Pelvic Pain in Women: Causes, Symptoms, and When to See a Doctor

Why does pelvic pain in women get worse at night? Pelvic pain is more noticeable at night because your body is at rest, which makes discomfort easy to feel. As per the World Health Organisation, about 10% of women of reproductive age globally are affected by endometriosis, a condition that is a common cause of chronic pelvic pain.

Pelvic discomfort may arise from the uterus, ovaries, bladder, bowel or pelvic floor, which is why pinpointing the real causes of pelvic pain requires a medical diagnosis. A clear medical evaluation is also useful in detecting other types of conditions such as pelvic inflammatory disease and irritable bowel syndrome.

If you are experiencing such pain, a clinical assessment at the best multispeciality hospital in Jaipur can guide you toward real answers. To help you with that, this guide explains how pain occurs in the pelvic area, its causes, symptoms that need close attention, and the treatment process.

What Is Pelvic Pain?

As the name suggests, pelvic pain is a discomfort around your belly button and hips. You may experience this pain around your hipbones, and it often feels like a continuous low-grade pain, a sudden sharp cramp or high pressure. It may occur episodically or continuously, and may also extend to your lower back or thighs.

Organs Involved in Pelvic Pain

Pelvic pain arises from multiple organs located around your hip bone. There are mainly five organs whose inflammation may be felt as pelvic pain. Here they are as follows:

• Uterus: Pain arises when strong menstrual contractions reduce the blood flow to the woman, which causes cramping discomfort. Some of the typical uterine conditions that lead to pelvic pain are painful periods, fibroids, and endometriosis.
• Ovaries: Discomfort in the ovaries develops when an expanding cyst stretches the ovary’s outer layer, which produces dull or sharp aches. The common causes of pain are ovarian cysts, ovulation, or pelvic infections that inflame the ovarian tissues.
• Fallopian Tubes: In the fallopian tubes, pelvic pain occurs when infection or an ectopic pregnancy fills the tube with fluid or blood. This leads to painful distension. Some of the common triggers are salpingitis or a pregnancy that grows outside the uterine cavity.
• Bladder: You may feel a burning or pressure-like sensation when bacteria inflame the bladder’s delicate lining. The typical conditions that cause pelvic pain are a urinary tract infection or chronic bladder irritation from other underlying disorders.
• Bowel or Rectum: You may feel a sudden or recurring ache if trapped gas or hardened stool overstretches your intestinal wall beyond its normal limits. Some common causes of the pain are irritable bowel syndrome and constipation.
• Muscles or Nerves of the Pelvic Floor: Muscle pain follows a sustained tension that creates tender knots and restricts local circulation. At the same time, nerve pain stems from entrapment or compression mainly due to heavy lifting, childbirth or longer duration of sitting in a single place.

Acute vs Chronic Pelvic Pain

Simply put, acute pelvic pain means the pain that starts suddenly and lasts for a shorter period. On the other hand, chronic pelvic pain lasts for about six months or longer and may involve more than one cause.

Here is a side-by-side view of key differences between them:

Feature	Acute Pelvic Pain	Chronic Pelvic Pain
Meaning	Pain that starts suddenly	Pain that continues or keeps returning
Duration	Usually less than 3 months	6 months or longer
Pattern	Often sharp, sudden, or worsening	May be dull, repeated, constant, or triggered by periods, sexual intercourse, urination, or bowel movement
Common causes	Infection, ovarian cyst, appendicitis, ectopic pregnancy	Endometriosis, fibroids, IBS, bladder pain syndrome, pelvic floor dysfunction
Medical need	May need urgent care	Needs detailed evaluation and long-term management

What Causes Pelvic Pain in Women?

The causes of pelvic pain in women are categorised into five main groups: gynaecological, urinary, digestive, pregnancy-related, and musculoskeletal. A closer look at each of these groups can help you understand how they affect your pelvic health.

Gynecological Causes

Pelvic pain in the gynaecological region typically originates from hormonal imbalance or infections that affect reproductive organs. The specific mechanism and common triggers for each condition are outlined below:

