What’s Causing Pain in My Pelvis?

Medically reviewed by Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHT on November 16, 2017Written by Stephanie Watson

Is this cause for concern?

The pelvis is the area below your belly button and above your thighs. Both men and women can get pain in this part of the body. Pelvic pain may signal a problem with your urinary tract, reproductive organs, or digestive tract.

Some causes of pelvic pain — including menstrual cramps in women — are normal and nothing to worry about. Others are serious enough to require a doctor or hospital visit.

Check your symptoms against this guide to help figure out what’s causing your pelvic pain. Then see your doctor for a diagnosis.

1. Urinary tract infection (UTI)

A UTI is a bacterial infection somewhere in your urinary tract. This includes your urethra, bladder, ureters, and kidneys. UTIs are very common, especially in women. About 40 to 60 percent of women will get a UTI in their lifetime, often in their bladder.

You’ll typically have pelvic pain with a UTI. The pain is usually in the middle of the pelvis and in the area around the pubic bone.

Other symptoms include:

  • an urgent need to urinate
  • burning or pain while urinating
  • cloudy, bloody, or strong-smelling urine
  • side and back pain (if the infection is in your kidneys)
  • fever

2. Sexually transmitted infections (STIs)

Gonorrhea and chlamydia are bacterial infections that are transmitted through sexual activity. About 820,000 people are infected with gonorrhea each year. Chlamydia infects nearly 3 million people. Most cases of these STIs affect people ages 15 to 24.

In many cases, gonorrhea and chlamydia won’t cause symptoms. Women may have pain in their pelvis — especially when they urinate or have a bowel movement. In men, the pain can be in the testicles.

Other symptoms of gonorrhea include:

  • abnormal vaginal discharge (in women)
  • bleeding between periods (in women)
  • discharge, pain, or bleeding from the rectum

Other symptoms of chlamydia include:

  • discharge from the vagina or penis
  • pus in the urine
  • urinating more often than usual
  • pain or burning when you urinate
  • pain during sex
  • tenderness and swelling of the testicles (in men)
  • discharge, pain, or bleeding from the rectum

3. Hernia

A hernia occurs when an organ or tissue pushes through a weak spot in the muscles of your abdomen, chest, or thigh. This creates a painful or achy bulge. You should be able to push the bulge back in, or it will disappear when you lie down.

Hernia pain gets worse when you cough, laugh, bend over, or lift something.

Other symptoms include:

  • a heavy feeling in the area of the bulge
  • weakness or pressure in the hernia area
  • pain and swelling around the testicles (in men)

4. Appendicitis

The appendix is a thin tube that’s attached to your large intestine. In appendicitis, the appendix swells up.

This condition affects more than 5 percent of people. Most people who get appendicitis are in their teens or 20s.

Appendicitis pain starts suddenly and it can be severe. It’s usually centered in the lower right part of your abdomen. Or, the pain can start around your bellybutton and migrate to your lower right abdomen. It gets worse when you breathe deeply, cough, or sneeze.

Other symptoms include:

  • nausea
  • vomiting
  • appetite loss
  • low-grade fever
  • constipation or diarrhea
  • swelling of the belly

5. Kidney stones or infection

Kidney stones form when minerals like calcium or uric acid clump together in your urine and make hard rocks. Kidney stones are usually more common in men than women.

Most kidney stones don’t cause symptoms until they start to move. Then the pain can be severe.

The pain usually starts in your side and back, but it can radiate to your lower belly and groin. You can also have pain when you urinate. Kidney stone pain comes in waves that get more intense and then fade.

A kidney infection may develop if bacteria gets into your kidneys. This can also cause pain in your back, side, lower abdomen, and groin. Sometimes people with kidney stones also have a kidney infection.

