Pelvic pain can be nebulous. As a result, it is sometimes dismissed by women as something benign that will eventually go away on its own.

However, pelvic pain is a very real condition that should be addressed if it continues for two weeks or more. Pelvic pain can have many different causes, sometimes, a combination of causes, often making it difficult to diagnose. 

“Pelvic pain is associated with pain below the belly button to the upper thigh and occurs in up to 25% of reproductive women,” says Sydney Randall, MD, Nebraska Medicine obstetrician and gynecologist. “It can be gynecological-related or related to other problems associated with the bladder or intestines, or conditions like inflammatory bowel disease or kidney stones.”

Pelvic pain can vary in sensation and may feel slightly different for each woman. It may be described as a severe and steady pain, a dull aching feeling, sharp pains or cramping or a feeling of pressure or heaviness deep within the pelvis. It may worsen during activities such as sex, bowel movements or prolonged sitting or standing. 

Some of the most common gynecologic causes include: 

• Ovarian cysts
• Endometriosis
• Pelvic inflammatory disease
• Pelvic floor muscles
• Urinary tract infection or other infection of the uterus, ovaries, fallopian tube or vagina
• Scar tissue from endometriosis or a prior surgery 
• Nerve damage from a prior surgery

People at greatest risk for gynecologic-related pain include those with:

• Endometriosis
• Surgery in the pelvic area
• Obesity
• Trauma to the pelvic area

Diagnosis starts with a physical exam, which may be followed by an ultrasound and possibly a CT scan to narrow the diagnosis. 

Treatment typically begins with physical therapy and medications, depending on the diagnosis, says Dr. Randall. For example, ovarian cysts or endometriosis are often managed with hormonal suppression medications in addition to physical therapy. Muscle spasms may be reduced with muscle relaxant medications. Adhesions from surgery may be minimized with physical therapy that can help loosen scar tissue. 

If these do not provide adequate relief, steroids or Botox injections may be the next line of treatment, if appropriate. Nerve pain can be more difficult to treat and may require help from a pain specialist. Treatments such as a local anesthetic block or ablative surgery to destroy the nerves are options that may be recommended.

“If you are having pelvic pain for more than a couple weeks, it’s important to seek evaluation by your obstetrician and gynecologist or other health care provider,” says Dr. Randall. “Pelvic pain can be debilitating and is not something you need to live with. In most cases, we can provide substantial relief with the correct diagnosis and the right combination of therapies.”