Abdominal and Pelvic Pain

What is it?

Abdominal pain is felt between the lower edge of the ribs and the groin; pelvic pain is felt below the navel, in the area enclosed by the pelvic bones. The pain can come from internal organs such as the stomach, bowel, pancreas, bile ducts, bladder, womb and ovaries, from the abdominal wall, or from the nerves in this region.

Pain that lasts a long time (usually more than three to six months) or keeps coming back is described as chronic abdominal and pelvic pain. Several factors are often involved together, and the pain can have a marked effect on sleep, work, sex life and mental health.

What causes it?

The causes are wide-ranging; the main ones include:

• Digestive system: chronic pancreatitis, irritable bowel syndrome, inflammatory bowel disease and adhesions after surgery.
• Gynaecological: endometriosis, adenomyosis and pelvic adhesions.
• Urinary system: bladder pain syndrome (interstitial cystitis) and, in men, chronic prostatitis/chronic pelvic pain syndrome.
• Abdominal wall and nerves: trapped nerves in the abdominal wall, nerve pain after surgery and irritation of the pudendal nerve.
• Muscles and joints: tension and trigger points in the pelvic floor muscles, and pain at the tailbone (coccyx).
• Cancer: cancers of the pancreas and other abdominal organs, and of the pelvic organs (cancer pain).

With long-standing pain, the nervous system can become more sensitive to pain signals. This is why pain can continue even after the original cause has been treated; it does not mean the pain is "imaginary".

How is it diagnosed?

Assessment starts with the relevant specialists (gastroenterology, general surgery, gynaecology and urology) looking for treatable causes. Blood and urine tests, ultrasound, CT, MRI and endoscopy may all be part of this process.

If pain persists despite these investigations, a detailed examination explores whether it comes from an internal organ, or from the abdominal wall or nerves. With abdominal wall pain, pain that stays the same or gets worse when you tense your abdominal muscles (Carnett's test) can be a useful clue. In some people, diagnostic nerve blocks help to identify the source of the pain.

Treatment options

Treating chronic abdominal and pelvic pain often requires several specialties working together.

Conservative care

• Treating the underlying cause: conditions such as endometriosis, inflammatory bowel disease or pancreatitis are treated by the relevant specialists.
• Pelvic floor physiotherapy: specialised programmes address tension and trigger points in the pelvic floor muscles.
• Medication: painkillers and medicines aimed at nerve pain are used, depending on the type of pain. Long-term use of strong painkillers is considered carefully because of its side effects.
• Psychological support: help with the stress, sleep and mood problems that long-standing pain brings is an important part of treatment.

Interventional pain treatments

Pain from the abdominal and pelvic organs travels through networks of nerves (plexuses) that belong to the sympathetic nervous system. Sympathetic nerve blocks target these networks:

• Coeliac plexus block: used for pain from upper abdominal organs such as the pancreas, stomach, liver and bile ducts, particularly pain caused by pancreatic cancer.
• Superior hypogastric plexus block: can be used for pain from pelvic organs such as the womb, bladder and lower bowel.
• Ganglion impar block: may be considered for pain in the back passage, perineum and tailbone.

In chronic pain not caused by cancer, the effect of these blocks may be more limited and shorter-lived, so the decision is made after discussing the source of the pain and realistic expectations. Trapped nerves in the abdominal wall can be treated with blocks aimed at the relevant nerve. In suitable patients these procedures can provide a meaningful reduction in pain; results vary from person to person.

When is surgery considered?

If a cause that can be corrected surgically is found, such as endometriosis, adhesions or a hernia, treatment is planned together with the relevant surgical specialty.

When should you see a doctor?

If your abdominal or pelvic pain has lasted for months, remains unexplained despite investigations, or significantly limits your daily life, an assessment focused on pain treatment can also be helpful. An algology (pain medicine) specialist will consider pain-focused options in cooperation with your other doctors; you can request an appointment through our contact page.