Pelvic pain: causes, symptoms, pelvic pain in pregnancy and when to get help

Some women develop pelvic pain in pregnancy, which the NHS says is sometimes called pregnancy-related pelvic girdle pain (PGP) or symphysis pubis dysfunction (SPD). It is a collection of uncomfortable symptoms caused by stiffness of the pelvic joints or the joints moving unevenly at the back or front of the pelvis.

The NHS says PGP is not harmful to your baby, but it can be painful and make it hard to get around. Women may feel pain over the pubic bone at the front, across one or both sides of the lower back, in the area between the vagina and anus (perineum), or spreading to the thighs, and may feel or hear a clicking or grinding in the pelvic area. The pain can be worse when walking, going up or down stairs, standing on one leg, turning over in bed or moving the legs apart. It estimates that PGP affects up to 1 in 5 pregnant women to some degree.

Call your midwife or GP if it is hard to move around, it hurts to get out of a car or turn over in bed, or it is painful to go up or down stairs. Getting diagnosed early can help keep pain to a minimum. You may be referred to a physiotherapy service that specialises in obstetric pelvic joint problems, which can include exercises to strengthen your pelvic floor, stomach, back and hip muscles and equipment such as crutches or pelvic support belts.

The NHS says these problems tend not to get completely better until the baby is born, but treatment from an experienced practitioner can improve symptoms during pregnancy, and most women with PGP can have a vaginal birth. The NHS general pelvic pain page says to get help from NHS 111 if you have pelvic pain and you are or may be pregnant, and to contact your midwife or maternity unit if you are 20 weeks pregnant or more.

The NHS describes pelvic pain as pain in the lower part of the tummy. The type of pain varies, and it may be sudden and severe (acute pelvic pain) or last 6 months or longer (chronic pelvic pain). It may affect a small area around the pelvis, the lower back or the whole area.

It is a symptom rather than a diagnosis. The NHS says the symptoms of pelvic pain are very similar to those of other common conditions, which is why it is important to give your doctor as much information as possible.

The NHS lists the different types of pelvic pain. Describing which of these your pain is most like, and when it happens, helps your doctor.

• a sharp, stabbing or burning pain that happens suddenly

• a pain that comes on slowly but does not go away

• a dull or heavy ache, or a feeling of pressure

• a twisted or knotted feeling

• a cramping or throbbing pain that may come and go

• pain only when you are doing something, like exercising, having sex or peeing

The NHS says pelvic pain can be caused by many things: an infection, or a condition that affects organs in the pelvic area such as the bowel or bladder. Common causes include constipation or irritable bowel syndrome, urinary tract infections (UTIs) and sexually transmitted infections (STIs). Some causes can be serious and need urgent treatment, including appendicitis and peritonitis, which require surgery.

In women, the NHS says common causes include period pain, conditions affecting the female reproductive organs such as an ovarian cyst or endometriosis, and pelvic pain in pregnancy. Rarely it could be something more serious, such as ectopic pregnancy, womb cancer, ovarian cancer or pelvic inflammatory disease. In men, pelvic pain can sometimes be caused by an inguinal hernia, or conditions affecting the testicles or prostate, such as prostatitis.

The NHS says to see a GP if you have pelvic pain that comes and goes or does not go away, bloating that comes and goes or does not go away, you are losing weight without trying to, you feel full quickly or have no appetite, or you have constipation or diarrhoea that does not go away.

Get help from NHS 111 if you have pelvic pain and you find it difficult to pee or poo, have blood in your pee or poo, have unusual discharge, fluid or bleeding from the vagina, have pain when peeing or need to pee more than usual, have a very high temperature, have vomiting and diarrhoea or feel sick, or you are pregnant or may be pregnant. If you are 20 weeks pregnant or more, contact your midwife or maternity unit.

Call 999 or go to A&E if your pelvic pain is severe, getting worse, or hurts when you move or touch the area; you feel faint, dizzy or lightheaded or pass out; you have pain in the tip of your shoulder; you have difficulty breathing; you have heavy bleeding from the vagina; or you suddenly feel confused. The NHS advises not to drive yourself: ask someone to drive you or call 999.

The NHS says getting diagnosed may take some time. A GP may refer you for tests or to a specialist if they do not know what is causing your pain.

Depending on the suspected cause, tests described by the NHS include a blood test, a pregnancy test, an ultrasound scan and swabs for infection (for PID), and an examination, ultrasound, MRI scan or laparoscopy (a camera passed through a small cut in the tummy) for endometriosis. The NHS says endometriosis can take a long time to diagnose and you might need several different tests, because its symptoms can be similar to adenomyosis, fibroids, PID and irritable bowel syndrome.

Treatment depends on the cause. The NHS says a GP might suggest antibiotics, painkillers, physiotherapy such as exercises for the pelvic floor muscles, or hormone treatments.

Specific causes have their own treatment. The NHS says PID is treated with antibiotics if diagnosed early, prostatitis is treated with antibiotics, and for endometriosis, medicines are often the first treatment (painkillers such as paracetamol and ibuprofen, and hormones such as the combined contraceptive pill), with surgery possible if other treatments are not working. There is more on each in the related guides below.

There is no single home remedy, because the right approach depends on the cause. For pelvic pain in pregnancy, the NHS suggests keeping active but avoiding things that make the pain worse, resting when you can, wearing supportive shoes, putting equal weight on each leg when standing, sitting down when getting dressed, putting a pillow between your legs in bed, and keeping your knees together when getting in and out of the car.

The NHS says you should also avoid sitting or standing for long periods, going up and down stairs too often, and lifting heavy objects such as shopping bags. For prostatitis, it suggests drinking plenty of fluids and taking paracetamol or ibuprofen for pain.

Do not use self-help to delay getting assessed if the pain is persistent or has any of the warning features above.

On the NHS, start with a GP, NHS 111 or, for sudden severe pain, A&E. In pregnancy, contact your midwife or GP, who can refer you to a physiotherapy service for pelvic joint problems. Many people with persistent pelvic pain are assessed by a gynaecology or urology service depending on the suspected cause.

Some people choose a private consultation with a gynaecologist, urologist or pelvic health physiotherapist. The Pelvic Pain Support Network, a UK charity, provides information and support about pelvic pain.