An Overview of Gynecologic Abdominal Pain (2022)

Abdominal pain refers to pain or discomfort felt in the abdomen, the anatomical area below the lower margin of the diaphragm and above the pelvic bone. While pain can arise from the tissues of the abdominal wall, the term abdominal pain generally defines discomfort that comes from organs adjacent to the abdominal cavity. The pain is caused by distention of an organ, inflammation, or by loss of blood supply to the organ. Organs of the abdomen include small intestines, stomach, liver, colon, spleen, pancreas, and gallbladder.

The lowermost portion of the abdomen is the pelvis, which contains the rectum, urinary bladder, ovaries, and fallopian tubes. In most cases, it can be difficult to know if abdominal pain is coming from the pelvis or the lower abdomen. Sometimes the pain may be experienced in the belly even if it’s originating from organs surrounding the abdominal cavity, such as the lower lungs, uterus, ovaries, and the kidneys. It’s also possible for the discomfort to arise from organs within the belly but be felt outside of it. For instance, pain caused by pancreatic inflammation can be felt in the back. Such pain is defined as “referred” since it doesn’t arise from the location that it is felt.

The cause of abdominal pain is diagnosed by its characteristics, physical examination, and testing. In some cases, surgery may be required for diagnosis. The medical diagnosis can sometimes be challenging since the characteristics may be atypical, diseases responsible for pain may mimic each other, and the characteristics of the discomfort may change over time. Treatment is based on the patient’s history of diseases or health conditions, causing pain.

Types of Abdominal Pain

Abdominal pain can be cramp-like, localized, or colicky.

  • Cramp-like pain. This type of abdominal pain may be associated with constipation, diarrhea, flatulence, or bloating. In women, however, the pain can be linked to miscarriage, menstruation, or complications in the female reproductive organs. This pain often comes and goes and may subside on its own.
  • Localized pain. This type of abdominal pain is limited to one section of the abdomen and often caused by problems in a particular organ.
  • Colicky Pain. This pain is a sign of more severe conditions like kidney stones or gallstones. This pain may feel like a severe muscle spasm and tends to happen suddenly.

An Overview of Gynecologic Abdominal Pain

As a woman, you will experience some discomfort or pain in your abdomen from time to time. It could be because of poor sleeping habits or something you ate that is distressing your stomach. However, issues arising from the digestive tract are not always the root cause of abdominal pain. For women, gynecological problems may manifest as abdominal pain arising from the pelvic area and at times, the back.

The symptoms of abdominal pain may vary from one woman to another. Some women feel a mild irritation, while others experience severe pain that makes it difficult to manage everyday responsibilities. In essence, abdominal pain may be:

  • A dull ache
  • Intense or constant
  • A sharp, cramping sensation
  • Intermittent (on-and-off)

The discomfort may also feel like pressure, fullness, or heaviness in the lower abdomen. Symptoms of abdominal pain may worsen during urination or bowel movements, intercourse, or long periods of standing or sitting.

Certainly, you should consider seeking medical attention if the pain persists. However, most women choose to persevere, hoping the pain will go away. Persistent abdominal pain should never be overlooked because it can be a sign of a serious underlying gynecological problem. For this reason, it’s recommended that you visit a gynecologist to have it checked. It can be difficult to tell whether the discomfort is being caused by something simple or more serious. The first fear for every woman experiencing abdominal pain is cancer. While there are chances that it is caused by cancer, it could be as a result of something different.

Discussed below are conditions that could cause abdominal pain in women.

OVULATION

If you have not gone through menopause and your ovaries are still intact, you may get cramps about 10-14 days before your period. This occurs when an egg is released to prepare your body for a possible pregnancy. Physicians depict painful ovulation as “mittelschmerz,” which means middle pain.

During ovulation, the ovaries release an egg together with other fluid. The egg then moves through the fallopian tube into the uterus. The fluid discharged can spread within the pelvic area and can cause irritating and pain in the pelvis. The distress may last for a few minutes or hours and may switch sides, depending on which ovary the egg is released from. The pain can be sharp and impulsive, or you just may have a dull cramp. This pain is temporary and does not require any specific treatment.

