During pregnancy a woman s body undergoes constant changes. The entire body tries to accommodate place for the growing uterus as hormones levels drastically fluctuate and ligaments stretched. Pelvic pain and the ensuing discomfort around this time is a common phenomenon experienced by most women. 

Though the pain may be harmless, at times it may also lead to serious repercussions. Therefore the identification of the causes that lead to pelvic pain during pregnancy is crucial. Some of them are: 

1. Accommodation pain: In the initial stages of pregnancy, women may experience cramps which are akin to the pain that precedes menstruation. However, in the case of pregnant women, the pain leads to no bleeding, but in all probability, is caused due to the expansion of the uterus.
2. Round ligament pain: Amidst the host of changes that the body goes through, the ligament that goes from the uterus to the groin also undergoes a change; it expands. This is responsible for the pain in the sides especially when women are walking or getting up from a chair.
3. Baby s weight: As the weight of the fetus begins to increase it exerts a pressure on the nerves that move from the vagina to the legs. This causes a dull pain in the pelvic region which increases considerably with walking and riding a car. This is most commonly felt by women who are in their third trimester.
4. Urinary Tract Infection: According to reports, most women suffer from urinary tract infection or UTI during pregnancy. This results in uncontrolled, often times, bloody urination and a pain in the abdomen. This is a major cause of concern as, if untreated, it infects the kidneys which in turn increases the risk of an early labour.
5. Miscarriage: In the first trimester, a pain in the abdomen may be an indication of a miscarriage. In such a situation, the pain is followed by bleeding and cramps.
6. Early labour: During pregnancy, an intermittent pain in the pelvic area and a back ache can also be suggestive of an early labour. If the contractions continue for over two hours after taking the necessary precautions like urinating and taking rest, it may be a sign of an early labor.

Pelvic Pain During Pregnancy

Pelvic pain is generally referred to as the pain in the lower abdominal region. Pelvic pain might be acute, sudden, or chronic, recurrent, cyclical in nature. It may present as central or lateralized pain and might spread to the thighs and buttocks. Pelvic pain might be an indication that something is wrong with the internal reproductive organs located in the pelvic region such as ovaries, fallopian tube, uterus and vagina in which case occurrence of pain may be related to particular time in menstrual cycle.

Pelvic pain can be indicative of a pelvic infection or related to the pelvic bones/spine problems.

Also it may indicate that there is something wrong with the digestive system or urinary system.

Causes-

The causes are as follows:

Pelvic pain occurs commonly in disorders of the internal reproductive organs such as ovarian cysts or pelvic inflammatory disease (where in sexually transmitted bacteria spread through the reproductive organs and cause infection) or pain during ovulation.

Pelvic pain might also occur due to endometriosis (a form of disorder where the endometrial tissues that are located inside the uterus tend to grow outside the uterus resulting in severe pain), adenomyosis (a disorder wherein the endometrial tissues which line the wall of the uterus tend to grow within the uterus), , pelvic adhesions or ectopic pregnancy (when the fertilized egg gets inserted somewhere else other than the main uterine cavity),

Pelvic pain can occur due to bladder disorders, kidney stones, infection in the urinary tract, constipation, flatulence,inflammatory bowel disease, irritable bowel syndrome and chronic hernia.

It can also be a symptom in some cancers such as ovarian cancer, colonic cancer, advanced ovarian , endometrial and cervical cancer.

The following symptoms might occur along with pelvic pain:

Sustained pain in the hips and the groin

Sudden fever

Severe pain while urinating , passing stools or during sexual intercourse (dysparuenia)

Vaginal bleeding or vaginal discharge .

Blood in stool

Severe menstrual pain ( dysmenorrhoea)

Repeated instances of constipation or diarrhoea

Increase In pain with stress and physical movements

Investigations-

The Gynaecologist will do physical examination including bimanual internal examination. Also, complete blood count, urine for microscopy, vaginal swabs if discharge, stool examination. Ultrasound examination of the pelvis is an important investigation.

Treatment-

If the pain is gynaecological and depending on the cause doctors might suggest different therapies. In cases where pain is due to an ovarian cyst or endometriosis, doctors may prescribe birth-control pills. In cases of suspected pelvic infection, antibiotics are prescribed. Also, laparoscopic surgery might be advised in cases of acute pain due to cyst, endometriosis, or pelvic adhesions: for confirmation of diagnosis and excision or removal of cysts and endometriotic implants and division of adhesions respectively. In some cases of chronic pain, the gynaecologist may manage the case with inputs from gastroenterologist and pain consultant.

