Inguinal region

Pelvic pain: causes and treatment


Pelvic pain

The term "pelvic pain" usually refers to all those complaints that occur in the area between the abdomen and the thighs. However, exact localization is often difficult, which is why there is often talk of hip or abdominal pain. However, while the latter occur more in connection with the organs located in the pelvic area (stomach, intestine, pancreas, etc.), pelvic problems mostly arise from the bony pelvic girdle. A common cause is accordingly injuries such as bruises or a pelvic fracture, but also poor posture, osteoporosis and a pelvic obliquity, which in addition to the typical pelvic and back pain e.g. can also lead to complaints in the neck and head. Because of the sometimes difficult localization, a doctor should always be consulted as a precautionary measure for pelvic pain in order to clarify the cause and to rule out serious illnesses.

Definition

The term “pelvic pain” is usually used to summarize all symptoms that occur in the area of ​​the pelvis, ie the body section between the abdomen (abdomen) and the legs (inferior membrane). The bony pelvis consists of the sacrum (Os sacrum), the coccyx (Os coccygis) and the two hip bones (Os coxae dextrum et sinistrum), the latter in turn consisting of the ilium, sit and pubis. While the space between the two iliac scoops is referred to as the "large pelvis" (pelvis major), the space underneath is the "small pelvis" (pelvis minor), which becomes narrower towards the bottom and therefore the so-called pelvic funnel represents.

The pelvis is used on the one hand to connect the trunk skeleton to the legs, and thanks to its structure and strength, it enables the human body to remain stable and upright. It also protects the organs in the pelvic area, such as the prostate, uterus and bladder, and serves as the child's point of passage during birth. Accordingly, there are clear differences between the sexes when building, for example, in women, the pelvic blades are laterally protruding, and the angle between the two pubic branches is significantly larger than in men.

Symptoms

The pain in the pelvis can occur in very different intensities and also radiate to other areas of the body, which can lead to groin, leg and / or buttock pain, for example. In many cases, the symptoms in this area cannot be clearly identified or assigned, so that they are often referred to as abdominal, abdominal or hip pain. Delimitation is indeed often difficult here, but while pelvic pain mostly comes from the bony pelvic girdle, abdominal and abdominal pain are often more related to the organs located there (stomach, intestine, liver, pancreas, uterus, etc.). There are numerous causes, such as Constipation, intestinal obstruction, inflammation of the bladder or kidney, reflux, diarrhea or a so-called irritable bowel syndrome.

Causes of pelvic pain

The causes of pain in the pelvic area are diverse, precisely because it is often difficult to pinpoint the exact location and, for example, it can also be radiating abdominal or back pain. In many cases, pelvic bone complaints are caused by injuries such as bruises or fractures (breaks). Often (especially in older people) there is osteoporosis (bone loss), which is a disease that is characterized by a decrease in bone density due to an excessively rapid breakdown of the bone substance and structure.

In addition to this, the pain in the pelvis can also be triggered by the organs located there. Accordingly, this could be caused, for example, by prostate ailments, diseases of the female genital organs (vulvitis, adnexitis, etc.) or cystitis. It is also possible that the complaints come from an irritable bowel or a tumor or a daughter tumor (metastases), as well as chronic inflammatory bowel diseases, food intolerances such as e.g. a gluten allergy, poor diet or infectious diseases.

Last but not least, the pain in the pelvic area can of course also be psychosomatic in nature. In this case, no organic cause can be found for the complaints, instead they are an expression of a mental strain such as stress, tension, overwhelming or fear.

Pelvic pain one-sided

A very common cause of one-sided pain in the hip and pelvic area is incorrect posture, which can result, for example, from injuries or from “bad habits”, as can be observed in connection with posture in many people. A typical example here is the shifting of weight when standing on one leg, which causes the whole body to become skewed.

