist of an overgrowth of muscle cells within the wall of the uterus. These noncancerous tumors may cause heavy, irregular, or painful periods and local pressure symptoms, including frequent urination, trouble defecating, and lower back pain.

Vulvodynia.² This condition (pronounced vuhl-voh-DIN-ee-uh) involves pain or discomfort of the vulva (the external female genitalia)), especially during intercourse. The pain may range from sharp pain to burning to itching. Although the vulvar pain is outside the pelvis, health care providers who see patients with pelvic pain may also care for patients with this disorder.