Adolescent pelvic pain

What are the causes of adolescent pelvic pain?

The cause of pelvic pain varies and is specific to the condition originating the pain.

• Adenomyosis – Glands from the uterine lining become implanted in the uterine muscle.
• Appendicitis – The appendix (a narrow tube of the intestine that extends from the colon) becomes infected and swollen. Acute appendicitis can cause abdominal pain and is the most common childhood surgical emergency.
• Bladder or intestinal spasms – Contractions (tightening) of the bladder or intestine can occur for several reasons, including urinary tract infection (UTI) and irritable bowel syndrome (IBS).
• Cancer – Ovarian and colon cancer can lead to pelvic pain.
• Crohn's disease – This lifelong inflammatory bowel disease impacts sections of the digestive system.
• Constipation – When a child is unable to have a bowel movement, the colon becomes enlarged and causes pain.
• Diverticulitis – Small, protruding pouches in the digestive system tear and become irritated that are much more common in older adults.
• Ectopic pregnancy – A fertilized egg implants outside of the uterus (womb).
• Endometriosis – Uterine endometrial cells grow outside the uterus. Tissue may form growths and cause pain.
• Fibromyalgia – Generalized pain accompanies fatigue (extreme tiredness), sleep, memory, and mood issues.
• Inguinal hernia – The path from the abdomen to the labia (vaginal lips) doesn’t close. Abdominal sections (most commonly intestine or an ovary) can then slide in and out of this opening.
• Interstitial cystitis – Also known as painful bladder syndrome, this chronic issue causes pain and a feeling of pressure in the bladder.
• Intestinal obstruction – A blockage can damage sections of the intestine and prevent bowel movements and food from digesting.
• Irritable bowel syndrome (IBS) – This group of gastrointestinal (GI) symptoms produce abdominal pain and cramping.
• Kidney stones – A kidney stone forms when substances in the urine become highly concentrated. Stones can be extremely painful before and during the process of passing out of the body through urine.
• Menstrual issues – Issues with menstrual cycles can lead to menstrual cramps (dysmenorrhea).
• Miscarriage – A loss of a pregnancy before the 20th week, resulting in painful cramping.
• Mittelschmerz – Usually one-sided, lower belly pain associated with the egg releasing from the ovary.
• Musculoskeletal pain – Any injury to the bones, joints, muscles, tendons, ligaments or nerves.
• Ovarian cysts – Fluid-filled sacs can form on or near the ovaries.
• Physical or sexual abuse – Trauma from past or current abuse can damage internal organs, exterior surfaces (abrasions, bruises, or cuts), break or fracture bones and cause life-altering damage.
• Pelvic floor muscle spasms – A brief, uncontrolled jerking action can cause pain and urinary difficulties.
• Pelvic inflammatory disease (PID) – This is an infection of the female reproductive organs (uterus, fallopian tubes, cervix, or ovaries).
• Ulcerative colitis (UC) – This is a type of inflammatory bowel disease. Ulcers can form and inflame (swell) the inner lining of a child’s colon (bowel) and rectum.
• Urinary tract infection (UTI) – Bacteria enters the urinary tract, causing painful urination. It can also inflame the two kidneys, two ureters (ducts that pass urine from the kidney to bladder), the urethra (duct that transfer urine out of the body) and the bladder.
• Vulvodynia – Chronic, unexplained pain around the vagina.

How is adolescent pelvic pain treated?

Over-the-counter medication

• Mild to moderate pelvic pain caused by menstrual cramps or ovulation can be treated with over-the-counter pain medications.
• If your daughter’s pelvic pain is muscular, her doctor will recommend over-the-counter pain medication and rest.
• For bladder spasms, your daughter’s doctor may recommend dietary changes, timed trips to the bathroom, pelvic floor exercises, and medicines to relax the bladder.

Prescription medication

• If your daughter has a bladder infection, her doctor will prescribe antibiotics.
• In the case of PID, your daughter’s doctor will prescribe antibiotics and recommend that any sexual partners be treated as well.

Specialty referral

• If your daughter’s pelvic pain seems to have a gastrointestinal cause, her doctor will refer her to a gastroenterologist who may suggest diet and lifestyle changes and/or order additional tests like a colonoscopy.

Surgery

• If your daughter has endometriosis, she may be treated with pain medication, hormonal contraceptives, and –occasionally – surgery.
• Ruptured ovarian cysts that cause mild symptoms can often be managed with pain medicines. If a ruptured cyst is causing severe symptoms – especially internal bleeding – your daughter may need surgery to control the bleeding and remove the cyst (and sometimes the ovary).
• Torsion of the ovary or fallopian tube must be treated with surgery to untwist the structures.
• If her daughter has appendicitis, the appendix will be surgically removed.