6 Conditions That Cause Uterus or Pelvis Pain

This pain can be caused by gynecological, urinary, GI, or muscular conditions. Learn more about these conditions and treatments.

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Minor cramps during your period are normal. However, if you have chronic pelvic pain that lasts more than six months, you might want to talk to a healthcare provider to find the cause.

According to the American Academy of Family Physicians, chronic pelvic pain can feel like cramps, burning, or a shock. It also may or may not be associated with your period, depending on the cause.

"Pelvic pain is a big puzzle that can be caused by many factors," Barbara Diakos, MD, a gynecologist at Northwestern Medicine Lake Forest Hospital in Illinois, told Health. "That's why it's so important for your doctor to listen to you, to hear what all your symptoms are, and to take you seriously."

The good news is once you and your healthcare provider find the cause of your pelvic pain, that can help determine your treatment. Learn more about the most common causes of chronic pelvic pain.

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Pain in Your Uterus

One major cause of pelvic pain is endometriosis. Endometrium is the tissue that normally lines your uterus. If you have endometriosis, tissue similar to the endometrium grows outside your uterus. This can cause mild to severe uterine pain, including pain during sex or bowel movements. Furthermore, endometriosis is often but not always associated with your period. The condition affects about 10% of all reproductive-age cisgender women, but it's woefully underdiagnosed, Mark Dassel, MD, director of the Center for Endometriosis at the Cleveland Clinic, told Health. It can take from 5 to 20 years to get the right diagnosis. Furthermore, endometriosis can affect people of all genders.

Fibroids are a type of benign uterus tumor and another cause of uterine pain. They are common and can grow inside, on the wall, or outside your uterus. If you have larger or multiple tumors, your fibroids are more likely to cause symptoms like heavy bleeding during periods, unpredictable bleeding, and pressure in your pelvis. However, not all tumors cause symptoms. Even large fibroids may not cause pain—symptoms of fibroids vary widely from person to person.

What to do

One way to treat pain caused by endometriosis or fibroids is hormonal birth control, such as the pill or Mirena IUD.

If your healthcare provider suspects you have endometriosis, you might consider laparoscopy. In this procedure, a specially trained gynecological surgeon looks inside your abdomen and removes endometrial tissue, Magdy Milad, MD, chief of minimally invasive gynecologic surgery at Northwestern Memorial Hospital, told Health.

Other treatment options for fibroids include hormone therapy, embolization (in which small particles are injected into uterine arteries to cut off blood flow, causing the fibroids to die), and a range of surgical methods.

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Pain in Your Gastro-Intestinal System

"It can be hard to figure out whether pelvic pain is GI-related or gyno-related, since parts of your colon lie near your pelvic area," said Health contributing medical editor Roshini Rajapaksa, MD, a gastroenterologist at NYU Langone Health. But if your pain is accompanied by bloating, gas, diarrhea, constipation, or mucus in your stool, you might have irritable bowel syndrome (IBS).

Experts are not sure what causes IBS, but people with anxiety, depression, a family history of IBS, or a stomach virus are more likely to develop the condition. Furthermore, IBS is more common among cisgender women.

What to do

IBS is diagnosed by ruling out other conditions. To manage your pain, make an appointment with a gastroenterologist for these tests and to discuss first-line treatments for IBS. These may include dietary changes, like cutting back on possible trigger foods (for example, dairy or gluten). You can also try a probiotic to build up "good" bacteria in your gut—two over-the-counter options Dr. Rajapaksa recommended are Culturelle and Align. Other treatments your healthcare provider might suggest include mental health help, getting enough sleep and exercise, antihistamines, or specific medications depending on your symptoms.

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Pain in Your Urinary Tract

A common cause of pelvic pain is a urinary tract infection (UTI). In this condition, bacteria infect the parts of your body that create urine, like your kidneys, bladder, or urethra (the tube that carries urine outside your body). UTI symptoms include pelvic pain, pain when urinating, inability to urinate, or urine that is foul-smelling, cloudy, or bloody.

However, painful bladder syndrome (also known as interstitial cystitis) is another condition that causes pain when urinating. "My patients describe it as if it were a constant low-level UTI: They feel discomfort and pressure in their pelvic area and are always running to the bathroom, with very little urine coming out," Suzanne Fenske, MD, assistant professor of ob-gyn at the Icahn School of Medicine at Mount Sinai in New York City, told Health. It can also cause pain during sex.

According to the American Urological Association, the cause of this condition is still unknown. As of July 2022, they believe painful bladder syndrome may be associated with other chronic pain conditions like IBS.

What to do

UTIs are diagnosed with a urine culture, so see your healthcare provider for a test. After checking for a UTI, they will prescribe antibiotics to fight the infection. If you have frequent UTIs, they may also prescribe you antibiotics for after sex or several months of low-dose antibiotics.

On the other hand, painful bladder syndrome is usually diagnosed only after ruling out several other conditions like kidney stones and even bladder cancer, Dr. Fenske said. After conducting several tests, your healthcare provider may recommend eliminating foods and drinks that can irritate your bladder, like citrus, or making other lifestyle changes. Several different medicines can also help relieve your pain. According to the International Cystitis Association, Elmiron is specifically approved for painful bladder syndrome; it may help repair the inner surface of the bladder. Your gynecologist can inject a cocktail of prescription medicines directly into your bladder to help numb it. This usually involves six to eight weekly treatments and then follow-ups as needed. Nerve stimulation may also be a treatment option.

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Pain in Your Abdomenal Muscles

Pelvic floor dysfunction is a condition where some muscles in your lower abdomen are too weak or tightening too much. "Imagine the bones of your pelvis as a bowl, and on top of them are muscles that support organs such as your uterus, bladder, and bowel," Dr. Milad said. "When these muscles are inflamed, they can contract, which causes pain and other symptoms, such as constipation and even pain during intercourse." Additionally, this condition can cause overactive bladders and pain during bowel movements.

About one in four cisgender women in the United States have this problem, according to a 2014 study published in Obstetrics & Gynecology. Risk factors include having clinical obesity, increased age, a hysterectomy, and prior childbirth.

What to do

Talk to your healthcare provider about a physical exam to check your pelvic floor muscles for spasms, knots, or weakness. If they suspect you have pelvic floor dysfunction, they can use tests like checking muscle control with electrodes.

After getting a diagnosis, you should work with a pelvic floor physical therapist, according to Dr. Milad. Treatment can involve learning to relax and contract your pelvic muscles, often with the help of techniques such as biofeedback. Additionally, some physicians now inject Botox directly into a patient's pelvic floor muscles, Dr. Milad added. According to a 2022 Sexual Medicine Reviews review, several studies have found that the injections are effective, and pain did not return one year after treatment.

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