Pelvic pain
Low down in the abdomen, behind the pubic bone and between the hip bones, three systems sit together: the far end of the bowel, the bladder with its ureters…
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Medicines commonly prescribed for Pelvic pain
For informational purposes only. Always consult a doctor before taking any medication.
Dosage form: TABLET, 600 mgActive substance: ibuprofenManufacturer: Kern Pharma S.L.Prescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 100 mg/5mlActive substance: ibuprofenManufacturer: Farmalider S.A.Prescription requiredDosage form: INJECTABLE, 250 mg/mlActive substance: testosteronePrescription required
Low down in the abdomen, behind the pubic bone and between the hip bones, three systems sit together: the far end of the bowel, the bladder with its ureters and, in women, the womb with the ovaries and tubes. Add the pelvic floor muscles, the ligaments and the nerves that hold it all in place. Pain from any of those organs travels along shared nerve pathways and is felt in roughly the same spot, so "pain in the pelvis" is not a diagnosis and not even much of a clue. The whole job here is telling things apart: working out what is actually hurting and, before anything else, whether it is one of the things you go to hospital for today.
When to call an ambulance
Ectopic pregnancy. A missed period, or a period that came oddly — lighter and off schedule — plus pain on one side low down and some vaginal bleeding. A pregnancy test may be only faintly positive. The danger is that the growing pregnancy ruptures the fallopian tube and blood spills into the abdomen. Signs of rupture: sharp and worsening pain, weakness, dizziness, pallor, clammy sweat, pain at the tip of the shoulder or under the shoulder blade — that last one seems odd, but it is blood irritating the diaphragm, and it means calling an ambulance immediately.
Ovarian torsion. Sudden, very severe pain on one side, often with nausea and vomiting, sometimes starting with a sharp movement or a jump. The ovary, usually with a cyst on it, twists around its own stalk and cuts off its own blood supply. This is counted in hours: an ovary untwisted in time is saved, one left for a day is lost.
Appendicitis and widespread inflammation in the abdomen. Pain that starts around the navel and over a few hours settles low on the right, with nausea, loss of appetite and a temperature. The alarming turn is when the abdomen goes board-hard, any jolt — a step, a cough — sends pain through it, and the person lies still with the knees drawn up.
Separately, some general signs make the cause beside the point: a temperature above 38 with shivering and confusion, fast breathing, cold mottled hands and feet, heavy vaginal bleeding, fainting. The single European emergency number is 112, which works in Spain, Italy, Portugal, Poland and Ukraine; if the ambulance number where you live is different, use that one.
What will not wait until Monday
Some things do not need an ambulance but do need a doctor the same day.
Pelvic inflammatory disease. Pain low down on both sides, a temperature, discharge with an unpleasant smell, pain during sex and on deep pressure over the lower abdomen, sometimes bleeding between periods. It often follows a sexually transmitted infection and often runs quietly. Treated early it clears without a trace; left alone it leaves adhesions, chronic pain and trouble becoming pregnant, which is why antibiotics are started here early rather than after every result is back.
Urinary retention. The bladder is full, the belly above the pubic bone is distended and painful, and no urine comes out at all or only drips. This is not something to sit out: the bladder has to be emptied with a catheter, or the kidneys suffer. In men the usual cause is an enlarged prostate; in women it follows childbirth or surgery, or comes with severe pain or certain medicines.
Renal colic. Pain in waves running from the loin down into the groin and genitals, with the person unable to find a position and pacing about — the opposite of inflammation inside the abdomen, where people keep still. There is often blood in the urine. Colic with a temperature and shivering is an emergency in its own right: a blocked and infected kidney needs urgent treatment.
A bladder infection with stinging and constant urgency is treated calmly, but loin pain, fever and nausea mean the infection has climbed to the kidney, and that is a conversation for today.
Working out where the pain is coming from
A doctor makes the diagnosis, but one simple observation narrows things down a great deal: what the pain is tied to.
If it changes with meals and bowel movements, travels with bloating, diarrhoea or constipation and eases after the toilet, look at the bowel. If there is stinging on passing urine, dragging above the pubic bone and a constant need to go, look at the urinary tract. If the pain is tied to the cycle — arriving before a period and in the first days, or the other way round, exactly mid-cycle and on one side — this is gynaecology and most likely benign. Pain landing precisely in mid-cycle, short-lived and switching sides from month to month, is a separate and largely harmless story with a page of its own; pain that fits into the first days of a period and has been familiar since the teenage years is dealt with on the page about period pain.
It is also worth noticing exactly where it hurts. Dead centre behind the pubic bone points rather to the bladder; low and to one side, to an ovary, a tube or the appendix; deep inside, radiating to the sacrum and the back passage, to the womb, the ligaments or the pelvic floor muscles.
And it helps to note what makes the pain worse: movement, sex, sitting for long stretches, a full bladder or, conversely, an empty one. Those details are worth more in the consulting room than describing the severity on a scale of ten.
When the pain drags on for months
Pelvic pain is called chronic once it has lasted six months or longer. A single culprit is rarely found, and that does not mean the pain is imaginary or "just nerves".