MENSTRUATION

Pelvic pain can also occur during and is typically described as cramps in the lower abdomen or the pelvis. The intensity of pain can vary from month to month. Pain experienced before menstruation is referred to as premenstrual syndrome (PMS). When the pain is so severe that it prevents you from going about your daily activities, it’s called premenstrual dysphoric disorder (PMDD). PMDD and PMS are often accompanied by other symptoms such as irritability, bloating, anxiety, insomnia, tender breasts, joint pain, headache, and mood swings. Though not always, these symptoms dispel as soon as menstruation begins.

Pain experienced during menstruation is known as dysmenorrhea. This pain may feel like a badgering pain in the thighs and lower back, or like cramps in the abdomen. The pain might be accompanied by headache, nausea, vomiting, and lightheadedness. If you experience severe menstruation pain, consider visiting a gynecologist to discuss pain management. OTC medications may help.

OVARIAN CYST

A cyst is a sac of fluid that forms on your ovaries. Ovarian cysts are common, especially with women in the childbearing age as well as expectant mothers. They are usually harmless, painless, and disappear on their own without requiring medical attention. You could even have one every month without even noticing it. One type of cyst referred to as follicular cyst breaks open to release an egg and later on dissolves. An ovarian cyst becomes a problem when it grows bigger and does not disappear. Also, there is a likelihood of it becoming cancerous, though uncommon. The risk increases with age.

If a cyst is large, you may feel a dull or sharp pain in your abdomen or pelvis. You may also experience bloating or heaviness in the lower part of your abdomen, lower back, or thighs. An enlarged cyst could burst, causing sudden, sharp pain in the area below the belly button. The pain can be felt on either side of your lower stomach, depending on which ovary had the cyst. You may experience spotting as well.

Since most ovarian cysts disappear on their own, treatment is not always required. However, it may be important to see a gynecologist if the cyst is too large or causing problems. Your doctor could recommend medication to make the cysts disappear or prescribe birth control pills to stop new ones from developing. Since ovarian cysts in women near menopause can be cancerous, surgery may be necessary to remove the cysts or ovaries, depending on how severe the condition is. Common types of procedures used include laparoscopy or laparotomy.

UTERINE FIBROIDS (Uterine myomas)

Fibroids are benign tumors that develop in the uterus. These non-cancerous growths occur in more than 70% of women in their reproductive years. Symptoms of uterine fibroids are varied and depend on their size and location of growth. Many women may not exhibit any symptoms at all. Large fibroids may cause dull aching pain or a feeling of pressure in the lower abdomen or the pelvis. They may also cause heavy periods, bleeding during sexual intercourse, leg pain, back pain, constipation, or trouble with urination. Fibroids can cause infertility.

When fibroids outgrow their blood supply and begin to die, they can cause a very sharp, severe abdominal pain. You should seek immediate medical attention if you experience the following:

  • Sharp pelvic pain
  • Chronic pelvic pain
  • Trouble voiding your bladder
  • Heavy vaginal bleeding in between periods

PELVIC INFLAMMATORY DISEASE (PID)

PID is an infection or inflammation of the female reproductive organs. It can affect the ovaries, fallopian tubes, uterus, or a combination. The pelvic inflammatory disease usually occurs when sexually transmitted bacteria from the vagina or cervix spread to other reproductive organs. PID often causes no symptoms but might be detected later if you develop chronic pelvic pain or have trouble with conception.

PID is usually a complication of an STI like chlamydia or gonorrhea. If you have this disease, you may feel pain in your lower abdomen, pelvis, and lower back. Other symptoms include heavy vaginal discharge with a foul odor, abnormal uterine bleeding, pain or bleeding during intercourse, nausea, vomiting, fever, or painful or difficult urination. Seek urgent medical care if you experience these symptoms. PID escalates a woman’s risk of infertility. According to the CDC, 1 in 8 women who have had PID have trouble becoming pregnant. Treatment for PID usually involves taking antibiotics to treat bacterial infection.

