Medically reviewed guide · Last updated: 23 November 2026 · Reading time: approx. 12 min

Pelvic Pain: Gynaecological, Bladder or Bowel?

The most common causes compared

The causes in detail

In this article, “pelvic pain” means pain in the lower abdomen and pelvis below the navel. Pain throughout the abdomen, in the upper abdomen or around the navel is covered in the article on abdominal pain, and the typical cramps during your period in the article on period pain. Here, the question is which organ in the pelvis is behind the pain — and when it is urgent.

The cycle: period pain and ovulation pain

Cramping pain in the first days of your period is caused by tissue hormones (prostaglandins) that make the womb contract. It is very common and usually harmless. Ovulation pain (mittelschmerz) occurs around ovulation: a one-sided pulling pain that lasts from a few hours to about two days, sometimes with light spotting. First step: warmth, exercise and, if needed, a painkiller. If the pain gets stronger over the years, starts before your period or painkillers are no longer enough, there is often more behind it.

Endometriosis, adenomyosis and fibroids

In endometriosis, tissue similar to the lining of the womb grows outside the womb; in adenomyosis, it grows into the muscular wall of the womb. Typical signs are increasing period pain, pain during sex, when opening the bowels or when passing urine during your period, and sometimes difficulty getting pregnant. Fibroids, benign muscle growths, tend to cause a feeling of pressure, a frequent urge to pass urine and heavy periods. First step: a gynaecological examination with ultrasound and a pain diary covering two to three cycles.

Ovarian cysts, ovarian torsion and ectopic pregnancy

Functional ovarian cysts are common and usually go away by themselves. If a cyst ruptures, sudden one-sided pain occurs, which often eases after a few hours. If an ovary twists on its stalk (torsion), the pain is intense, usually with nausea and vomiting — the ovary is then cut off from its blood supply. An ectopic pregnancy shows up in the first weeks of pregnancy with one-sided pain and spotting, often before the pregnancy has even been noticed. First step: with sudden severe pain, go to an emergency department straight away; for every woman of childbearing age, a pregnancy test is part of the assessment.

Inflammation: ascending infection of the womb and fallopian tubes

Bacteria, often chlamydia or gonococci, can ascend from the vagina through the cervix to the womb, fallopian tubes and ovaries. Doctors speak of adnexitis or pelvic inflammatory disease. Typical signs are dull lower abdominal pain on both sides, fever, unusual discharge, bleeding between periods and pain during intercourse. Without treatment, the fallopian tubes can become scarred — with the risk of infertility and ectopic pregnancies later on. First step: a gynaecology practice the same day, treatment with antibiotics, and your partner treated as well.

Bladder and ureters

Cystitis causes pressure and cramps above the pubic bone, burning when passing urine and a constant urge to pass urine — more in the article on urinary tract infection. In bladder pain syndrome (interstitial cystitis), the bladder hurts as it fills, and the pain eases after passing urine, even though no bacteria can be found in the urine. A ureteric stone causes intense colic that comes in waves and runs from the flank into the groin and lower abdomen, often with blood in the urine. First step: a urine test at the GP practice; colic with fever means going to an emergency department straight away.

Bowel: irritable bowel syndrome, constipation, diverticulitis and appendix

Irritable bowel syndrome causes recurring, cramping pain that improves after opening the bowels, together with bloating and changing stools. Constipation causes pressure and cramps mainly in the lower left abdomen. In diverticulitis, pouches in the bowel wall become inflamed, usually in the lower left abdomen, with fever and tenderness — typically from middle age onwards. Appendicitis often begins with pain around the navel that moves to the lower right abdomen within hours, with nausea and a mild fever. Inflammatory bowel diseases such as Crohn’s disease can also cause lower abdominal pain. First step: with persistent pain and fever, see a doctor today; otherwise keep an eye on your bowel habits and discuss them at the GP practice.

In men: prostate, testicles and groin

Inflammation of the prostate or chronic pelvic pain syndrome causes pressure in the perineum and lower abdomen, often with discomfort when passing urine or during ejaculation. Pain that radiates from the testicle into the lower abdomen belongs under testicular pain — if it is sudden and intense, it is an emergency. An inguinal hernia shows up as a bulge in the groin that becomes more noticeable when straining.

Pelvic floor, back and chronic pelvic pain

Tense pelvic floor muscles and problems with the sacroiliac joint or the lumbar spine can radiate into the pelvis. If pain in the pelvis lasts longer than six months, doctors speak of chronic lower abdominal or pelvic pain. Often several causes act together, and the pain system itself has become more sensitive. This is real and treatable, but it takes staying power and usually several specialties.

When ovarian cancer needs to be considered

To put it honestly: cancer is only rarely behind pelvic pain. Ovarian cancer, however, causes only non-specific symptoms for a long time. If a bloated abdomen, a feeling of pressure in the pelvis, feeling full quickly or a frequent urge to pass urine persist for weeks and are new — especially from middle age onwards — this should be checked by a gynaecologist.

Self-tests: first clues at home

These observations do not replace an examination or a diagnosis. But they help you narrow down the organ system involved and end up at the right practice.