Other symptoms of a kidney stone or infection include:

  • blood in your urine, which may be pink, red, or brown
  • cloudy or foul-smelling urine
  • a need to urinate more often than usual
  • an urgent need to urinate
  • burning or pain when you urinate
  • nausea
  • vomiting
  • fever
  • chills

6. Cystitis

Cystitis is an inflammation of the bladder that’s usually caused by an infection of the urinary tract. It causes pain or pressure in your pelvis and lower belly.

Other symptoms include:

  • a strong urge to urinate
  • burning or pain when you urinate
  • urinating small amounts at a time
  • blood in the urine
  • cloudy or strong-smelling urine
  • low-grade fever

7. Irritable bowel syndrome (IBS)

IBS is a condition that causes intestinal symptoms like cramps. It’s not the same as inflammatory bowel disease, which causes long-term inflammation of the digestive tract.

About 5 to 7 percent of American adults have been diagnosed with IBS, but the condition might affect up to 15 percent of people. IBS affects about twice as many women as men, and it usually starts before age 45.

The abdominal pain and cramps of IBS usually improve when you have a bowel movement.

Other IBS symptoms include:

  • bloating
  • gas
  • diarrhea
  • constipation
  • mucus in the stool

8. Pudendal nerve entrapment

The pudendal nerve supplies feeling to your genitals, anus, and urethra. An injury, surgery, or growth can put pressure on this nerve in the area where it enters or leaves the pelvis.

Pudendal nerve entrapment causes nerve pain. This feels like an electric shock or deep aching pain in the genitals, the area between the genitals and rectum (perineum), and around the rectum. The pain gets worse when you sit, and improves when you stand up or lie down.

Other symptoms include:

  • trouble starting the flow of urine
  • frequent or urgent need to urinate
  • constipation
  • painful bowel movements
  • numbness of the penis and scrotum (in men) or vulva (in women)
  • trouble getting an erection (in men)

9. Adhesions

Adhesions are bands of scar-like tissue that make organs and tissues in your abdomen stick together. You can get adhesions after you have surgery to your abdomen. About 93 percent of people who have abdominal surgery develop adhesions afterward.

Adhesions don’t always cause symptoms. When they do, belly pain is most common. Sharp pulling sensations and pain are often reported.

While adhesions usually don’t cause a problem, if your intestines become stuck together and get blocked, you can have severe abdominal pain or symptoms like these:

  • nausea
  • vomiting
  • swollen belly
  • constipation
  • loud sounds in your bowels

See your doctor right away if you have these symptoms.

Conditions that only affect women

Some causes of pelvic pain only affect women.

10. Mittelschmerz

Mittelschmerz is the German word for “middle pain.” It’s pain in the lower belly and pelvis that some women get when they ovulate. Ovulation is the release of an egg from the fallopian tube that occurs halfway through your menstrual cycle — hence the word “middle.”

The pain you feel from mittelschmerz:

  • is on the side of your abdomen where the egg is released
  • can feel sharp, or cramp-like and dull
  • lasts for a few minutes to a few hours
  • may switch sides every month, or be on the same side for a few months in a row

You can also have unexpected vaginal bleeding or discharge.

Mittelschmerz usually isn’t serious, but let your doctor know if the pain doesn’t go away, or if you have a fever or nausea with it.

11. Premenstrual syndrome (PMS) and menstrual cramps

Most women get cramps in their lower abdomen just before and during their monthly menstrual period. The discomfort comes from hormone changes, and from the uterus contracting as it pushes out the uterine lining.

Usually cramps are mild, but sometimes they can be painful. Painful periods are called dysmenorrhea. About 10 percent of women have pain severe enough to disrupt their daily life.

Along with cramps, you might have symptoms like these before or during your period:

  • sore breasts
  • bloating
  • mood changes
  • food cravings
  • irritability
  • fatigue
  • nausea
  • vomiting
  • diarrhea
  • headaches

12. Ectopic pregnancy

An ectopic pregnancy occurs when a fertilized egg grows outside of the uterus — usually in the fallopian tubes. As the egg grows, it can cause the fallopian tube to burst, which can be life threatening. Between 1 and 2 percent of all pregnancies in the United States are ectopic pregnancies.