The trigger is often to try to avoid pain (e.g. due to a previous leg or foot injury) by protecting the affected side and loading only the "intact" leg. As a result, this is often more muscular and pronounced than the other, moreover, the incorrect or gentle posture is usually also maintained in other positions, e.g. the weight is also shifted to a certain side while sitting. This shift is finally noticeable in the hip and pelvic area, because since the weight is distributed over only one leg, there is permanent tension in the hip on this side, and the pelvis is distorted and inclined upwards on one side.

If there is such an increased tension in the muscles, those affected often repeatedly adopt the incorrect posture "automatically", which in many cases develops to the extent that it is considered "normal". Accordingly, one-sided pelvic pain in women often arises from the fact that they habitually carry their toddlers asymmetrically on their hips, which means, however, that this must be pushed up and out on the corresponding side. As a result, there are often uncomfortable and painful tensions that can no longer be resolved on their own under permanent stress, but instead are compensated for by the so-called pelvic obliquity.

Pelvic obliquity

One of the most common causes of pain in the pelvis and hip area is the so-called "pelvic obliquity". The background here is that the pelvis plays an important role for the entire posture and, ideally, is in an almost horizontal position. Are e.g. the back muscles are tense or the legs are not the same length, the pelvis tilts from this normal position. In principle, however, this is not uncommon, because only very few people have a really straight basin; instead, it is estimated that every second person in western industrialized countries is affected by an anomaly.

If this is only slightly present, the body can usually compensate for the imbalance itself, so that the person affected experiences little or no complaints or restrictions. If, however, it is a more pronounced pelvic obliquity, the spine must bend more to compensate, which threatens permanent lateral bending (scoliosis). As a result, back pain and discomfort frequently occur in the pelvic or hip area, in addition, the inclined pelvis can also affect other areas of the skeleton and, for example, Cause shoulder or knee pain. Problems with the bit are also possible, e.g. Nocturnal gnashing of teeth or strong clenching of the teeth, which in turn can lead to tense neck muscles and headaches from the neck.

Pelvic obliquity can have many causes, with a medical distinction being made between two categories: If there is a so-called "structural obliquity", it is an anatomical condition that prevents the spine from returning to a straight position on its own. This can be caused by accidents, operations or a genetic predisposition such as congenital scoliosis, but in most cases a difference in leg length is responsible. A few millimeters of difference are usually not a problem, but the larger it gets, the greater the complaints.

In addition to this, skewing can also result from muscular tension in the buttocks and lower back muscles, since in this case the pelvis changes into an oblique position in order to "avoid" the pain. A muscular imbalance can also be the trigger, which e.g. can result from one-sided stress in sports or injuries to the musculoskeletal system. As a result, the pelvis becomes unbalanced and tilts to one side, giving the impression of a difference in leg length, even though both legs are the same length (“functional oblique pelvis”).

Pelvic ring syndrome

Another possible cause is the so-called pelvic ring syndrome. These are pathological disorders in the areas of sacrum, sacroiliac joints (short: ISG, also called "sacroiliac joints") and hipbones, which together form the so-called pelvic ring. Various causes can be considered for this, for example blockage of the sacroiliac joint or irritation of the ligamentous apparatus. A "lumbar spine syndrome" (short: "LWS") is also conceivable, which refers to all those pains that occur in the lower back or lumbar region. This can be triggered, for example, by degenerative changes (damage to the intervertebral discs, functional disorders of the holding straps, etc.), congenital malformations of the spine, growth disorders or inflammatory diseases, and fractures or injuries (trauma) can also lead to an LWS syndrome.

Depending on the variety of causes, the pelvic pain in a pelvic ring syndrome can also occur in very different places with different intensities and e.g. radiate into the buttocks, groin or legs. If peripheral nerves are also affected, neurological failures can also occur.

Pelvic pain in pregnancy

If the pelvic pain occurs during pregnancy, so-called “relaxation of the symphysis” can also be the cause, which occurs in around one in 600 pregnant women. This is a loosening of the pubic symphysis (symphysis) that occurs before or during childbirth, which refers to a disc-like, cartilaginous connection of the two halves of the pelvis on the front. In the course of pregnancy, as the child grows, the pressure on the pelvic bones and thus also on the symphysis increases, and the connective tissue becomes looser and more elastic due to the hormonal changes. This primarily affects the ligaments of the pubic symphysis, which can widen during pregnancy to make the baby's path through the pelvis as easy as possible.