• Endometriosis: In this condition, pain occurs when tissues that are similar to the womb lining grow outside and bleed. Some of the common triggers of endometriosis are severe period cramps, ovulation or bowel movements that aggravate these scattered deposits.
• Fibroids in the Uterus: You may feel pelvic discomfort when larger non-cancerous growths of the uterus press against the surrounding organs or when they outgrow their blood supply and begin to degenerate. Some of the common triggers of this condition are heavy menstrual bleeding or the physical pressure of a bulky tumour on the bladder or bowel.
• Pelvic Inflammatory Disease (PID): Pelvic pain occurs when untreated bacteria from the vagina or cervix ascend into the upper reproductive tract, which causes acute inflammation, swelling and the formation of scar tissue. One of the main causes of this infection is sexually transmitted bacteria such as chlamydia and gonorrhoea.
• Ovarian Cysts: This condition causes a dull or sharp pain when a fluid-filled sac on the ovary stretches its outer covering. You may experience pelvic pain if the cyst ruptures or twists, which cuts off blood supply to the ovary itself.
• Polycystic Ovary Syndrome (PCOS): It is a chronic dull ache that stems from the chronically enlarged ovaries that contain multiple small cysts, which stretch your ovarian capsule. Because these metabolic effects are now seen as central to the condition, many specialists point out that PCOS is now PMOS.

Urinary Causes (UTI, Interstitial Cystitis)

You may experience pain from your urinary system mainly because of inflammation or injury to the bladder lining. These linings sensitise nearby nerve endings and cause discomfort during filling and emptying of the bladder. The two primary conditions that may cause pelvic pain are:

• Urinary Tract Infection (UTI): It is a burning or pressure sensation that arises when bacteria such as E.coli inflame the bladder’s inner lining (urothelium), irritating nerve fibres. This infection leads to the classic symptoms of pelvic pain during urination and a frequent, urgent need to avoid it.
• Interstitial Cystitis (Painful Bladder Syndrome): In this condition, chronic pelvic pressure, pain and urinary urgency result from a weakened bladder lining that no longer blocks urine from inflaming deeper nerve endings.

Digestive Causes (IBS, Constipation, Appendicitis)

The following factors may lead to the occurrence of pelvic pain, considering the proximity of the intestines to the pelvic structures:

• Irritable Bowel Syndrome (IBS): It is a condition characterised by abdominal cramps, bloating, and changes in bowel movements.
• Constipation: It is the presence of hard stools within the rectum, leading to increased pelvic pressure and causing pelvic pain.
• Appendicitis: It is an inflammation of the appendix, which usually starts with abdominal pain around the belly button area.

Pregnancy-Related Causes

Pain in the pelvis in pregnant women differs due to physiological changes that take place or any complication of pregnancy.  Some of the common causes of pelvic pain during pregnancy are:

• Round Ligament Pain: Pain due to tension of the ligament that supports the uterus.
• Growth of Uterus:  Increase in size of the uterine muscles and ligaments in response to the increasing size of the fetus.
• Braxton Hicks Contractions:  These are sporadic, irregular tightenings of the uterine muscles that prepare the body for childbirth. Some other causes of Braxton Hicks contractions include dehydration, fullness of the bladder or physical activity.

Musculoskeletal Causes (Pelvic Floor Dysfunction)

Another reason for pain in the pelvis includes disorders related to muscles, joints, ligaments, and connective tissue of the pelvis. An example of such a disorder includes Pelvic Floor Dysfunction. This condition occurs when the pelvic floor muscles tighten or weaken.

Pelvic Pain by Location: What Left-Side and Right-Side Pain Might Mean

The location of pain is helpful in restricting the number of possible causes of the problem. The following is a brief description of how pain on either side affects pelvic pain:

Left Side Pelvic Pain

Pelvic pain occurring in the left part of the pelvis is a result of problems with the left ovary, bowels, urinary system, or other pelvic organs. Some of the common causes of pelvic pain include:

• Ovarian cysts
• Endometriosis
• Constipation
• Kidney stones
• Diverticulitis
• Ectopic pregnancy

Right Side Pelvic Pain

Right-sided pelvic pain is caused by problems that affect the appendix, right ovary, urinary system, or other pelvic organs. Causes of right-sided pain include:

• Appendicitis
• Ovarian cysts
• Ovarian torsion
• Endometriosis
• Kidney stones
• Ectopic pregnancy

What Symptoms Often Come With Pelvic Pain?

The symptoms accompanying pelvic pain vary depending on the woman suffering from it. While some women might experience mild pain, other women may have pelvic pain that keeps recurring. The pelvic pain symptoms that may appear alongside it include the following:

• Abdominal pain
• Pelvic pain that gets worse during menses and ovulation
• Pain when having sex
• Excessive vaginal bleeding and irregular vaginal bleeding
• Unusual vaginal discharge
• Painful or burning sensation while urinating
• Difficulty passing stool, constipation, gas, and diarrhoea
• Backache or hip pain
• Fever, nausea, and vomiting

Pelvic Pain Red Flags: When Is It a Medical Emergency?

