Pelvic Pain

Pelvic inflammatory disease (PID) is a bacterial infection that affects the female upper genital tract; including the endometrium lining and tissue around the uterus (womb), ovaries and fallopian tubes. It can even reach the lining of the abdomen. Men cannot suffer from PID, but they can carry and transmit the bacteria to future sexual partners.

PID mainly affects sexually active women between the ages of 15-24 in the UK. In America, this equates to 4.4% of the sexually active female population.

If left untreated, PID can quickly result in pelvic tubo-ovarian abscesses in the ovaries and fallopian tubes. This can irreparably scar the tubes, making them too narrow for eggs to pass into the womb. This can lead to fertility issues, and makes you 6 times more likely to have an ectopic pregnancy (where the pregnancy is in the fallopian tubes rather than in the womb). Occasionally...

The pelvic floor muscles are responsible for your posture, the function of your bladder and bowel, and intimate sensations. Pelvic floor dyssynergia is a loss of coordination between these muscles and others in the pelvis. Often leading to issues in the way your bladder and bowel work, issues with the related muscles and bones in your hips and back, and pelvic pain as a result. Pelvic floor dyssynergia is an unintentionally acquired behavioural issue, often referred to as a functional issue rather than a structural (i.e. damaged muscle), neurological (i.e. disease of the brain) or pathological issue (i.e. disease).

The most common outcome of pelvic floor dyssynergia is issues with defecation. For an efficient bowel movement, there are a number of complex voluntary and involuntary movements that need to occur. The puborectalis sling muscle (involuntary) and the anal sphincter muscles (voluntary) need to relax. At the same time the abdominal muscles push down. This changes the ano-rectal...

Pelvic congestion syndrome (PCS), also known as pelvic venous congestion syndrome, is where the veins in the pelvis widen (dilate) allowing excessive blood to stay in the area. In women this is mostly concentrated around the ovaries, and in men it occurs in the scrotum and is called varicocele. The affected veins are classified as varicose veins, often with weak valves that allow blood to flow backwards and pool in the pelvis, instead of moving up and away to the heart. The extra blood often causes painful pressure that gets worse when the pelvis moves or is touched.

PCS is a common cause of chronic pelvic pain in women, reports suggest it affects more than 1/3 of women. Most of which have had multiple pregnancies and are aged between 20-45. Varicoceles occur in 15% of men, and only 2-10% of them will have any symptoms. Not all women suffer with the painful symptoms of PCS, and some may not even be aware they have the condition as they show no symptoms (asymptomatic)...

Pelvic abscesses are fluid filled masses of inflamed tissue that can occur within the female pelvis. The abscesses are caused by bacteria reaching the upper genital tract. The bacteria often originates from a separate genital tract infection, such as pelvic inflammatory disease (PID), or from otherwise healthy bacteria from the lower genital tract that has travelled up past the cervix.

Pelvic abscesses are exceptionally rare in men, and when they do occur they grow above the prostate. In women they are more common. The first area of the upper genital tract that is affected is the endometrial lining of the uterus. The infection can then spread through the fallopian tubes and to the ovaries, where they are called tubo-ovarian abscesses (TOA). The infection can also spread as far as the lining of the abdomen. Along this route the pelvic abscesses that form can cause a fever and a...

The ovaries are an important part of the female reproductive system. Sitting either side of the uterus (womb), they release an egg once every 28 days as part of the menstrual cycle. Once an egg is released, the follicle in which it formed bursts and shrinks ready for the next cycle to begin. If the follicles do not correctly shrink after the egg is released, a fluid filled sac, called a cyst, can develop in the ovary. 1 in 10 ovarian cysts also involve growth into the fallopian tubes and other nearby organs. Ovarian cysts can also form on the outside of the ovary, from a group of abnormal cells that would otherwise create the eggs, which is less common.

Ovarian cysts are often non-cancerous (benign), cause no symptoms, and disappear without the need for treatment. However, this is not always the case. They can be painful and grow up to the size of a large melon before they rupture (burst) or begin to shrink. They can block the blood supply to the ovaries, or cause internal...