On the other hand, this hormone-related loosening and the stretching of the symphysis bands due to the increased pressure can also lead to complaints, which often occur in the pubic area and in the groin area. Since the entire pelvic girdle is affected, the symptoms can also radiate into the back or the inner thighs. In addition, those affected often speak of hip pain. A rubbing or crunching feeling in the area of ​​the symphysis is possible, and in most cases the complaints become stronger when moving. In addition, in some cases the pain begins before delivery and can increase continuously.

Other women, on the other hand, only experience a sudden shooting pain during or even after childbirth, e.g. if a very large child was born or if the birth was supine. The triggers for loosening the symphysis have not yet been fully clarified, but risk factors such as previous back problems, hip injuries and arthritic joint inflammation are considered to be beneficial for loosening the symphysis.

Pelvic pain treatment

In the case of non-specific pelvic pain, a doctor should always be consulted, especially if the cause is not clearly recognizable and / or the symptoms are pronounced. With the help of a comprehensive medical history and a thorough examination, the doctor can often make a diagnosis, and in some cases supportive imaging procedures such as ultrasound or magnetic resonance imaging (MRI) are used. If the pain occurs suddenly and massively or persists for a longer period of time, a referral to a clinic should be carried out in order to rule out serious or even life-threatening diseases such as an intestinal obstruction or an appendectomy.

The treatment of pain depends on the cause and can therefore mean very different periods, measures and procedures from case to case. For example, if there is a relaxation of the symphysis due to pregnancy, the treatment is generally also carried out in accordance with the symptoms, the most important step being the stabilization of the pelvic ring. This can often be achieved quite simply with a lap belt, which by relieving the bowel legs relieves and relieves the pain. In addition, there are other possible treatment measures such as heat therapies, long-wave treatment or special pelvic floor exercises, but in rare cases, surgical intervention to stabilize the symphysis is indicated.

If the pelvis is slightly oblique, no special treatment is usually necessary, as this can usually be compensated for by the body itself. However, if the curvature is more pronounced and / or complaints arise from skewing, therapy is definitely recommended, although the specific measures depend on the cause, the age of the person affected and the extent of the malposition. Is the trigger in adults e.g. a "real" leg length difference ("structural pelvic obliquity"), heel pads (up to a centimeter difference) or a heel or sole increase (up to three centimeters) can be used.

The so-called spine therapy according to Dorn and Breuss can be helpful for correcting apparent differences in leg length (“functional pelvic obliquity”). On the other hand, if there is a muscle imbalance, special strength or physiotherapy exercises are helpful to restore the balance. If the reason for the crookedness is tension, exercises to reduce stress can also be very beneficial and pain-relieving, whereby yoga and progressive muscle relaxation (PMR), for example, are particularly suitable.

Home remedies and naturopathy for pelvic pain

As an alternative or in addition to the conventional treatment methods, depending on the cause, natural healing methods can also be used in some cases. For example, acupuncture, magnetic field therapy or physical cold or heating applications come into question here, and in many cases massages, Schüssler salts and corresponding remedies from the field of homeopathy have also proven their worth. However, those concerned should always discuss in advance which procedures are appropriate and suitable here with a naturopath or naturopathic doctor, as well as the exact dosage, duration of use or possible interactions.

Osteopathy can help with pain in the hip and pelvic area and provide more mobility by using special grip techniques e.g. Muscle tension, blocked joints or a pelvic obliquity can be corrected. In the case of an inclined pelvis, however, those affected can often do something themselves to alleviate the symptoms. Because this often arises from muscular tension or imbalance, for example as a result of constant stress on one half of the body when carrying small children or during sports. However, improvement can usually be achieved here with special strength exercises or physiotherapy by restoring balance and thereby promoting an upright symmetrical posture. Relaxation techniques can also be very helpful and beneficial, especially in the case of tension, including yoga, autogenic training, massages or meditative forms of movement such as qigong and tai chi.