The occurrence of pelvic pain becomes a medical emergency when it is sudden, extreme or presents with other signs of distress, including heavy bleeding, fever, or fainting. Knowing when to worry about pelvic pain can prevent a delay that puts your health at risk.

Here are a few symptoms that you should never ignore:

• Extreme pain experienced in the pelvic area
• Heavy bleeding in the vaginal area
• A high fever or chills
• Dizziness, fainting, or signs of shock
• Inability to preserve liquids or continued vomiting
• Pelvic pain during pregnancy, especially on one side
• Pain with difficulty passing urine or stool

In cases of pelvic pain that is not an emergency situation, patients should see a physician as well. As per the ACOG chronic pelvic pain guidelines, pain that lasts six months or longer is called chronic and should be evaluated by a doctor.

Pelvic Pain vs Period Cramps vs UTI: How to Tell the Difference

The main difference between pelvic pain, period cramps and UTI lies in their timing, triggers and symptoms. The following table outlines the primary differences among each of them:

Factors	Period Cramps	Urinary Tract Infection	Other Pelvic Pain
Timing	One to two days before and during periods	Any time, associated with urination	Ongoing or irregular, unrelated to periods
Nature of pain	Cramping that occurs in waves	Burning, stinging, or pressure	Dull ache, sharp pain, or heaviness
Associated symptoms	Bloating, fatigue, mood changes	Frequent urge, cloudy urine, fever	Pain during sexual intercourse, bowel changes, fatigue
Common relief	Heat, rest, and pain relievers	Antibiotics and increased fluids	Requires medical diagnosis and treatment

How Is Pelvic Pain Diagnosed?

A pelvic pain diagnosis includes taking a detailed medical history and performing a thorough physical examination. The cause is then verified through testing and imaging.

Which Specialist Should You See?

The choice of specialist will be determined by what is most likely causing the pain. Most women begin with a doctor trained in obstetrics & gynaecology, who examines the reproductive organs and rules out possible gynaecological causes. In cases where the pain seems to be of urinary or digestive origin, one might be referred to a urologist or gastroenterologist, respectively. Physiotherapy can also be required when it is found that the pelvic muscles are responsible for the problem.

Common Tests and Scans

To diagnose pelvic pain, you may need to undertake one or multiple tests that identify structural abnormalities, infection or hormonal imbalance. The most frequently used tests are as follows:

• Urinalysis: Your urine is tested for the presence of any kind of bacteria, blood or abnormal elements. The main aim of this test is to diagnose UTI or kidney stones that may lead to pelvic pain.
• Pregnancy Test: This simple test can be done by checking blood or urine for the presence of human chorionic gonadotropin (hCG). The hCG is a hormone secreted during pregnancy. This test is important in diagnosing an ectopic pregnancy, one of the most dangerous causes of pelvic pain.
• Blood Test: A blood test is performed to check the level of hormones, signs of infection and signs of inflammation. Common types of blood tests include CBC and CA-125 to diagnose endometriosis or ovarian disease.
• Ultrasound: This imaging test involves the use of sound waves to give a view of your pelvic organs in real time. The test will help in locating uterine fibroids, ovarian cysts, ectopic pregnancy or other structural problems causing pelvic pain.
• Swab Test: The swab test entails collecting fluid or cells from your vagina or cervix using a cotton-tipped applicator. This is important in diagnosing sexually transmitted infections like chlamydia and gonorrhoea. These infections commonly cause pelvic inflammatory diseases.
• Laparoscopy: A surgical procedure involving a camera inserted through a small hole in the abdominal wall to detect and assess endometriosis as the source of the pain.

Which test should be performed will vary from case to case and will mainly depend on your medical presentation and the results of the physical examination. In some cases, imaging of the pelvis by MRI or cystoscopy, which gives a view into the bladder, may have to be done.

How Is Pelvic Pain Treated?

Pelvic pain treatment depends on the root cause of the pain, the degree of pain and the period of time the pain has been experienced. The World Health Organisation (WHO) sexual health guidelines emphasise that effective management must be tailored to the individual, often requiring a multidisciplinary approach. 

The following are key pelvic pain treatment options, starting with medication for pelvic pain.

Medications

The use of medication is usually the first line of therapy for pelvic pain. The choice of medication used will be determined by the physician after proper diagnosis.

Analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) decrease inflammation and relieve the cramps. Antibiotics will be used when there is an infection, such as in the case of a UTI or PID. Hormone therapy, such as the use of birth control pills, will be used to treat conditions like endometriosis and dysmenorrhea, while neuropathic pain requires particular drugs.

