Pain In The Pelvic Bones : Causes, Symptoms, Diagnosis & Treatment

Last Updated: 02/07/2022

Pain in the pelvic bones occurs with injuries, inflammatory and non-inflammatory diseases, tumors of bones, soft tissue structures, blood diseases, metabolic disorders in bone tissue. It can be strong, weak, constant, intermittent, sharp, dull, aching, stabbing, pulling, twitching, pulsating. Sometimes associated with physical activity, other circumstances. The cause of the pain is found out with the help of a survey, external examination, X-ray data, ultrasound, other instrumental and laboratory studies. Until the diagnosis is made, rest is recommended, sometimes analgesics can be taken.

Why do pelvic bones hurt

Traumatic injuries

Intense pain is observed in pelvic fractures that occur against the background of a high-energy injury. A sharp pain at the fracture site appears at the time of injury, subsequently slightly decreases at rest, intensifies with any movement, often forcing the patient to take a forced position. Possible limb shortening. Localization of pain is determined by the type of fracture:

  • fracture of the ilium - in the region of the wing of the bone;
  • fracture of the ischium - in the perineum;
  • fracture of the pubic bone - in the pubic area;
  • fracture of the acetabulum - in the lower outer parts of the pelvis, hip joint, inguinal region.

Pelvic fractures in children correspond to injuries in adults. In adolescence, the edge of the bone can be torn off during intense physical exertion, which is associated with the relative weakness of the bones compared to rapidly growing muscles. Symptoms in such cases are mild, pain is local, reminiscent of a bruise. A hematoma forms in the fracture zone.

Pregnancy period

Minor aching and pressing pains in the pelvic bones in the II-III trimesters of pregnancy may be associated with the physiological adaptation of the body to bearing a child. Superficial pain in the projection of the womb, aggravated during sexual contact, at night, with pressure on the pubis, spreading the legs to the sides, walking up the stairs is noted with symphysitis. In severe cases, lameness develops, symphiolysis is possible, manifested by intense pain, the inability to stand and walk.

Pelvic fractures in pregnant women are detected against the background of hypocalcemia. They are formed not only as a result of injuries, but also as a result of pathological childbirth or diseases of the pelvic bones (osteomyelitis, tuberculosis, osteodystrophy). They are characterized by severe pain in the pubis, perineum or other pelvic area, impaired movement, forced position of the body.

Inflammatory and infectious diseases

With the defeat of the pelvic bones, the pain of the corresponding localization occurs in patients with deforming osteitis. Painful sensations are dull, aching, continuous, aggravated at rest, after rest. The affected bone thickens. Possible pathological fractures. When the process is located in the region of the acetabulum and neighboring departments, osteoarthritis is formed.

Soreness in the sacrum, ilium is noted with sacroiliitis. The purulent form of the pathology is manifested by a sharp jerking, tearing pain, deterioration of the general condition, intoxication, hyperthermia. Other forms of sacroiliitis are accompanied by flying pains along the posterior surface of the pelvis, persistent pain syndrome is less commonly observed.

Osteomyelitis of the pelvic bones is rarely detected, in adults it develops against the background of injuries and operations, in children it may be the result of hematogenous spread of infection. It is characterized by extremely sharp pains, aggravated by the slightest movement. The condition is rapidly deteriorating, hyperthermia, intoxication syndrome are detected. After the formation of the fistula, the intensity of pain decreases.

Pelvic tuberculosis is a rare form of osteoarticular tuberculosis that affects the sacroiliac joint, the articular surface of the ilium. It is manifested by pains of unclear localization, stiffness of movements, moderate soreness of the affected area. Subsequently, local infiltration is observed, the formation of swell abscesses on the thigh.

Pain in the pelvic bones

 

Tumors

The pelvic bones are often affected by tumor processes. The nature of the pain syndrome depends on the type of neoplasia. With benign neoplasms, the pain is insignificant, local, of indefinite localization, transient, remains at the same level for many months or years. Malignant tumors are manifested by pain that grows over several months. At first, the pains are weak, aching or pulling, later - sharp, strong, constant, eliminated only by narcotic analgesics. The symptom is observed with the following tumors and tumor-like formations:

  • bone cyst;
  • osteochondroma;
  • osteoma;
  • chondrosarcoma;
  • chondroblastoma;
  • Ewing's sarcoma;
  • metastases in the pelvis.

