Abdominal and pelvic pain
There are a number of different body systems within the abdomen and pelvis; the digestive tract, kidneys, bladder, liver, reproductive organs and major blood vessels.
What is abdominal and pelvic pain?
Abdominal and pelvic pain can result from any of these systems or from the wall of the abdomen itself. Abdominal pain due to digestive problems is usually short lived.
It can be caused by conditions such as gastroenteritis (a stomach infection), acid reflux, trapped gas, constipation or appendicitis (swelling of the appendix).
What causes abdominal and pelvic pain?
Longer-term abdominal pain can be a result of irritable bowel syndrome, inflammatory bowel disease (also known as IBD, Crohn’s disease or ulcerative colitis) or a food intolerance such as coeliac disease (an intolerance to gluten).
Other causes of abdominal pain range from general muscular strain to liver inflammation, hernias and, rarely, tumours.
Lower abdominal and pelvic pain can be caused by a bladder infection, a sexually transmitted infection, menstrual pain (in women) or testicular pain (in men).
Pelvic pain in women can also be caused by any previous gynaecological surgery, including procedures that involve the insertion of vaginal mesh.
What types of abdominal pain are there?
Abdominal pain can be categorised by the location of the pain, as well as the nature and severity of pain.
Pain in the upper abdomen is usually associated with the stomach, liver and gall bladder, or sometimes a problem in the chest.
Central abdominal pain tends to be caused by the digestive tract, whereas lower abdominal and pelvic pain tends to be associated with the bladder and reproductive organs.
Where the symptoms are associated with upper back pain (flank or loin pain), the kidneys are sometimes considered to be the cause.
The nature of pain can vary from a sharp, stabbing pain at a defined point, to a more generalised ache over a larger area. The pattern of pain might show an association with exercise, eating or going to the toilet.
Often, abdominal pain is accompanied by additional symptoms depending on the underlying cause of the pain.
For example, pain caused by a problem in the digestive system may be associated with reflux, nausea, or a change in bowel habit. A urinary tract infection may also give symptoms of increased frequency of passing urine, or a burning sensation when passing urine.
If abdominal or pelvic pain is associated with weight loss, a change in bowel habit that does not resolve, or blood in the stool or urine, then it is important to seek the immediate advice of a doctor.
How is abdominal and pelvic pain diagnosed?
Following a discussion with a doctor about the patient’s symptoms, and a clinical examination, a number of investigations may be required to help diagnose the cause of pain:
This can help to look for a number of different factors, including anaemia (low haemoglobin in the blood), vitamin deficiencies, markers of inflammation, and liver and kidney function.
This is a camera test that can be used to look inside the digestive tract either from the mouth (gastroscopy) or back passage (colonoscopy). It can also be used to look inside the bladder (cystoscopy).
Ultrasound is often used to look at the liver and gall bladder, kidneys and bladder, uterus (in women), and blood vessels in the abdomen.
Stool, urine or vaginal swab samples can be used to test for infections or inflammatory conditions.
Magnetic resonance imaging (MRI) scan
An MRI scan can help identify inflammation or other soft tissue changes, especially after surgery (with or without mesh insertion), or to investigate suspected damage to a nerve bundle.
How is abdominal and pelvic pain treated?
The majority of conditions that cause abdominal or pelvic pain can be managed by either one of or a combination of the following strategies:
Modification of lifestyle factors
This could include changing the patient’s diet and/or exercise regime, and looking at ways to reduce stress levels.
These include the use of antibiotics for infections, antacid medication, anti-inflammatories for inflammatory conditions, and other painkillers.
In some cases, surgery may be required - for example, for severe conditions like inflammatory bowel disease that doesn’t respond effectively to medications, or for acute abdominal pain caused by problems like appendicitis.
Long-term pain management
Referral and assessment from a pain specialist is sometimes required for effective treatment of longstanding or difficult-to-treat pain.