Scarring cannot be treated, which makes early treatment all the more important. Immediate medical attention also helps prevent PID complications, such as:

  • Ectopic pregnancy
  • Infertility
  • Scaring on the reproductive organs
  • collections of infected fluid in your fallopian tubes (abscesses)

ENDOMETRIOSIS

Endometriosis occurs when the tissue that lines the inside of the uterus (endometrium) attaches to other organs and begins to grow. This condition may be a source of chronic, long-term abdominal pain in some women. When an individual’s periods start, the tissue outside of the uterus acts the way it would if it were within the uterus, including responding to hormonal changes, thickening, and shedding. This may cause inflammation and bleeding in the pelvis. The discomfort may feel like regular period cramps but can occur at any time of the month. You may feel pain and cramps in your stomach below your belly button and your lower back.

Abdominal pain caused by endometriosis can be mild, severe, or debilitating. Often, this pain is most definite during the menstruation period. It can as well occur during intercourse and with bladder or bowel movements. Pain is mainly centered within the pelvic area but can extend into the abdomen. Other symptoms include nausea, heavy periods, and bloating.

Although rare, endometriosis can affect the lungs and diaphragm. Endometriosis can also cause infertility by:

  • causing inflammation that disturbs the function of the uterus, ovary, fallopian tube, and the egg
  • distorting the fallopian tubes making it difficult for them to pick an egg

Treatments may include OTC pain medications or surgical procedures like laparoscopy. Early diagnosis of endometriosis can help reduce chronic symptoms.

PREGNANCY PAIN

In many cases, abdominal or pelvic pain during pregnancy is not a cause for concern. Your bones and ligaments tend to stretch as the body adjusts and grows. That can cause pain and discomfort. You may also be experiencing “implantation pain,” which happens when the baby inside of you is attaching to the lining for your uterus. This type of pain is a sign of pregnancy progress. About four weeks into your pregnancy, you might have a few instances of cramps and discomfort. It’s a good idea to take a test if you aren’t sure whether you’re pregnant.

Nevertheless, any type of pain that makes you nervous should be discussed with your own doctor. This is highly recommended, particularly if it’s accompanied by other symptoms such as vaginal bleeding, or if it lasts for a protracted period of time.

ECTOPIC PREGNANCY

An ectopic pregnancy occurs when a fertilized egg implants itself in a fallopian tube or somewhere other than the womb. In most cases, an ectopic pregnancy occurs in one fallopian tube. This type of pregnancy is not viable and is life-threatening to the mother because it may result in the rupture of the fallopian tube as well as internal bleeding.

Ectopic pregnancy is characterized by mild cramps followed by impulsive, sharp stabbing pains on one part of the abdomen or the pelvis. This pain can be so intense that it radiates up toward the shoulder, lower back or neck if there’s internal bleeding and the blood has pooled under the diaphragm. Before the abdominal pain, you may have had other typical pregnancy signs, such as sore breasts and nausea.

Ectopic pregnancies can be dissolved with medication, but some may require a surgical procedure.

PELVIC-FLOOR MUSCLE DYSFUNCTION

Pelvic-floor dysfunction is a group of disorders that affect a person’s ability to have a bowel movement. It involves severe spasms in the muscles that support your vagina, womb, and rectum, and bladder. It can occur after an injury or after you’ve had trauma with vaginal childbirth. You may experience sudden, severe leg cramps in your lower belly. You may as well have ongoing pain in your back and groin.

Others symptoms of pelvic-floor muscle dysfunction include:

  • Pain during sex or periods
  • Problems pushing out stools
  • A burning feeling in the vagina when you pee
  • A very strong urge to urinate all the time

If you have the aforementioned signs, it’s important to see a gynecologist for a urine test to rule out a bladder infection. Your doctor may as well perform a physical evaluation to check for muscle spasms, knots, or muscle weakness. Treatment includes medication, surgery, kegel exercises, and other self-care techniques.

OVARIAN CANCER

Ovarian cancer is a type of cancer that starts inside, near, or on the outer layer of the ovaries, the organs that make your eggs. In many cases, this type of cancer is not detected until when it spreads to the pelvis and abdomen. As such, you may not experience any symptoms of ovarian cancer in its early stages. Symptoms of advanced-stage cancer are non-specific and can be confused for common benign diseases.