Causes and Symptoms of Pelvic Pain

Pelvic inflammatory disease (PID) refers to the infection that occurs in the female reproductive organs. It happens when sexually transmitted bacteria infect the uterus, ovaries or fallopian tubes on spreading from the vagina. Generally, the cervix plays the role of preventing the bacteria from entering the vagina and infecting the reproductive organs. But when the cervix becomes exposed to an STD, it loses its power to put a stop to the spread of these microorganisms to the reproductive organs.

What causes this condition?
STDs like gonorrhea and chlamydia have been found to be responsible for about 90% of PID cases.

Some of the other causes include
- Abortion
- Childbirth
- Pelvic procedures

The condition is only detected later in life when you face difficulty in getting pregnant or have chronic pelvic pain complaints. If you experience symptoms like vomiting, high fever, pain in the lower abdomen and instances of fainting, you should immediately seek a doctor.

What puts you at risk for PID?
Certain factors may put you at a higher risk for PID and these are:

- Instances of sexually transmitted diseases like Chlamydia (an STD that can occur from anal, oral or vaginal sex) and gonorrhea (a condition that causes discharge from the vagina or urethra) can make you prone to developing PID.

- Douching on a regular basis can increase your risk of PID as it disrupts the equilibrium of good and bad bacteria in your vagina, and may hide the symptoms of the condition as well.

- Even a previous history of PID can increase your chances of having another episode of PID.

- Compared to older women, teenagers who are sexually active are more prone to developing PID.

- Having multiple sexual partners can also put you at a greater risk for PID and STDs.

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Could you be at a risk of pelvic inflammatory disease (PID)?

If there is a recurrent pain in the lower pelvic and the lower abdomen region of the body, chances are you might be suffering from pelvic pain. In women, severe pelvic pain can be a warning sign of some internal damage in the reproductive organs (ovaries, fallopian tube, uterus, and vagina) present in the pelvic region or the digestive system of the body. Although not common in men, pelvic pain might be indicative of an infection or severe pain in the colon region or the pelvic bones. Pelvic pain might be acute or chronic in nature and the pain might spread to the thighs and buttocks of the body.

The causes of pelvic pain differ among the genders, which are as follows:
1. For women, pelvic pain can be an indication of more serious disorders in the internal reproductive organs such as uterine cancer, cervical cancer, ovarian cysts, ovarian cancer and other pelvic inflammatory diseases (when the sexually transmitted bacteria spread to the reproductive organs and causes infections).
2. In women, pelvic pain might also occur due to endometriosis (a disorder wherein the internal endometrial tissues grow outside the uterus resulting in severe pain), adenomyosis (a disorder wherein the endometrial tissues which line the wall of the uterus start growing within the uterus), severe pain during ovulation and miscarriages.
3. The causes of pelvic pain in both men and women include sexually transmitted diseases, a disorder in the pelvic region or the bladder, kidney stones, urinary tract infection, colon cancer, and chronic hernia.

If you suffer from the following symptoms, chances are you might be suffering from pelvic pain:
1. Severe pain in the hips and the groin
2. Sudden fever along with the presence of blood in the stool.
3. Severe menstrual pain
4. You might feel severe pain while urinating or in the middle of a sexual intercourse
5. Bloody vaginal discharge might be indicative of pelvic pain in women
6. Recurring episodes of constipation or diarrhoea
7. Pain resulting from stress and intense physical movements

Treatment
If the pain is chronic, doctors might suggest prescribed a dosage of birth-control pills, antibiotic (especially for blood in the stool and pain due to infection) and anti-depressants. In extreme conditions, the doctor might prescribe laparoscopic surgery (operation by making minor incisions performed far from the actual source).

Can Severe Menstrual Pain be a Sign of Pelvic Pain?

