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Pelvic Pain & Abdominal Pain in Women: Causes & Symptoms

Illustration of a woman holding her stomach in pain

Introduction and Summary

There are a plethora of systems and organs that can cause women to have abdominal and pelvic pain. Sometimes pain is due to digestive issues while other times it can be caused by the reproductive system and menstrual cycle. Your body gives you many signs that can help you uncover what might be causing your pain. We’re here to help you understand the pangs, aches, and cramps you may be feeling.

In this article we’ll explore:

Causes of Abdominal Pain in Women

Here is a list of some of the primary conditions that can cause abdominal pain in women. We’ll explain each one briefly and review some of the most common symptoms.

Menstrual cramps

Painful menstrual cramps, or dysmenorrhea, can feel like cramping of the lower abdomen, with pain in the low back and rectum as well. The prostaglandin hormones are the culprit here. They cause the uterus to contract so it can expel its contents, but higher levels of prostaglandins can cause stronger cramping. Prostaglandins can also irritate the stomach and rectum, causing them to contract or spasm as well, which can cause pain, gas, diarrhea, bloating, and constipation.

Mild cramping pain can be treated with over-the-counter medicine like ibuprofen or Midol, and with home remedies like hot showers and baths, or placing heating pads on the abdomen and lower back. If pain is severe, you might have a related condition, like polycystic ovary syndrome (PCOS) or endometriosis.

Polycystic ovary syndrome (PCOS)

PCOS is a hormonal disorder that is common in reproductive-age women. PCOS can cause irregularities of the menstrual cycle, such as very heavy periods or irregular cycle lengths. PCOS also results in higher levels of androgens, hormones that play a role in male reproductive development. These androgens can cause unwanted hair growth, weight gain, acne, or fatigue. If you have these symptoms, your pain might be due to PCOS. Visit your doctor for diagnosis, which typically includes measuring hormone levels and a pelvic ultrasound.

Ovulation

Some women experience pain during ovulation, which is when the egg is released from the ovary. The pain can be a momentary twinge, or it can be more severe and last for several hours. Many women feel it on one side of the lower abdomen. Since only one ovary releases an egg each month, the pain occurs on the side of the ovary releasing the egg. If you’re wondering whether your abdominal pain is due to ovulation, check to see if you’re about halfway through your cycle, or 14 days before your next period. In fact, this is why this type of pain is sometimes referred to as mittelschmerz, German for “middle pain.” Ovulation pain can be accompanied by some spotting or increased vaginal discharge. Some women become nauseous at this time as well, due to pain or hormonal fluctuations. Ovulatory pain is usually short-lived, and it is not harmful or a sign that anything is wrong.

Ovarian cysts

The ovaries, which rest on either side of the uterus, have the distinguished job of producing eggs, as well as the hormones estrogen and progesterone, all crucial elements of the menstrual cycle and fertility. Sometimes, a cyst, which is a fluid-filled sac, will develop on one of the ovaries. However, cysts can sometimes be symptomatic and cause quite a bit of discomfort. Common symptoms include abdominal bloating or swelling, painful bowel movements, pain during sexual intercourse, and increased menstrual cramps. More severe symptoms, which could mean the cyst has ruptured or twisted the ovary, can present as sharp pelvic pain, nausea and vomiting, fever, and dizziness. If you have these more severe symptoms, you should be seen by a medical professional. Your doctor can check for ovarian cysts using a pelvic exam or an ultrasound.

Uterine fibroids

You may have uterine fibroids (also known as leiomyomas) if you’re experiencing:

  • Heavy periods that last longer than usual and have many clots
  • Worse menstrual cramping than you normally experience
  • An increased need to urinate
  • Painful intercourse
  • A swollen abdomen
  • Pressure or fullness in your lower abdomen

Fibroids are quite common and usually harmless; sometimes they cause no symptoms and a woman can have them for years without knowing they’re there. The National Institutes of Health reports that up to 80% of women will have them by the time they reach their 50th birthday. They can be microscopic in size, or can grow to be quite large (bigger than the size of a grapefruit), and while they can be uncomfortable, they are almost always benign. No one knows why they develop or how to prevent them, but if you have the symptoms above, or are having trouble conceiving, make an appointment with your doctor. An ultrasound or even a physical exam can quickly reveal if they’re there. Menopause often shrinks fibroids or eliminates them altogether, as there is a drop in levels of the hormones estrogen and progesterone, which stimulate fibroid growth.

