Persistent pelvic pain: assessment and care

When to seek help sooner

Go to an emergency department for severe pelvic or abdominal pain, whether it starts suddenly or builds up. Call 000 if you collapse, feel faint with severe pain or bleeding, or need an ambulance. Do not assume a new or very different pain is part of your usual condition, or wait for a routine telehealth appointment.

Seek urgent medical attention for pelvic pain with fever, persistent vomiting, blood in urine or bowel motions, a swollen abdomen, or being unable to pass urine, a bowel motion or gas. Healthdirect explains when abdominal pain needs urgent care.

If pregnancy is possible and you have pelvic pain, seek prompt medical assessment. Pain with vaginal bleeding, shoulder-tip pain, dizziness or faintness can indicate an ectopic pregnancy: go to an emergency department now. Healthdirect explains ectopic pregnancy symptoms.

What can contribute to pelvic pain?

Possible contributors include endometriosis or adenomyosis (where tissue similar to the womb lining grows within the womb muscle), bladder pain conditions, irritable bowel syndrome, and pelvic muscle or nerve pain. Infection can also cause pelvic pain and needs assessment. The pattern of symptoms helps guide investigation, but cannot confirm a cause on its own.

Pelvic-floor muscles can become tense and painful. Pain pathways can also become more sensitive over time, so pain may continue even after an original injury has healed. These changes can coexist with an ongoing condition; they do not mean the pain is imagined or that further assessment is unnecessary.

The RACGP describes pelvic-organ, muscle and nerve contributors, and healthdirect explains persistent pain pathways.

How can telehealth help with persistent pelvic pain?

A telehealth GP can discuss where and when you feel pain, how it affects your life, and any related period, bladder, bowel or sexual symptoms. They can review previous results and treatments, then recommend the next step. This may include tests, an in-person examination, specialist referral or suitable treatment while assessment continues.

If tests are recommended, you attend the relevant local provider. A follow-up telehealth appointment can cover the results, what remains uncertain and the care options available. Your GP can prescribe when clinically appropriate, review treatment and side effects, and help coordinate ongoing care.

Whether you need a physical examination depends on your symptoms, history and previous assessments. If one is needed, your doctor can help arrange in-person care. It is not a prerequisite for every appointment. The Australian Digital Health Agency explains telehealth and follow-up care.

What tests or examinations might help?

Tests are chosen to investigate possible causes of your symptoms. They might include urine or pregnancy testing, infection tests or an ultrasound. An ultrasound can help investigate some pelvic conditions, but it cannot identify every cause of persistent pelvic pain. Some people need specialist assessment or further investigations. RCOG describes assessment for long-term pelvic pain.

An in-person examination may include your abdomen and, when appropriate, an internal pelvic examination. The clinician should explain what they recommend and ask for your consent. You can ask for a chaperone, decline an internal examination or ask to stop. Discuss alternatives and what they may or may not show. RCOG explains consent for pelvic examinations.

What if my tests are normal?

A normal result can be useful without explaining all your symptoms. For example, a normal ultrasound does not rule out endometriosis. Ask what the test has checked, what remains uncertain and what the next step is if pain continues. RCOG explains the limits of scans for endometriosis.

Care can include symptom management while assessment continues. A normal test is not a reason to dismiss pain or leave you without a follow-up plan.

What can help?

A care plan should address identified conditions as well as the effect of pain on your life. Depending on your needs, it may include:

• Treatment for a contributing condition, such as a gynaecological, bladder or bowel problem.
• Pelvic health physiotherapy to assess muscle involvement and guide suitable treatment.
• Pain-management support, including a review of medicines, balancing activity and rest, and support for sleep.
• Psychological support to help with distress, sleep and coping with pain.

The Royal Women's Hospital describes a team approach to pelvic pain care, and healthdirect explains pain-management options.

Agree on goals that matter to you, such as sleeping better or managing everyday activities, and when to review progress. Ask about further assessment or specialist support if pain remains difficult, changes, or treatment causes problems.

Preparing for an appointment

If you have previous results or a medicines list, have them available during your appointment. It can also help to mention treatments you have tried. A few notes about pain timing, other symptoms and the activities it affects can help, but you do not need a completed diary before seeking care.

Useful questions include: “Could more than one thing be contributing?”, “What can we do to help the pain now?” and “When should we review the plan?”

Related HerDoc guides

• Endometriosis — Symptoms, assessment and treatment options for this possible cause of pelvic pain.
• Heavy, painful or changing periods — Understanding pain, bleeding and cycle changes.