Endometriosis. Tissue resembling the lining of the womb grows outside it and bleeds where it sits every cycle. The typical picture: pain worse than an ordinary period pain, pain on deep penetration during sex, pain on opening the bowels or passing urine during a period, fatigue, difficulty conceiving. Women spend years between first complaining and being diagnosed, and the main reason is not that the disease is hard to find but that the pain is treated as normal for far too long, by the women themselves and by everyone around them. If period pain puts you to bed, makes you miss school or work and does not respond to ordinary painkillers, that is grounds to insist on being investigated rather than to put up with it.
Adhesions are bands joining organs together after surgery, a caesarean section or a past infection. They cause a dragging pain that is worse on movement and during sex.
Irritable bowel syndrome is a very common cause that nobody suspects behind pelvic pain. The pain relates to bowel movements, there is bloating and an alternation of diarrhoea and constipation, and tests and scans come back normal.
Pelvic floor muscle pain. The muscles sit in a permanent spasm, like a cramped calf but on the inside. It feels like a deep, nagging ache, a sense of heaviness, discomfort on hard seats, pain at the start of penetration and sometimes difficulty getting the urine stream started. It is the most underrated cause of chronic pelvic pain and one of the few where the answer is not a tablet but work with a pelvic floor physiotherapist.
Interstitial cystitis (bladder pain syndrome). The pain builds as the bladder fills and eases immediately after passing urine, urgency is frequent, and urine cultures come back sterile time after time. People with this picture are often given antibiotics for years for an infection that is not there.
Pelvic pain in men
Pages about pelvic pain are usually written as though men never had it. They do, and fairly often.
Acute prostatitis means fever, shivering, pain in the perineum and low abdomen, and painful, difficult urination. It is a serious illness: a doctor is needed the same day, and with urinary retention or a high fever with rigors, an ambulance.
Chronic pelvic pain in men — also called chronic prostatitis without infection — means months of aching in the perineum, the scrotum, above the pubic bone or at the tip of the penis, discomfort when sitting, pain during or after ejaculation, and frequent urination. Bacteria are usually not found, and repeated courses of antibiotics do not help. The underlying story is the same as in women: pelvic floor muscles, sensitised nerves, sometimes the bowel; and what helps is pelvic floor physiotherapy, medicines that act on nerve pain and work on anxiety, rather than one more antibiotic.
Separately: sudden severe pain in one testicle with swelling is testicular torsion, and it tolerates delay even less than ovarian torsion. Ambulance, not "let us see how it is in the morning".
Pelvic pain in pregnancy
A dragging pain in the pubic area, the sacrum and the groins in the second half of pregnancy, worse on walking, climbing stairs and turning over in bed, is usually pelvic girdle pain: the ligaments soften and the pelvic joints become more mobile. It is unpleasant but not dangerous, and it responds well to physiotherapy, a support belt and simple everyday tricks such as turning over in bed with the knees held together.
A handful of situations in pregnancy, on the other hand, need a doctor at once: bleeding, regular cramping pains before term, waters leaking, constant severe abdominal pain, pain under the right ribs with headache and flashing lights in the vision, or the baby's movements stopping. With any sudden pain early in pregnancy, the first thing to rule out is an ectopic pregnancy.
Tests and what genuinely helps
The doctor will start by asking, and here that is worth more than any scan: how long, where, what it goes with, what has been happening with the cycle, periods, bowels and urine, whether there have been pregnancies, whether there have been operations. Then an abdominal and, where appropriate, an internal examination, a pregnancy test in any woman of childbearing age, a urine test, swabs for infection and blood tests. Of the imaging, an ultrasound scan is usually the useful one; MRI and laparoscopy are arranged when there is a specific question, not just in case.
Treatment follows the finding: antibiotics for infection, surgery for torsion and ectopic pregnancy, hormone treatment for endometriosis, bowel-directed treatment for irritable bowel syndrome, pelvic floor physiotherapy for muscular pain. With chronic pain there is one thing worth understanding: the aim is not always to find something and cut it out. What often works is a combination — the right kind of pain relief, exercise therapy, sorted-out sleep, and work on a nervous system that, after long-standing pain, starts amplifying signals on its own. That is not pain "in the head"; it is a separate and entirely physical mechanism, and it can be treated.
And separately, the things you take to a doctor without panic but without postponing either: pain that does not settle over weeks; bloating that persists for several weeks running; weight loss you did not intend; blood in the urine or stool; unusual vaginal discharge or bleeding. Pain that has to be silenced with painkillers over and over is itself a reason to be seen, not a reason to stock up on tablets.
Online consultation
Pelvic pain is one of those subjects where half the journey is covered by talking. An Oladoctor doctor will ask in detail about the things people rarely volunteer: how the pain relates to the cycle, to the bowels and to passing urine, what makes it worse, how it has changed month by month, what tests have already been done and what they showed. From those answers they will say what it looks like, which investigation is worth doing first and who to see — gynaecology, urology, gastroenterology or a pelvic floor physiotherapist — and will also help make sense of reports you already have and adjust pain relief around your other conditions.
What a remote appointment does not replace is worth stating plainly too. Sudden severe pain, a missed period with pain and bleeding, fever with shivering, fainting, or being unable to pass urine are not matters for messages; they are reasons to call an ambulance.
This material is for information only and does not replace medical advice.
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