Irritable bowel syndrome (IBS)

IBS symptoms include:

  • Abdominal cramping
  • Bloating
  • Gas
  • Alternating constipation and diarrhea
  • An irresistible urge to empty your bowel
  • Mucus in your stool

The symptoms can vary in severity and in how frequently you experience them, but in order to receive an IBS diagnosis, you must have had them for at least one day per week for at least three consecutive months. For unknown reasons, most IBS sufferers are women. Symptoms may also worsen around the time of menstruation.

Endometriosis

Endometriosis can be a very painful condition, and it affects up to 10% of American women between the ages of 15-44, with the highest concentration of those affected in their 30’s and 40’s. It occurs when the endometrium, tissue that usually grows inside the uterus, grows outside the uterine cavity—most commonly on the ovaries, bowel, and other parts of the pelvis. Pain from endometriosis can vary from moderate to severe, but pelvic pain is a hallmark of the condition. Some women experience this pain all the time, while others feel it only when menstruating or during the one or two weeks before their periods.

Other common symptoms of endometriosis are:

  • Heavy menstrual bleeding
  • Bleeding between periods
  • Painful bowel movements
  • Lower back pain
  • Pain during or after sexual intercourse

If you suspect your pain is due to endometriosis, make an appointment with your gynecologist for diagnosis and treatment. Endometriosis can cause debilitating pain that is disruptive to your life, but medical and surgical options can help you manage or cure the condition.

Urinary tract infections

Urinary tract infections (UTIs) cause pain, pressure, and bloating in the lower abdomen. They are also often accompanied by frequent and painful urination, and a feeling of needing to urinate even when the bladder is empty. UTIs are most frequently caused by E.coli, a bacteria naturally present in the digestive tract, infecting the urethra and bladder. When the infection involves the bladder, it’s called cystitis, although UTIs can also involve higher parts of the urinary tract, including the kidneys. Other symptoms of UTI include cloudy or strong-smelling urine, fever, blood in the urine, and cramping of the abdomen and/or back.

Interstitial cystitis

Interstitial cystitis (IC), also referred to as bladder pain syndrome (BPS) is a chronic feeling of pain and pressure in the bladder area, sometimes accompanied by more generalized pelvic pain and UTI symptoms. According to Mayo Clinic, the pain can be mild or severe, and can fluctuate over time, often growing worse with “menstruation, sitting for a long time, stress, exercise, and sexual activity.” In addition to pelvic pain and UTI symptoms, IC can include pain between the genitals and anus, and pain when the bladder is full. While IC can present as similar to a bladder infection, with IC there is no infection.

Sexually transmitted diseases (STDs)

Sexually transmitted diseases (STDs), also called sexually transmitted infections (STIs), can cause a variety of symptoms, some of them painful. The most common STDs are chlamydia and gonorrhea, which are both bacterial infections of the genital tract.

Chlamydia symptoms usually appear about one to three weeks after exposure, and include painful urination, lower abdominal pain, vaginal discharge, painful intercourse, and bleeding between periods.

Gonorrhea symptoms typically occur roughly ten days after exposure, and can affect the throat, eyes, and anus, as well as the genital tract. Symptoms include painful or burning feeling when urinating, thick, cloudy or bloody vaginal discharge, anal itching, painful bowel movements, and bleeding between periods.

STDs can be asymptomatic, so if you think you might have contracted one, get tested by your doctor. Even asymptomatic STDs can still cause long-term complications and it’s still possible to transmit to sexual partners. Oral, anal and vaginal intercourse can all transmit STDs.

Pelvic inflammatory disease (PID)

Pelvic inflammatory disease (PID) occurs when the reproductive organs—the fallopian tubes, ovaries, cervix, and uterus—become infected. This is usually caused by an STD. This condition affects about 5% of sexually active women in the United States. The most common symptom of PID is lower abdominal pain. Others are fever, painful sex and urination, bleeding outside of your period, and increased vaginal discharge that can have an unpleasant odor. If PID becomes more severe, symptoms can also include vomiting, fainting, and a fever higher than 101° F (38.3° C). The condition is treatable, but untreated infection can have important complications, like difficulty getting pregnant. If you suspect you have PID, see your doctor right away. Risk factors for PID are having unprotected sex with multiple partners, douching, and recently having had an IUD inserted.

Pelvic adhesions

Lower abdominal pain in women that occurs during a bowel movement or when walking, sitting, or lying in certain positions might be due to pelvic adhesions. These occur when organs within the pelvis, like the uterus, ovaries, fallopian tubes, or bladder, stick together by a band of scar tissue. Pelvic adhesion pain feels like cramps, and arises in predictable ways, like from certain motions or positions. If you’ve recently had surgery, or have endometriosis, your pain might be due to adhesions, as they can form while your body creates scar tissue to try to heal itself. Pelvic adhesions can also form after infection or injury, and can aggravate IBS symptoms.

