Pelvic Pain

There are many causes for pain in the lower pelvic area including infections, inflammatory conditions such as endometriosis, ovarian cysts, adhesions (scar tissue) between the bowel and either the pelvic sidewall or pelvic organs, and bowel related issues.

Pain can be intermittent or continuous and can range in severity. Sometimes the pain can be cyclical related to menstrual bleeds in which case this can be hormonal in origin. If the pain continues for longer than a week or two, then you should book an appointment to discuss possible investigations with your doctor.

Your doctor will take a careful history and thereafter will want to perform an abdominal and internal examination to assess if there are any obvious causes for the pain. The doctor may also wish to organise an ultrasound scan (either transabdominal or usually transvaginal as this is more accurate) and depending upon the results of that may wish to investigate further with an MRI or CT scan of the abdomen or pelvis.

A laparoscopy is an examination using a camera to look at the abdomen or pelvis. This is performed under general anaesthetic and will assess more accurately any abnormalities within the pelvis such as endometriosis or adhesions– which may not always be visible on ultrasound scan, infections, twisted ovarian cysts or other ovarian pathology and abnormalities within the uterus or fallopian tubes. A laparoscopy will also allow an inspection of the bowel and other abdominal organs and peritoneal surface.

Treatment of pelvic pain can be medical or surgical. Medical treatments include hormones such as the combined contraceptive pill or the mini pill to switch off the cycle and supress the growth of any abnormal cells such as endometriosis or issues associated with the menstrual cycle. 

In the case of endometriosis, ‘down regulators’ such as Zoladex can switch off the development of endometriosis for the duration of its use.

Diathermy of endometriosis, excision of ovarian cysts, division of adhesions between the bowel and pelvis organs can all be performed laparoscopically. This is performed under general anaesthetic and can be done either as a day case or an overnight stay depending upon the extent of the treatment and the amount of discomfort postoperatively.