The Clues That Point to Pelvic Problems in Women and, Yes, Even Men

Few things put a damper on a day like unrelenting pain. Some aches are easy to pinpoint. Pelvic pain, not so much.

“There are a variety of disorders that can cause either acute or chronic pelvic pain,” says Dr. Esther Han,  a urologist with Orlando Health Medical Group Urology. “Too often, pelvic pain is simply categorized as chronic pain and some patients suffer for years without a diagnosis.”

Located in the lower torso, the pelvis houses the intestines, bladder, colon, rectum and reproductive organs, all of which are supported by the muscles, ligaments and connective tissues that form the pelvic floor. In men, the prostate is included; in women, the uterus, cervix and vagina.

Many painful pelvic conditions have similar symptoms, making diagnosis difficult. Depending on the cause, discomfort can be mild or severe, steady or intermittent, dull and achy or sharp and crampy. It can feel like a continuous heaviness, lower back pain or a burning sensation. Left untreated, it can become chronic and debilitating.

Research cited by the World Health Organization (WHO) found one in six women have experienced pelvic pain in the past few months. Sixteen percent of men will suffer pelvic pain in their lifetime, according to another study

Quality-of-Life Issue

“This is not a minor inconvenience nor an uncommon problem,” says Dr. Han. “It’s a quality-of-life issue because pain can interfere with daily activities.”

Certain high-impact exercises, straining during bowel movements and lifting a child can all create downward pressure on the pelvic floor. Ditto sneezing, coughing, running or laughing. If the area’s muscles are stretched and weakened, pain and bladder leakage can occur.

“When I hear a patient say, ‘It’s OK, I don’t have to go running any more,’ or ‘I don’t have to lift my grandkids,’ I tell them -- it sounds like you are living with a lot of ‘I don’t have to’s’ when in reality you could be living a life you love,” says Dr. Han, who is fellowship-trained in female pelvic medicine and reconstructive surgery (FPMRS).

For women, pelvic pain might appear in the bedroom during sex or in the bathroom during urination or bowel movements. Women also are susceptible to pelvic organ prolapse caused by weakened pelvic floor muscles.

“With prolapse, one or more of the pelvic organs can drop and press into or out of the vagina,” says Dr. Han.

According to a National Institutes of Health study, almost 25 percent of women suffer pelvic floor problems. That number jumps to 37 percent of women 60 to 79 years old, and nearly half of women 80 or older.

For men, additional complaints include pressure in the area behind the scrotum and dull pain in the rectum, bladder, groin or tip of the penis. They may also suffer urinary or fecal incontinence. While occasional testicular pain is normal, continuous pain is not.

A Pain for Both Sexes

Pelvic pain from reproductive, urinary or intestinal issues plagues both men and women. Problems like urinary tract infections (UTI), sexually transmitted infections (STI), hernias, kidney infections and stones, irritable bowel syndrome (IBS), appendicitis and abdominal adhesions are equal opportunity offenders. Pelvic floor dysfunction, the inability to properly relax the area’s muscles, also afflicts both sexes and impacts the ability to urinate or have a bowel movement. 

Pudendal neuralgia is another condition that causes pelvic discomfort or numbness that abates when you lay down. It too affects men and women. “Pudendal pain happens when a major nerve in the lower body is damaged from an injury or irritated from exercise like bike riding,” says Dr. Han. “It can make it hard to use the bathroom, have sex or just sit down for periods of time.”

Triggered by Stress

For some, stress triggers painful pelvic floor dysfunction. “There are a lot of different muscle groups in the pelvic floor that can tighten and spasm,” says Dr. Han. “People hold their stress in different ways and, for some that stress results in pelvic pain.”

Dr. Han remembers one patient suffering severe, recurring pain. “She went to several doctors before we pinpointed stress as a factor,” says the urologist. “We helped her work on stress reduction, and when she came back for her next visit, she was 100 percent better.

“Sometimes it’s that simple. Sometimes, it’s not. But fortunately, we have many tools to help people feel better.”

Finding an Answer

If you experience pelvic pain, start with a visit to your primary care physician (PCP). 

“Solving pelvic pain is often a multi-disciplinary effort among physicians, with the PCP as the quarterback,” says Dr. Han. “After your initial visit, you may be sent to an OB-GYN, urologist or pain-management specialist for further evaluation.”

In addition to urine samples and blood work, a doctor might order an ultrasound, CT scan or MRI and do a physical exam of the pelvis. “No one is comfortable with a pelvic exam,” says Dr. Han, who performs these exams vaginally in women and rectally in men. “If a gentle pelvic push makes a patient want to jump off the table, I know I have found the source of their pain.”

Solutions for relieving pelvic pain are as varied as its causes. UTIs, prostatitis and STIs can be treated with antibiotics. Kidney stones, hernias, appendicitis, urethral strictures and abdominal adhesions may require surgery.

Physical therapy relaxes and stretches the muscles of the pelvic floor, easing the pressure that irritates the pudendal nerve and calming muscle dysfunction. Trigger-point injections into specific muscles also help ease painful pelvic floor spasms. Prolapse responds to physical therapy, prescription medication and/or surgery. Kegel exercises can help strengthen weak or loose pelvic floors. Pain caused by tense, stressed muscles demand relaxation techniques.

“If you have pelvic pain, please don’t wait,” says Dr. Han. “I hate to see someone suffer when there are so many other options to help them feel better.”