• The cycle check: when was your last period? Does the pain occur regularly at the same point in your cycle? For two to three cycles, note down the day, intensity and location.
• The pregnancy test: if a pregnancy is possible, even with contraception or irregular periods, take a test from the pharmacy or drugstore. Positive with pain means: get it checked by a doctor today.
• The urination check: does it burn, do you constantly need to go, is the urine cloudy or reddish? Does the pain ease after passing urine? Then the bladder is more likely.
• The stool check: does the pain improve after opening your bowels? Do diarrhoea and constipation alternate, is there bloating, blood or mucus? Then the bowel is more likely.
• The jolt test: if the pain becomes clearly worse when coughing, hopping on one leg or driving over bumps, the lining of the abdomen may be irritated — for example with appendicitis. Then do not wait, but have it examined by a doctor today.

Warning signs: when not to wait

• Sudden, intense pelvic pain, especially on one side and with nausea or vomiting
• Pelvic pain with a missed period, a positive pregnancy test or spotting
• Dizziness, a racing heart, cold sweats or feeling faint
• Fever with lower abdominal pain, discharge or burning when passing urine
• A hard, tense abdomen, pain with every jolt
• Vomiting, no more stools or wind, a swollen abdomen
• Colicky pain with fever or chills; sudden severe testicular pain
• Any bleeding after the menopause, blood in the stool, unintentional weight loss

The treatment pathway: step by step

1. First assessment at home. Without warning signs: warmth, rest, drinking enough and, with known period pain, a painkiller. Do not mask unexplained, new or increasing pain with painkillers for weeks.
2. Choose the right practice. Pain linked to the cycle, discharge or a possible pregnancy: gynaecology practice. Problems passing urine, changes in your stools or unexplained pain: GP practice. Men with prostate or testicular problems: urology practice.
3. Basic examination. A conversation, feeling the abdomen, a urine test, a pregnancy test, blood values such as a full blood count and CRP. At the gynaecology practice, swabs and a vaginal ultrasound are added; at the GP practice, often an abdominal ultrasound.
4. Further tests. Depending on what is suspected, CT or MRI, colonoscopy, cystoscopy or a keyhole examination of the abdomen (laparoscopy), with which endometriosis can be confirmed and often treated at the same time.
5. Treatment according to the cause. Antibiotics for cystitis or inflammation of the fallopian tubes, hormone therapy or surgery for endometriosis and fibroids, diet and stool regulation for irritable bowel syndrome and constipation, emergency surgery for ovarian torsion, ectopic pregnancy or appendicitis. Which treatment suits you is always decided by the practice treating you.
6. A multimodal approach to chronic pain. With persistent pelvic pain, current evidence suggests that a combination of several approaches helps most: pelvic floor physiotherapy, exercise, pain psychotherapy and targeted medicines — often at endometriosis or pain centres.

The medication angle: when tablets strain the pelvis

A lot of pelvic pain has to do with medicines — through constipation, irritation of the bowel, infections or because painkillers mask warning signs.

Constipation as a side effect

Opioids such as tilidine, tramadol, oxycodone and morphine almost always slow down the bowel; unlike nausea, the constipation usually does not ease by itself and is therefore often treated alongside from the outset. Iron supplements, anticholinergic bladder and Parkinson’s medicines, tricyclic antidepressants, verapamil and antacids containing aluminium or calcium can also cause constipation and trigger cramping lower abdominal pain.

Bowel irritation from antibiotics, metformin and weight-loss injections

Antibiotics disturb the gut flora and cause abdominal cramps and diarrhoea. If watery diarrhoea with fever and abdominal pain occurs during or after a course of antibiotics, an infection with Clostridioides difficile may be behind it — this needs to be checked by a doctor. More on this in the guide Taking antibiotics correctly. Metformin and GLP-1 receptor agonists such as semaglutide often cause abdominal pain, bloating, diarrhoea or constipation, especially at the start.

SGLT2 inhibitors: infections in the genital area

Diabetes and heart medicines such as empagliflozin and dapagliflozin make the body excrete sugar in the urine. According to the summary of product characteristics, fungal infections in the genital area and urinary tract infections occur more often as a result. Very rarely, a severe infection of the perineum (Fournier’s gangrene) has been described: severe pain, redness or swelling in the genital or perineal area with fever and feeling unwell is an emergency.

Contraception and hormones

A copper coil can make period pain and bleeding worse, especially in the first few months. Hormonal methods such as the pill or the hormonal coil, on the other hand, often relieve period pain and are also used for endometriosis. New, severe pelvic pain shortly after a coil has been fitted should be checked at a gynaecology practice.

Painkillers: helpful, but with limits

For period pain, anti-inflammatory painkillers such as ibuprofen or naproxen work well according to current evidence, because they slow down the prostaglandins. Antispasmodics such as hyoscine butylbromide are used for colicky pain; their effect as a tablet is rather moderate. Over-the-counter painkillers should not be taken for longer than three to four days in a row or on more than ten days a month without medical advice. Anyone who masks unexplained pain with painkillers may be letting an inflammation drag on. For an overview, see the guide Painkillers compared.

How to prevent pelvic pain

• Use condoms — they protect against chlamydia and gonococci, the most common triggers of ascending infections in the pelvis.
• Take up the chlamydia test — for young women up to the age of 25, statutory health insurance pays for a test once a year, even without symptoms.
• Drink enough and eat fibre — this helps prevent cystitis, urinary stones and constipation; exercise also keeps the bowel moving.
• Treat constipation alongside — if you take opioids or iron long term, it is best to discuss a laxative right at the start.
• Document your pain — a diary of your cycle, bowel movements, urination and medicines shortens the path to a diagnosis, especially with endometriosis.

Symptoms and medicines in view — with brite

Medication plan, dose reminders and symptom history in one place. Free of charge.

Start for free