Pain from an ectopic pregnancy comes on quickly and can feel sharp or stabbing. It may only be on one side of your pelvis. The pain can come in waves.

Other symptoms include:

  • vaginal bleeding between periods
  • pain in your lower back or shoulder
  • weakness
  • dizziness

Call your obstetrician-gynecologist if you have these symptoms. Ectopic pregnancy is a medical emergency.

13. Miscarriage

A miscarriage refers to the loss of a baby before the 20th week of pregnancy. About 10 to 15 percent of known pregnancies end in miscarriage. Even more women probably miscarry before they realize they’re pregnant.

Cramps or severe pain in your belly is one sign of a miscarriage. You might also have spotting or bleeding.

These symptoms don’t mean you are definitely having a miscarriage. However, they’re worth reporting to your doctor so you can get checked out.

14. Pelvic inflammatory disease (PID)

PID is an infection in a woman’s reproductive tract. It starts when bacteria get into the vagina and travel to the ovaries, fallopian tubes, or other reproductive organs.

PID is usually caused by an STI like gonorrhea or chlamydia. About 5 percent of women in the United States get PID at some point.

The pain from PID is centered in the lower belly. It can feel tender or achy. Other symptoms include:

  • vaginal discharge
  • abnormal vaginal bleeding
  • fever
  • pain during sex
  • painful urination
  • frequent need to urinate

See your doctor if you have these symptoms. If left untreated, PID can lead to infertility.

15. Ovarian cyst rupture or torsion

Cysts are fluid-filled sacs that can form in your ovaries. Most women get cysts, but they usually don’t cause any problems or symptoms. However, if a cyst twists or breaks open (ruptures), it can cause pain in your lower belly on the same side as the cyst. The pain can be sharp or dull, and it may come and go.

Other symptoms of a cyst include:

  • a feeling of fullness in your abdomen
  • an ache in your lower back
  • pain during sex
  • unexplained weight gain
  • pain during your period
  • abnormal vaginal bleeding
  • the need to urinate more often than usual
  • bloating
  • fever
  • vomiting

See a doctor right away if the pain in your pelvis is severe, or you’re also running a fever.

16. Uterine fibroids

Uterine fibroids are growths in the wall of the uterus. They’re common during a woman’s reproductive years, they usually aren’t cancerous.

Fibroids can range in size from tiny seeds to large lumps that make your belly grow. Often, fibroids don’t cause any symptoms. Larger fibroids may cause pressure or pain in the pelvis.

Other symptoms include:

  • heavy bleeding during your periods
  • periods that last more than a week
  • a feeling of fullness or swelling in your lower belly
  • backache
  • frequent need to urinate
  • pain during sex
  • trouble emptying your bladder fully
  • constipation

17. Endometriosis

In endometriosis, tissue that normally lines your uterus grows in other parts of your pelvis. Each month, that tissue thickens and attempts to shed, like it would inside the uterus. But tissue outside of your uterus has nowhere to go, causing pain and other symptoms.

More than 11 percent of women between the ages of 15 and 44 develop endometriosis. The condition is most common in women who are in their 30s and 40s.

Endometriosis causes pelvic pain before and during your period. The pain can be severe. You may also have pain when you urinate or have sex.

Other symptoms include:

  • heavy bleeding
  • fatigue
  • diarrhea
  • constipation
  • nausea

18. Pelvic congestion syndrome (PCS)

In PCS, varicose veins develop around your ovaries. These thick, ropy veins are similar to the varicose veins that form in the legs. The valves that normally keep blood flowing in the right direction through the veins no longer work. This causes blood to back up in your veins, which swell up.

Men can also develop varicose veins in their pelvis, but this condition is much more common in women.

Pelvic pain is the main symptom of PCS. The pain can feel dull or achy. It will often get worse during the day, especially if you’ve been sitting or standing a lot. You can also have pain with sex and around the time of your period.

