Symptom · Pelvis & genitals
Pelvic pain
Also known as: pain in the pelvis, lower abdominal pain, chronic pelvic pain, pelvic cramps
Pain felt low in the abdomen, below the navel and between the hip bones. The pelvis holds the bladder and the lower bowel in everyone, the uterus, ovaries and fallopian tubes in women and anyone with these organs, and the prostate in men and anyone with a prostate, including trans women, all resting on the sling of the pelvic floor muscles. Pain from these organs is often felt in the same place, so its timing (with periods, with passing urine or stool, with sex), whether it is one-sided, and whether a pregnancy is possible do more to point to the cause than the site alone. Pain that lasts six months or more is called chronic pelvic pain; it frequently has more than one contributing cause, including tension in the pelvic floor muscles and sensitised nerves, and is managed differently from a single acute episode.
Seek urgent care if
- Pelvic pain with a positive pregnancy test or a missed period, especially with vaginal bleeding, shoulder-tip pain, faintness or collapse
- Sudden, severe pain on one side, particularly with vomiting, a racing pulse or cold, clammy skin
- Pain with a high temperature, shivering or an unusual vaginal discharge
- Pain with an inability to pass urine, or with blood in the urine
- New and persistent bloating, feeling full quickly or loss of appetite, pelvic or abdominal pain, or passing urine more often or more urgently, when these happen on most days (NICE uses more than about 12 times a month), especially at age 50 or over
Common causes
Period pain (primary dysmenorrhoea)Cramping pain in the lower abdomen and back during the first days of a period, caused by the uterus contracting; it usually eases with heat and simple painkillers.
Ovulation pain (mittelschmerz)A one-sided ache or sharp twinge around the middle of the cycle, lasting from a few hours to a day or two, as a follicle releases its egg.
Urinary tract infectionA suprapubic ache with burning on passing urine, frequency and urgency, and cloudy or bloody urine.
Constipation and irritable bowel syndromeCramping, bloating and a change in bowel habit, often relieved by passing stool or wind; irritable bowel syndrome is a common contributor to long-standing pelvic pain.
EndometriosisPainful periods that worsen over the years, pain during or after sex, and pain on opening the bowels or passing urine during a period; a common cause of chronic pelvic pain that often takes a long time to diagnose.
Pelvic inflammatory diseaseInfection of the uterus, tubes and ovaries, often following a sexually transmitted infection such as chlamydia or gonorrhoea, although other bacteria spreading up from the vagina or cervix also cause it, with pain, unusual discharge, bleeding after sex or between periods and sometimes fever; untreated, it can scar the tubes.
Less common causes
Ectopic pregnancyA pregnancy implanted outside the uterus, most often in a fallopian tube: one-sided pain and light bleeding about six to eight weeks after the last period, with shoulder-tip pain or faintness if the tube ruptures. An emergency.
Ovarian cyst torsion or ruptureMost ovarian cysts cause no pain, but a cyst that twists on its blood supply or bursts causes sudden, severe one-sided pain, often with vomiting; torsion needs urgent surgery to save the ovary.
AppendicitisPain that starts around the navel and settles in the lower right abdomen, with loss of appetite, nausea and fever; it can be hard to tell from pain in the right ovary or tube.
FibroidsBenign growths of the uterine muscle that cause pressure, heaviness and heavy periods, and acute pain if a fibroid outgrows its blood supply or twists.
Prostatitis and chronic pelvic pain in menPain in the perineum, testicles, lower back or penis with urinary symptoms; acute bacterial prostatitis brings fever and feeling very unwell and needs urgent antibiotic treatment, whereas chronic pelvic pain syndrome in men usually has no identified infection.
Adhesions and pelvic floor muscle dysfunctionScar tissue after surgery or infection, and pelvic floor muscles that are over-tight or poorly coordinated, can cause persistent deep pain, pain with sex and difficulty emptying the bladder or bowel.
Often occurs with
Conditions to read about
EndometriosisEctopic pregnancyUrinary tract infectionPelvic organ prolapseFibroidsAppendicitisKidney stonesInflammatory bowel diseaseOvarian cancerCervical cancer
How it is investigated
Educational content. This page explains what a symptom can mean so that the anatomy and the medical reasoning make sense. It cannot tell you what is causing yours: only a clinician who can examine you and order tests can do that.