Even in the case of pregnancy-related relaxation of the symphysis, those affected can do a few things themselves to relieve the pain. For example, regular exercises for strengthening the pelvic floor, buttocks and trunk muscles can be used to relieve the pelvis. Here, for example, a workout is suitable for which the woman lies on her back and raises her legs at about a right angle and waist width. Now, when exhaling, the pelvic floor and lower abdominal muscles are tensed, then the feet are pressed firmly into the floor until the pelvis rises slightly. In this position, the tension is now held for several breaths and finally released again. This exercise should be repeated six times, but always make sure that no hollow back is created.

In addition to pelvic floor exercises, gentle sports such as swimming, light (water) gymnastics or individually tailored physiotherapy can be helpful. When loosening the symphysis, women should definitely avoid certain activities such as heavy lifting or carrying. Frequent climbing stairs or sitting cross-legged, for example, are unfavorable. Instead, a breastfeeding pillow between your legs can be a real boon while you sleep. During the day, regular breaks help, among other things, by putting the person concerned on a large exercise ball and slowly rotating their hips, and the so-called "four-footed stand" can also provide a pleasant relief for the pelvis.

Prevention of pelvic pain

In order to prevent pelvic pain, care should generally be taken to strengthen the back and maintain an upright posture. Regular movement is essential for this, especially if e.g. you work in a sitting position for hours every day. To train the muscles, nobody has to go to an expensive gym. Rather, a little more movement can be provided in many places in everyday life, for example by using the bicycle or the stairs instead of the elevator instead of the car.

In addition to exercise, sufficient rest and relaxation are necessary for a healthy and painless back, because those who are constantly under negative stress, pressure and "high tension" quickly risk health effects. In addition to pelvic obliqueness due to tension, headache and back pain, high blood pressure, hardening of the arteries or indigestion, but also life-threatening diseases such as a heart attack or stroke are possible. (No)

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Social Science Nina Reese, Barbara Schindewolf-Lensch

Swell:

  • Fritz Uwe Niethard; Joachim Pfeil; Peter Biberthaler: Dual series orthopedics and trauma surgery, Thieme, 2017
  • Horst Huber; Eva Winter: Checklist Pain Therapy, Thieme, 2005
  • M.E. bag; W. Weidner; E. Brähler: "Chronic Pelvic Pain and Its Comorbidity", in: The Urologist, Edition A, Volume 43 Issue 3, 2004, Springer
  • Kelly M. Scott: "Pelvic Pain", in: Physical Medicine and Rehabilitation Clinics of North America, Volume 28 Issue 3, 2017, sciencedirect.com
  • Beate Carrière: pelvic floor, Thieme, 2012
  • D. H. Zermann: "Chronic Pelvic Pain - Pathophysiology, Diagnostics and Therapy", in: Current Urology, Volume 32 Issue 2, 2001, Thieme Connect
  • Pschyrembel Online: www.pschyrembel.de (access: August 16, 2019), oblique pelvis
  • Uwe Wegner: Sports injuries: symptoms, causes, therapy, Schlütersche Verlag, 2003
  • Maurice Stephan Michel; Joachim Wilhelm Thüroff: Urological differential diagnosis, Thieme, 2019
  • Marion Stüwe: Post-gymnastics and regression gymnastics, Thieme, 2004
  • Zongshi Qin; Jiani Wu; Jing Zhou; Zhishun Liu: "Systematic Review of Acupuncture for Chronic Prostatitis / Chronic Pelvic Pain Syndrome", in: Medicine (Baltimore), Volume 95 Issue 11, 2016, NCBI
  • Oliver Ploss: Naturopathy for muscular and neuromuscular diseases: fibromyalgia, (late) Lyme disease, restless legs syndrome, polyneuropathy, Karl F. Haug, 2010


Video: Causes and Treatment for Pelvic Pain in Adolescent Females (January 2022).