What it is
Pelvic pain comes in two kinds. Sudden pain is worked up as an emergency. Pain lasting six months or more is worked up as chronic pain.
The pelvis holds the uterus, ovaries, bladder, bowel and the muscles of the pelvic floor. Any of them can be the source. Often more than one is involved.
Dr. Mueller ran a 24/7 gynecologic emergency service for eight years. Separating urgent from chronic is the first job at every visit.
What you might notice
- Sharp one-sided pain that came on suddenly
- A dull ache low in the belly most days
- Pain that flares with your period
- Deep pain with sex, rather than pain at the entrance
- Pain with a full bladder, or on urinating
- Pain with bowel movements, or new bloating
- Pain that wakes you at night
- Fever, vomiting or fainting along with the pain
How Dr. Mueller finds the cause
- 1
Rule out urgent
A pregnancy test and a check for fever, fainting and vomiting come first.
- 2
Pain history
Where it sits, what sets it off, and what eases it.
- 3
Pelvic exam
Maps the tender spots one at a time.
- 4
Pelvic ultrasound
In the office, looking at the uterus, ovaries and tubes.
- 5
Bladder and bowel
A urine test and a few questions, because both refer pain here.
- 6
Laparoscopy, if needed
When imaging stays clear but the pain does not, a camera looks directly.
Questions people ask
- When is pelvic pain an emergency?
- Sudden severe pain, fainting, heavy bleeding, fever, or vomiting you cannot stop. Go to an emergency room.
- Could this be an ovarian cyst?
- It can be. Most cysts stay quiet, and the ones that cause pain usually show on ultrasound.
- Why does sex hurt?
- Deep pain points toward the uterus, ovaries or pelvic floor muscles. Where exactly it hurts narrows the list.
- Do I have to be examined?
- The exam is how the tender spots get mapped, so it is hard to skip. You can ask Dr. Mueller to pause or stop at any point, and she will.
- My ultrasound was normal. Now what?
- A normal scan rules things out. It does not end the search. Endometriosis and pelvic floor pain both look normal on it.
- How long should I wait before coming in?
- Come in for new pain lasting more than a few days, or for pain that is changing. Sudden severe pain does not wait.