6 Common Causes of Pelvic Pain That Aren't UTIs

For individuals assigned female at birth, a urinary tract infection (UTI) may be the first thing that comes to mind if you start to develop pelvic pain. Bladder infections are relatively common — and they can certainly cause discomfort in the pelvic or lower abdominal region, but they aren’t the only culprits. Here are 6 potential causes for pelvic pain and discomfort, and how they’re treated.

Also known as interstitial cystitis, bladder pain syndrome can cause mild discomfort or severe pain in the bladder, along with bladder pressure and pelvic pain. Unlike a UTI, which is caused by an acute infection, interstitial cystitis is a chronic, non-infectious, and potentially long-term condition.

The cause of the pain in this condition is not well understood, but may involve increased sensitivity of the pain signals between the bladder and the nervous system. Bladder pain syndrome may cause:

• Bladder pressure or spasms
• Pelvic pain
• Pain between the vagina and anus or between the scrotum and anus
• Persistent urge to urinate
• Frequent urination in small amounts
• Pain while the bladder fills
• Pain during sex

There’s no cure for bladder pain syndrome, but healthcare providers can help people manage the symptoms. Pelvic floor physical therapy can help relieve muscle tenderness and correct muscle/tendon abnormalities to help reduce pelvic pain. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen may also help relieve pain. In some cases, a healthcare provider may consider prescription medications to help manage the symptoms.

Vaginal atrophy — also known as atrophic vaginitis — is a condition that most commonly affects individuals during or after menopause. With vaginal atrophy, the lining of a person’s vagina becomes dry and thin due to lower estrogen levels in the body. Vaginal atrophy can cause a feeling of pressure in the pelvis and urinary discomfort, which may mimic symptoms of a UTI. Dryness in the vagina can also make people more prone to UTIs.

Other symptoms of vaginal atrophy may include:

• Burning and itching in the vagina
• Pain during sex
• Yellow vaginal discharge
• Spotting or bleeding
• Frequent urination

If you have vaginal atrophy, your provider may recommend an over-the-counter treatment to relieve your symptoms. For example, vaginal moisturizers or lubricants can restore moisture in the vaginal area and reduce discomfort. Estrogen therapy may also be an option if lubricants or moisturizers are not working, but these will need to be prescribed by your healthcare provider.

Your pelvic floor is a group of muscles that sits at the base of your pelvis and supports organs such as the bladder and uterus. Pelvic floor dysfunction occurs when the muscles of the pelvic floor are tight, painful, and difficult to relax. This can cause problems with urinating or having a bowel movement. Because pelvic floor dysfunction can cause frequent urination or difficulty urinating, it may be confused for a urinary tract infection.

Pelvic floor dysfunction may also includes other symptoms, such as:

• Constipation or pain during bowel movements
• Leaking urine or stool
• Lower back pain
• Pelvic pain
• Pain in the genitals or rectum
• Pain during sex
• Difficulty keeping an erection

Pelvic floor dysfunction can be uncomfortable, but symptoms can improve with treatment. Relaxation and stress reduction can make a big difference in relaxing pelvic floor muscles. For some patients, symptoms can improve with a few months of pelvic floor physical therapy. You can also practice kegel exercises on your own to help strengthen your pelvic floor. Medication prescribed by your healthcare provider can also help with symptoms of pelvic floor dysfunction.

Endometriosis is a condition that causes the tissue that normally lines the inside of the uterus to build up on other organs, most commonly reproductive organs, such as the ovaries and fallopian tubes. In some cases, endometriosis can cause tissue to build up on the bladder or in the pelvic region, which may result in bladder discomfort or pain. Common symptoms of endometriosis include:

• Painful periods with pelvic pain, lower back pain, and abdominal pain
• Pain during or after sex
• Pain with urination or bowel movements
• Excessive bleeding during periods
• Bloating
• Nausea
• Constipation
• Fatigue

If you have endometriosis, your healthcare provider may start by treating painful symptoms with anti-inflammatory medication. Hormone therapy, such as hormonal birth control, may also help manage the hormones responsible for menstruation and, as a result, minimize symptoms. In severe cases, surgery to remove the endometrial tissue may be necessary.

Pelvic inflammatory disease is a serious pelvic infection that occurs when bacteria travel from the vagina to the reproductive organs. It most commonly affects a person’s uterus, ovaries, or fallopian tubes, and like a UTI, it can involve pelvic pain. The most common cause of pelvic inflammatory disease is sexually transmitted infections, such as gonorrhea and chlamydia. Other symptoms of pelvic inflammatory disease may include:

• Lower abdomen and pelvic pain
• Painful or frequent urination
• Abnormal vaginal discharge
• Abnormal uterine bleeding between menstrual cycles
• Pain during sex
• Fever and/or chills

Pelvic inflammatory disease results from a bacterial infection, so it’s generally treated with oral antibiotics; however, sometimes the infection is severe enough to require hospitalization. A healthcare provider may also treat an infected person’s partner if it was caused by a sexually transmitted infection. Treatment should be started as soon as possible to prevent disease progression and complications, including scarring of the reproductive tract and pelvic abscess. If you have symptoms of pelvic inflammatory disease or are concerned you have an STI, it’s important to reach out to your healthcare provider ASAP. A same-day, in-person office visit is best so that your provider can examine you, but if you’re not able to be seen in person, you can request a video chat from your One Medical app to consult a provider to determine the best next steps.

Ovarian cysts are fluid-filled sacs that can develop in or on the ovaries. Most ovarian cysts are functional cysts, meaning they occur as part of the menstrual cycle. Many times, ovarian cysts are so small that they don’t cause noticeable symptoms, and they often resolve on their own. Because the ovaries are located near the pelvis, they can cause symptoms that feel similar to a UTI, but can also cause severe abdominal pain if they rupture. If you do experience symptoms, they may include:

• Pressure or bloating in the lower abdomen
• Bloating and swelling
• Pelvic pain
• Lower back pain
• Difficulty with urination or bowel movements
• Pain during sex
• Pain during menstruation
• Breast tenderness
• Frequent urination

Ovarian cysts usually go away on their own within a few months without medical intervention. If your provider is concerned about recurring ovarian cysts, they may prescribe hormonal birth control (but birth control won’t help with existing cysts). If you have a large cyst that’s causing significant pain, surgery may be an option.

If you’re experiencing bladder pain or pelvic discomfort that won’t go away or is getting worse, reach out to your healthcare provider. Your provider can properly diagnose what’s going on — UTI or not — and come up with a treatment plan that helps you feel better ASAP.

In-person office visits can be booked using your app or the One Medical website. If you’d like to consult with a provider urgently in real time to help you make a plan, on-demand video chats can be requested from your One Medical app.