Other symptoms include:

  • diarrhea
  • constipation
  • varicose veins in your thighs
  • trouble controlling urination

19. Pelvic organ prolapse

The female pelvic organs stay in place thanks to a hammock of muscles and other tissues that support them. Due to childbirth and age, these muscles can weaken and allow the bladder, uterus, and rectum to fall down into the vagina.

Pelvic organ prolapse can affect women of any age, but it’s most common in older women.

This condition can cause a feeling of pressure or heaviness in your pelvis. You might also feel a lump protruding from your vagina.

Conditions that only affect men

A few conditions that cause pelvic pain mainly affect men.

20. Bacterial prostatitis

Prostatitis refers to inflammation and swelling of the prostate gland. Bacterial prostatitis is an infection of the gland caused by bacteria. Up to a quarter of men get prostatitis at some point in their lives, but less than 10 percent of them will have bacterial prostatitis.

Along with pelvic pain, symptoms can include:

  • a frequent or urgent need to urinate
  • painful urination
  • inability to pass urine
  • fever
  • chills
  • nausea
  • vomiting
  • fatigue

21. Chronic pelvic pain syndrome

Men who have long-term pelvic pain with no infection or other obvious cause are diagnosed with chronic pelvic pain syndrome. To qualify for this diagnosis, you need to have had pelvic pain for at least 3 months.

Anywhere from 3 to 6 percent of men have chronic pelvic pain syndrome. It’s the most common urinary system condition in men under age 50.

Men with this condition have pain in the penis, testicles, area between the testicles and rectum (perineum), and lower belly.

Other symptoms include:

  • pain during urination and ejaculation
  • a weak urine stream
  • an increased need to urinate
  • muscle or joint pain
  • fatigue

22. Urethral stricture

The urethra is the tube that urine passes through from the bladder out of the body. Urethral stricture refers to a narrowing or blockage in the urethra caused by swelling, injury, or infection. The blockage slows the flow of urine out of the penis.

Urethral stricture affects about 0.6 percent of men as they age. In rare cases women can get strictures too, but the problem is much more common in men.

Symptoms of urethral stricture include pain in the abdomen, and:

  • a slow urine stream
  • pain while urinating
  • blood in the urine or semen
  • leaking of urine
  • swelling of the penis
  • loss of bladder control

23. Benign prostatic hyperplasia (BPH)

BPH refers to a noncancerous enlargement of the prostate gland. This gland, which adds fluid to semen, normally starts out the size and shape of a walnut. The prostate continues to grow as you age.

When the prostate grows, it squeezes down on your urethra. The bladder muscle has to work harder to push out urine. Over time, the bladder muscle can weaken and you can develop urinary symptoms.

BPH is very common in older men. About half of men ages 51 to 60 have this condition. By age 80, up to 90 percent of men will have BPH.

In addition to a feeling of fullness in your pelvis, symptoms can include:

  • an urgent need to urinate
  • weak or dribbling urine flow
  • trouble starting to urinate
  • pushing or straining to urinate

24. Post-vasectomy pain syndrome

A vasectomy is a procedure that prevents a man from getting a woman pregnant. The surgery cuts a tube called the vas deferens, so that sperm can no longer get into the semen.

About 1 to 2 percent of men who have a vasectomy will have pain in their testicles for more than 3 months after the procedure. This is called post-vasectomy pain syndrome. It can be caused by damage to structures in the testicle, or pressure on nerves in the area, among other factors.

The pain can be constant, or come and go. Some men also have pain when they get an erection, have sex, or ejaculate. For some men, the pain is sharp and stabbing. Others have more of a throbbing pain.

When to see your doctor

Temporary and mild pelvic pain is probably nothing to worry about. If the pain is severe or it continues for more than a week, make an appointment with your doctor.

You should also see your doctor if you experience:

  • blood in the urine
  • foul-smelling urine
  • trouble urinating
  • inability to have a bowel movement
  • bleeding between periods (in women)
  • fever
  • chills
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