Irritable bowel syndrome (IBS) is one of the most common conditions that results in pelvic pain. It is a lifelong intestinal disorder that prevents the large bowel from functioning correctly. Resulting in abnormal bowel movements which are often uncomfortable and occasionally painful. The symptoms can come and go as they are aggravated by certain activities and foods.

IBS can be categorised by the most common bowel habit:

• IBS-D - Diarrhoea.
• IBS-C - Constipation.
• IBS-M - Both diarrhoea and constipation together.
• IBS-A - Alternating diarrhoea and constipation.

IBS is quite common, affecting 10-20% of the population and twice as many women as men. Most people are diagnosed before they are 20, and it rarely develops in later life.

Although often painful and inconvenient, IBS is not related to other health problems and...

Fibroids (uterine leiomyomas) are non-cancerous growths that grow in and around the uterus (womb). They are very common, developing in 1 in every 3 women. Most women have no symptoms, however, they can cause heavy periods (menorrhagia) and pelvic pain if they grow large enough.

Fibroids can be categorised by where, on the uterus, they grow:

• Intramural fibroids – The most common type of fibroid, they develop within the muscle wall of the uterus.
• Subserosal fibroids – Develop on the outside of the uterus, and grow into the pelvis. If they are connected to the uterus only by a narrow piece of tissue, they are then known as pedunculated subserosal fibroids.
• Submucosal fibroids – Develop in the muscle layer beneath the inner lining of the uterus, and grow into the uterus. They can also be connected to the uterus only by a narrow piece of tissue, making...

Endometriosis is when the tissue that normally lines the uterus (womb) also grows on the outside of the uterus, and on the other pelvic organs. It most commonly effects the ovaries, fallopian tubes and uterine tissue. It is non-cancerous and is diagnosed through a hysteroscopy, where a hysteroscope (a light and camera on the end of a long, thin tube) is inserted through the vagina and into the womb.

Endometriosis is one of the most common conditions that results in pelvic pain, being the cause in 30% of chronic pelvic pain cases. It effects 1 in 10 women of reproductive age, peaking at 40 years of age. The pain is caused by inflamed endometrial tissue on the outside of the uterus, bleeding during menstruation. The bleeding can cause scarring and act as a glue, sticking the pelvic organs and tissue together, resulting in further pain. Not all women experience pain with endometriosis, however. Although most do, on average spending 18 days in...

There are many digestive diseases, infections and conditions which can affect the normal function of your bowel, and the control you have over it. They often have similar symptoms, characterised by a change in your bowel movements. Pelvic pain often accompanies bowel problems, usually localised to the abdomen and rectum.

The following conditions affect a large population of people around the world. Often, due to the intimate nature of bowel problems, treatment is not sought early and people suffer for longer than they need to. To avoid any permanent damage occurring to your digestive system, it is important that you understand the different symptoms of bowel problems and the early warning signs that you are suffering from something more serious.

• Bowel cancer includes colon (80%) and rectal cancer (20%). It is one of the most common types, often diagnosed in over 60's. If caught early it can be cured by surgery to remove the cancerous tissue...

Adenomyosis is a condition where the endometrial tissue, which normally lines the uterus (womb), grows into the muscle wall of the uterus. The condition was previously believed to be an extension of endometriosis. But it is now known to be a separate condition as the tissue only grows on the inside of the uterus, at a depth of at least 2.5mm into the outer muscular layer.

There are three types of adenomyosis:

• Focal - A distinctly separate mass in the middle layer of the uterus wall (myometrium).
• Extensive/diffuse - Growth of the endometrial tissue over a wide area.
• Adenomyoma tumours - These non-cancerous tumours mimic fibroids and can be microscopic or large enough to be visible. They can occur with both focal...

The International Association for the Study of Pain define pain as "An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." Pain is subjective but always unpleasant and emotional. There is not always an identifiable stimuli and can instead be the result of pathophysiological causes.

Chronic pelvic pain is often a result of a change in the complex interactions that occur within your pelvis. Amongst the urinary, gastrointestinal, musculoskeletal, endocrine, neurologic and gynaecologic systems. The experience of the pain can be influenced by psychological and sociocultural factors, such as personal outlook and available support.

You'll experience a change in the normal sensations and processes in your body. Consciously you may change your posture and movement. Involuntarily, the way that your organs function may change.

Chronic pelvic pain is often linked to depression...