Pelvic Floor Physiotherapy

Where pelvic pain results from pelvic floor dysfunction, pelvic floor physiotherapy becomes a very effective means of treatment. Pelvic floor physiotherapy is performed by a specialist who performs pelvic floor physiotherapy and may involve specific exercise techniques, manual therapies, and biofeedback aimed at improving muscle function and reducing pain. If the cause of pelvic pain is different, pelvic floor physiotherapy can be combined with medication.

Surgical Options

Surgical treatment may be recommended when pelvic pain is caused by a condition that requires operative management. In cases where a woman has endometriosis, the surgery that is usually done is laparoscopic surgery. Through this type of surgery, a diagnosis is made, and endometrium-type tissue found outside the womb is removed. Surgery can also be used to remove large fibroids and ovarian cysts in the pelvis.

Home Remedies and Lifestyle Changes

Some non-medicinal methods may help to relieve pelvic pain through relaxing muscles, reducing the compression of pelvic structures and improving circulation. The most effective home remedies for pelvic pain are outlined below.

• Heat application: Apply a heating pad or hot water bottle to the lower part of the abdomen. In this way, you will relax pelvic muscles and improve circulation in the pelvic region.
• Physical activity: Physical exercises like walking, swimming or yoga will build the pelvic muscles and release endorphins that will reduce pain perception.
• Stress relief techniques: Relaxation, deep breathing, meditation or progressive muscular relaxation will affect the nervous system positively and help to relax pelvic muscles. They will decrease pain perception.
• Proper posture and maintaining a healthy weight: Proper posture decreases strain of pelvic joints and pelvic ligaments. Likewise, maintaining a proper weight will reduce strain of pelvic muscles and lower back muscles, which worsen pelvic pain.

When Should You See a Doctor for Pelvic Pain?

You need to consult a doctor when the pain is severe, persistent for several days or keeps returning or comes with symptoms such as unusual vaginal bleeding. Knowing when to see a doctor for pelvic pain helps you act early, and the following symptoms are clear signs that need medical attention:

• The pain continues, increases in frequency, or gradually becomes worse.
• You get no relief from home treatment or over-the-counter painkillers.
• The pain keeps coming back every month during your period or in between periods.
• Your daily activities, exercise, work or sleep are affected by the pain.
• If you experience other symptoms such as menstrual irregularities, difficulty in urinating or vaginal bleeding.

Why Choose CKS Hospitals for Pelvic Pain Treatment?

CKS Hospitals is an accredited multispeciality hospital in Jaipur that boasts 30+ specialities and 50+ experienced physicians in its team. Thus, the hospital is fully capable of treating multi-organ issues associated with pelvic pain. It has all the necessary resources to provide proper medical care for pelvic pain patients.

Here is what makes CKS Hospitals the best hospital in Jaipur to relief from pelvic pain:

• CKS Hospitals brings together specialists from urology, gynaecology, gastroenterology, and other departments under one roof.
• The urology department treats multiple causes of pelvic pain, such as urinary tract infections, problems with the bladder and other urological diseases.
• State-of-the-art diagnostic services such as CT scans, ultrasound and laboratory services to identify the source of pelvic pain.
• The obstetrics and gynaecology department is home to the best gynaecologist for pelvic pain in Jaipur for managing conditions like ovarian cysts, pelvic inflammatory disease and other causes of gynaecological pain.
• With 200+ beds and 24/7 emergency services, the hospital ensures prompt attention for acute pelvic pain episodes.

FAQs

1. What is pelvic pain in women?

Pelvic pain refers to pain felt in the lower abdominal area, which is below the navel and between the hip bones.

2. What is the main cause of pelvic pain in women?

Pelvic pain is caused by a number of factors, including gynaecological conditions such as menstrual cramps, ovarian cysts, fibroids and endometriosis.

3. Is pelvic pain normal during periods?

Mild pelvic pain during periods is quite normal and occurs in many women, as the uterus contracts to shed its lining.

4. What is the cause of pelvic pain in a woman?

Apart from gynaecological organs, pelvic pain can originate from urinary problems, digestive issues, or muscles/joints of the pelvis, as well as from pregnancy-related factors.

5. What helps with pelvic pain?

Treatment of pelvic pain depends upon the root cause. Treatment might include anti-inflammatory medicines, hormonal therapy, physical therapy to the pelvis region, and self-treatment such as application of a hot pack to the pelvis region.

6. How do I know if pelvic pain is serious?

If you experience severe pelvic pain accompanied by such symptoms as excessive bleeding, fever, nausea, or fainting, consult a doctor without any delay.

7. Why does my pelvis hurt when I walk?

Pain in the pelvis during walking is caused either by the pelvic joints or muscles, such as sacroiliac joint irritation or pelvic girdle pain.⁠