Pelvic Inflammatory disease (PID) is a bacterial infection that affects a woman s reproductive organs. This disease is not contagious though men can host and transmit the bacteria that triggered the disease through intercourse. Chlamydia and gonorrhea are the two most common causes of this disease. Apart from being transmitted sexually, this disease can also develop through the insertion of an unsterilized contraception device into the vagina or during a gynecological procedure such as an abortion. In rare cases, normal bacteria from the vagina can also spread into the uterus and fallopian tubes triggering this disease.
PID can be fatal and should not be ignored. Lower abdominal pain is the primary symptom of this disease. This pain can vary from being mild to be seriously debilitating. Other symptoms of this condition are:
Abnormal or foul vaginal discharge.
Painful intercourse that may be accompanied by bleeding.
Irregular periods.
Spotting between periods.
Severe menstrual cramps.
Burning sensation while urinating.
Urge to frequently urinate and an inability to empty the bladder.
Swollen abdomen.
High fever alternating with chills.
Swollen lymph nodes.
Diminished appetite with nausea.
Weakness and depression.
Lowered libido.
PID can often produce a pus-like fluid that scars the reproductive organs. This can result in infertility. This risk is influenced by the duration and severity of the infection along with the number of times it recurs. Women suffering from pelvic inflammatory disease are also at a higher risk of having a tubal pregnancy. This type of pregnancy is fatal for the baby and also threatens the life of the mother.
In cases where the disease is triggered by an STD like gonorrhea or Chlamydia, it can also spread to the liver tissues. This is a complication known as the Fitz Hugh Curtis syndrome and causes a collection of pus in the form of an abscess in the fallopian tubes or ovaries. If this abscess ruptures, the pus would spread into the pelvic cavity causing severe pain, nausea and a fall in blood pressure. If it spreads further into the blood stream, it can be fatal.
Diagnosis of this disease is difficult as its symptoms are usually mild and common to a number of other conditions. However, once diagnosed, it can be easily treated through antibiotic medication. Surgery is required only in cases where there is no response to antibiotics or if an abscess bursts or is at a stage where it may.  


Can Pelvic Inflammatory Disease Prove to be Fatal?

Endometriosis is a painful disorder in which tissue that normally lines the inside of your uterus, the endometrium grows outside (endometrial implant). It commonly involves ovaries, bowel or tissues lining your pelvis. The main symptoms are pelvic pain and infertility. While chronic pain exists throughout, it tends to aggravate during menstruation and / or sex. Though the cause is not entirely clear, women with a family history of the condition need to be extra cautious. Endometriosis is normally detected by its symptoms combined with a medical imaging. Though the growth is not generally cancerous, a biopsy is recommended to eliminate doubts. 

The condition of endometriosis is attached with social and psychological effects as it affects a woman's child bearing ability. Most minds race anxiously as to what the surgeon might find and will your body heal after the procedure. Here are some tips to prepare for your endometriosis laparoscopy

 Before the surgery: read up as much as possible about your condition and note down questions you want to ask your doctor. Get details about the entire procedure and how the doctor is treating your specific case. Having knowledge will help you stay calm and focused. Next, gear your home for the process. Stock your fridge with quick heat home made meals. It's best for you and the family to have healthy food than the store bought preservative laden food. Clean your home, change your sheets and purchase some loose fit clothing for later use. Last but not the least, stock up on some reading material that will come handy during your rest period. 
 On day of surgery: do not eat or drink anything from 12 midnight until the time of your surgery. You may also need the unpleasant enema procedure during your prep. Remove your nail polish and leave your jewellery, watch and valuables at home. Shower and get to the hospital early to get on with the forms you'll need to fill. The procedure requires anesthesia so do discuss your allergies or any concerns you may have with this aspect of the procedure. Once you are set with you iv and anesthesia, the doctor takes over to do what they do best cure you.
 The procedure: a small incision is made near the belly button and the abdomen is filled with co2 gas which lifts it away from other organs. During the laparoscopy, the doctor examines the pelvic organs, looking for obvious and atypical endometriosis lesions as well as endometriomas (endometriosis'filled cysts, adhesions, and scarring. He may then remove the lesions to send to a lab for biopsy
 After surgery: you'll most likely wake up groggy in the recovery room after your surgery. You may feel some pain as you come around but if it's a day procedure, you'll be able to leave as soon as you feel ready. 

Although pregnancy may temporarily suppress the symptoms of endometriosis, it does not eradicate the disease. The symptoms will almost always return after the baby is born. If you are suffering from this painful condition and want to seek help, you can consult here.

How To Prepare For Your Endometriosis Laparoscopy

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