Persistent pelvic pain, often described as a “womb ache,” is a condition affecting many women. It’s characterized by pain in the pelvic area that lasts for six months or more. In Australia, it’s estimated that one in five women experiences persistent pelvic pain, and experts believe the actual number might be even higher due to challenges in diagnosis. Many women and even healthcare professionals may underestimate or misunderstand pelvic pain, especially period pain. Getting accurate information and finding the right healthcare providers are crucial steps in managing this condition.
This article will explore various conditions that can cause a “womb ache,” help you distinguish between different types of pelvic pain, and guide you on when to seek medical advice.
Period Pain (Dysmenorrhea)
Period pain is a very common experience for menstruating individuals. Studies indicate that a significant majority experience it, with one Australian study suggesting it affects up to 93% of senior high school students who menstruate. This pain arises from the uterus muscles contracting, which can feel like cramps or a heavy sensation in the pelvic area, lower back, or abdomen.
While period pain is common, severe pain could indicate underlying issues like endometriosis. According to Dr. Janine Manwaring, a gynaecologist, you should consult your General Practitioner (GP) if: “your pain lasts longer than the first day or two of your period, if it doesn’t improve with standard pain relief or the contraceptive pill, or if it prevents you from carrying out your daily activities.”
Dr. Pav Nanayakkara, another gynaecologist, highlights that many people consider severe period pain as ‘normal’ and don’t seek help. However, she advises, “if you find yourself planning your work, study or holidays around your period, it’s worth speaking to your doctor to rule out any other conditions.”
Endometriosis
Endometriosis is a condition that affects the female reproductive system and is frequently linked to pelvic pain. In endometriosis, tissue similar to the uterine lining (endometrium) grows outside the uterus, often in the pelvic region, such as on the pelvic lining, bowel, bladder, or ovaries.
These misplaced cells behave like the uterine lining during the menstrual cycle, thickening and bleeding. However, unlike menstrual blood from the uterus, this blood has no way to escape the body, leading to buildup, inflammation, scarring, and pain. Pain is a primary symptom, affecting three out of four women with endometriosis. This pain can manifest before, during, or after menstruation, during or after sexual activity, and can be felt in the pelvis, abdomen, back, or even during bowel movements, urination, or ovulation.
Adenomyosis
Adenomyosis is often referred to as endometriosis’s ‘sister’ condition due to similar abnormal cell growth. However, in adenomyosis, the endometrial-like cells grow into the muscular wall of the uterus itself.
Symptoms of adenomyosis closely resemble endometriosis, including heavy or prolonged menstrual bleeding, painful periods (which may develop later in life), and pain during intercourse.
Alt text: Illustration depicting adenomyosis, showcasing endometrial tissue embedded within the muscular wall of the uterus, causing uterine enlargement and potential pain.
Irritable Bowel Syndrome (IBS)
The precise cause of Irritable Bowel Syndrome (IBS) remains unclear, but it’s believed to involve increased sensitivity and irregular contractions of the bowel’s muscle wall, resulting in pain and bloating. Characteristically, pelvic pain from IBS tends to lessen after passing gas or stool. Managing IBS often involves identifying and avoiding dietary triggers and reducing stress.
Dr. Manwaring advises seeking medical attention if you notice “blood in your stool (either bright red on toilet paper or dark black stools), experience severe diarrhea, incontinence, or unexplained weight loss.”
Dr. Nanayakkara explains that diagnosing IBS can be challenging as it’s often a “diagnosis of exclusion.” This means IBS is considered only after ruling out other conditions with similar symptoms. Gastroenterologists, specialists in digestive disorders, typically diagnose IBS.
Pelvic Muscle Pain
The muscles within the pelvic region can spasm or contract, causing pain. This can be triggered by period pain or any pain originating in the pelvic area. Initially, the pain might be intermittent, but it can evolve into a more constant, persistent pain.
Dr. Manwaring describes pelvic muscle pain as feeling like “an ongoing cramp in your pelvic area. It can also be sharp or stabbing, radiating up into the vagina or rectum. Pain during sex or tampon use, which can linger for hours afterward, is also common.”
Activities like core-strengthening exercises, such as Pilates, sit-ups, or crunches, can worsen pelvic muscle pain. Relief can often be found by adopting the fetal position, using heat packs, performing pelvic muscle stretches (resources available at the Pelvic Pain Foundation website), and consulting a pelvic floor physiotherapist.
Bladder Pain & Urinary Tract Infections (UTIs)
Urinary Tract Infections (UTIs) are a frequent cause of pelvic pain, affecting over half of all women at some point in their lives. Symptoms of UTIs can include a burning sensation during urination and pain in the lower abdomen.
Although common, untreated UTIs can progress into serious kidney infections. If UTI symptoms persist beyond 24 hours and are accompanied by fever, chills, back pain, nausea, or vomiting, immediate medical attention is necessary.
Another bladder-related condition is painful bladder syndrome, also known as interstitial cystitis. Unlike UTIs, this condition involves bladder irritation without infection.
Dr. Manwaring recommends consulting your GP if you regularly experience troublesome bladder symptoms such as:
- Needing to urinate more than 8-10 times daily.
- Needing to urinate more than once during the night.
- Pain that worsens with a full bladder and improves after emptying it.
- Pain during sexual activity.
- A strong and sudden urge to urinate.
Vulval Pain
The vulva refers to the external female genitalia. Vulval pain can arise from various causes, including irritation, infections, inflammatory skin conditions, tissue damage from surgery or childbirth, and other factors.
Many women mistakenly attribute vulval pain and irritation to yeast infections (thrush). However, numerous potential causes exist, and accurate diagnosis is crucial for effective treatment.
Vulvodynia is a chronic condition characterized by persistent vulval pain, discomfort, or burning sensations lasting for months or years, without an identifiable cause. Touch can trigger the pain, which may be localized to one area of the vulva or spread across the entire region. For some women, vulvodynia pain can be so severe that activities like tampon use, sexual intercourse, or even prolonged sitting become extremely difficult or impossible.
Key Advice for Persistent Pelvic Pain
Navigating persistent pelvic pain can be confusing and overwhelming. Dr. Manwaring offers five key pieces of advice:
- Seek a Second Opinion: If you feel your concerns are not being adequately addressed by your healthcare provider, don’t hesitate to seek a second opinion.
- Multidisciplinary Approach: Managing persistent pelvic pain is most effective with a multidisciplinary team of experts. Chronic pain is complex, affecting various aspects of health and life. A holistic approach is crucial. This team may include a women’s health GP, gynaecologist, pain specialist, physiotherapist, psychologist, sexual counsellor, naturopath, and other complementary therapists.
- Track Your Symptoms: Keep a detailed record of your symptoms in an accessible format. The Jean Hailes Period Pain & Symptom Diary is a useful tool that can be downloaded for free. Documenting symptoms and treatments aids communication with healthcare professionals and helps monitor progress.
- Reliable Information Sources: Seek health information and self-care strategies from trustworthy sources. The internet offers abundant information, but prioritize evidence-based advice from reliable sources over anecdotal experiences from online forums.
- You Are Not Alone: Remember that you are not alone in this experience. Persistent pelvic pain can be challenging to manage, and it may feel isolating because the pain is invisible to others. Do not hesitate to seek help; there are professionals who will listen, understand, and take your symptoms seriously.
Understanding the potential causes of “womb ache” and persistent pelvic pain is the first step towards effective management and relief. Seeking professional medical advice is crucial for accurate diagnosis and personalized treatment strategies.