Abdominal pain or discomfort caused by ovarian cancer tends to be vague, and you may pass it off as something like gas or constipation. However, the pain and pressure in your lower abdomen won’t go away. Also, your belly may bloat or swell so much to the extent that you may not be able to button your pants. You might notice a strong, frequent urge to pass urine and might get full quickly when you eat. Other symptoms include constipation and weight loss.

If you have these symptoms for more than two weeks, make sure that you see a doctor. It’s had to treat advanced-stage ovarian cancer effectively, so early diagnosis is crucial. Ovarian cancer is generally treated using surgery and chemotherapy.

How Does Your Gynecologist Diagnose the Cause of Abdominal Pain

Since there are many possible causes of abdominal pain, your gynecologist will do a thorough physical exam and a series of tests. The physical examination may include pressing down on different parts of the abdomen to check for swelling and tenderness. Your gynecologist will also take an oral history to understand better the type of pain you have, other symptoms, and general health history. Typical questions you may be asked regarding the pain include:

  • When and where does the pain occur?
  • How suddenly did the pain begin?
  • How long does the pain last?
  • What does the pain feel like (is it dull or sharp)?
  • Is the pain related to urination, sexual activity, or your menstrual cycle?
  • Under what conditions did the abdominal pain begin?

Your doctor will use this information and the severity of the pain and its exact location within the abdomen to determine which tests to order. Imaging tests, such as X-rays, ultrasounds, and MRI scans, are used to provide a detailed view of tissues, organs, and other structures in the abdomen. These tests can help diagnose inflammation, ruptures, tumors, and fractures. Depending on the exact symptoms and duration of abdominal pain, other tests may include:

  • Vaginal swabs or cervical smears. Your doctor may perform specialized CA-15, blood tests for ovarian cancer. More invasive tests may be done depending on your doctor’s suspicion of the cause of pain.
  • An ultrasound may be performed from inside the vagina to allow your doctor to view your uterus, ovaries, vagina, fallopian tubes, and other organs within your reproductive system. The tests involve the use of a wand inserted into the vagina, which then transmits sound waves to a computer screen.
  • Urinary causes can be evaluated by ultrasound, urinary culture, or CT scan.
  • Blood and urine tests may be performed to check for signs of infection.

If the main cause of the pain is not identified from the aforementioned tests, additional tests may be required. This may include:

  • Cystoscopy
  • Pelvic laparoscopy
  • Pelvic MRI
  • Colonoscopy

How a Gynecologist Can Help You Deal with Abdominal Pain

Mild abdominal pain may go away on its own without treatment. In some cases, however, abdominal pain may require a visit to the doctor. If you experience any of the following symptoms, make sure you schedule an appointment with your doctor:

  • Abdominal pain that lasts for longer than 24 hours
  • Vomiting
  • Unexplained weight loss
  • Prolonged constipation
  • Fever
  • A burning sensation when urinating
  • Loss of appetite

Women above 21 years of age should visit an OBGYN at least once every year for checkups and screening. Early diagnosis is crucial in the treatment or management of a health problem. If you’re having abdominal pain, your OBGYN should be in a position to assess the problem and offer treatment options. Treatment will basically depend on your medical history and overall health, the cause of your condition, the extent of your condition, expectations for the course of the condition, and your tolerance for certain therapies, procedures, and medication.

This may include:

  • Pain medication
  • Antibiotics
  • Trigger point injection
  • Anti-inflammatory medications
  • Antidepressants
  • Physical therapy
  • Hormonal medications or birth control pills
  • Transcutaneous electrical nerve stimulation (TENS)
  • Relaxation exercises
  • Laparoscopy surgery

Your gynecologist could recommend counseling to help manage depression, stress, as well as the anxiety of living with chronic abdominal pain.

Find an Abdominal Pain Gynecologist Near Me

Persistent abdominal pain is one thing that you never ignore. It could be a sign of something minor or something serious, but it’s better to be safe than sorry. It’s highly important that you visit a gynecologist for evaluation. At All Women’s Care, we believe that early intervention is crucial for almost all underlying health conditions causing abdominal pain. It helps us make the right diagnosis and come up with an effective treatment plan.

Call us at 213-250-9461 or visit our offices for an appointment.

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