Urinary stones

Depending on where they’re located, urinary stones might be referred to as kidney stones, ureteral stones, or bladder stones. They all originate in the kidneys, where urine forms. There, deposits of minerals and salts calcify and can move down the urinary tract. Urinary tract stones can cause intense pain once they move either within the kidney or pass into the ureter, bladder, or farther down to the urethra. Pain associated with kidney stones is felt below the ribs, in the back or side, or in the lower abdomen and groin. The pain can come in waves and shift locations, and cause painful urination, nausea, vomiting, fever and chills, pink, red or brown urine, or urine that smells or looks cloudy.

Ectopic pregnancy

When a fertilized egg attaches to any place other than the inside of a uterus, it is called an ectopic pregnancy. These occur in about one out of 50 pregnancies. An ectopic pregnancy can not be carried to term, and it presents a serious risk to the mother as it can cause rupture of the fallopian tube, which is often where it implants. Symptoms of ectopic pregnancies are similar to those of pregnancy, like nausea, tender breasts, and fatigue. However, ectopic pregnancies also often cause sharp pain in the abdomen and pelvis that comes and goes, vaginal bleeding, dizziness or fainting, and rectal pressure.

Those at greater risk of ectopic pregnancy includes:

  • Mothers over 35 years old
  • Women who’ve previously had ectopic pregnancies
  • Those who have had pelvic or abdominal surgery
  • Women who’ve had pelvic inflammatory disease (PID) or endometriosis
  • Those who conceive while undergoing fertility treatments or while an IUD is in place

If you suspect you have an ectopic pregnancy, it’s important to see your doctor right away.

Appendicitis

The appendix is a small, narrow, tube-like organ located between the small and large intestines, which for most people lies in the lower right-hand part of the abdomen. Appendicitis, or inflammation of the appendix, often begins as a dull pain near the belly-button, gradually intensifying and moving to the lower right side, which can grow painful or tender when touched. Other symptoms of appendicitis include loss of appetite, nausea, vomiting, fever, constipation, and inability to pass gas. The causes of appendicitis are mostly unknown, but some doctors believe it can develop as a result of blockages from traumatic injury or a buildup of hardened stool. Untreated appendicitis can cause the appendix to rupture, which can lead to peritonitis, which is when bacteria from the appendix spills into the abdominal cavity. This is a serious medical emergency requiring surgery.

How Can I Prevent Pelvic and Abdominal Pain in Women?

Many of the causes of abdominal and pelvic pain cannot be prevented. But there are actions you can take to minimize your risk of certain types of abdominal and pelvic pain.

To prevent digestion-related pain:

  • Eat small, frequent meals
  • Eat plenty of foods rich in fiber, which can lead to normal bowel movements
  • Avoid overly greasy, spicy, and fatty foods
  • Drink plenty of water
  • Exercise regularly, but wait a few hours after eating to perform aerobic exercise
  • Don’t lie down within two hours of eating a big meal

To prevent reproductive-related pain:

  • Practice safe sex
  • Get tested with your sexual partner(s) for sexually transmitted disease
  • Don’t douche, spray, powder, or otherwise deodorize your vagina
  • Wipe from front to back to prevent bacteria from entering your vagina

When to Seek Help for Abdominal Pain

Most mild to moderate abdominal pain in women will resolve themselves within a few days. However, there are a few signs to watch out for that indicate you need to be evaluated by a doctor. If your pain doesn’t resolve in a few days, comes on suddenly, becomes so intense that you can’t sit still, or begins after an accident or injury, seek medical attention. You should also visit a doctor if you experience bloody stool, pain with fever (higher than 101° F or 38.3° C), unexplained weight loss, blood in vomit, abdominal swelling, or difficulty breathing.

How K Health Can Help

Find out what’s causing your pelvic pain. Did you know you can get affordable primary care with the K Health app? Download K to check your symptoms, explore conditions and treatments, and if needed text with a doctor in minutes. K Health’s AI-powered app is HIPAA compliant and based on 20 years of clinical data.

Gila Lyons

Gila Lyons' health writing has appeared in The New York Times, Oprah Magazine, Vice, Cosmopolitan, Health Magazine, Healthline, and other publications. Connect with her at www.gilalyons.com.