Osteodystrophy

Pain in the pelvic bones are noted in various forms of osteodystrophy, including those caused by somatic diseases. Osteomalacia is characterized by vague pain in the bones of the pelvis and extremities. Soreness worries both during movement and at rest, increases with pressure and the cessation of pressure on the iliac bones. Over time, the intensity of pain increases, pathological fractures, deformities, and movement restrictions occur.

Pain in the pelvic bones with osteoporosis is minor, can be combined with pain in the spine, ribs, hip, ankle joints. They are detected in postmenopausal, juvenile, and other types of osteoporosis. Among the pathological conditions that provoke secondary osteoporosis, osteomalacia or osteosclerosis include:

  • Endocrine pathologies : hyperthyroidism, diabetes mellitus, Itsenko-Cushing's disease, hyperparathyroidism, hypopituitarism.
  • Diseases of the gastrointestinal tract : malabsorption syndrome, liver disease, condition after gastric resection.
  • Kidney lesions : CRF, renal tubular acidosis, Fanconi disease.
  • Genetic diseases : osteogenesis imperfecta, Ehlers-Danlos syndrome, Marfan syndrome.
  • Blood diseases : leukemia, lymphomas, multiple myeloma, thalassemia.
  • Other conditions : COPD, organ transplant condition, fasting, anorexia nervosa, prolonged immobilization, alcoholism.
  • Taking medications : glucocorticoids, thyroid hormones, immunosuppressants.

Other diseases

Pain in the projection of the pelvis can be detected in the following diseases:

  • Forestier disease. Minor intermittent pain in the pelvis, combined with pain and stiffness of the spine.
  • fibrous dysplasia. Periodic mild pain, increasing deformities of the pelvic ring, causing the development of kyphosis or scoliosis.
  • ARS syndrome. Soreness in the projection of the symphysis after exercise, aggravated by hip abduction.
  • Mental disorders . Unusual, rapidly changing or pretentious nature of pain that does not fit into the picture of a certain somatic pathology.

Diagnostics

Diagnostic measures are carried out by orthopedic traumatologists. According to indications, an examination of surgeons, oncologists, and other specialists is prescribed. The examination program may include the following procedures:

  • Poll . The specialist finds out the time and circumstances of the appearance of the pain syndrome, its nature, frequency, duration, clarifies the connection with external factors, the presence of other symptoms.
  • Physical examination . The doctor evaluates the appearance of the pelvic area, detects deformities, pathological mobility, forced body position, examines the mobility of the spine and hip joints.
  • X-ray of the pelvis. Basic research in bone pathology. Detects fractures, signs of inflammation or osteodystrophy, infectious foci, neoplasms.
  • ultrasound . It is prescribed for diseases of soft tissues, suspicion of symphysitis during pregnancy. It makes it possible to clarify the localization and nature of the pathological process, to confirm the presence of inflammation, mass formations, and other changes.
  • Other visualization methods . With insufficient information content of the basic techniques, at the final stage of the examination, CT is performed for a detailed study of bone structures and MRI to assess the condition of soft tissues.
  • Laboratory tests . They are used to confirm the inflammatory process, clarify the type of pathogen, detect specific markers of rheumatic diseases.

Physiotherapy

 

Treatment

Help at the prehospital stage

Patients with pelvic fractures are laid on a shield, given an anesthetic. In other cases, rest is recommended, sometimes we can take analgesics, use local warming and anti-inflammatory drugs. Pain in the pelvic bones often indicates the presence of serious pathologies that require early diagnosis and early treatment, so if you have this symptom, you should immediately seek professional help.

Conservative therapy

Patients with fractures are treated with an intrapelvic block, skeletal traction, or bed rest using a special position. Therapeutic tactics for other lesions depends on the characteristics of the disease. The following methods are applied:

  • Protective mode . Patients are advised to limit physical activity. Sometimes it is necessary to use crutches or a cane.
  • Medical therapy . Taking into account the characteristics of the pathology, antibiotics, NSAIDs, analgesics, chondroprotectors and other agents can be prescribed.
  • Physiotherapy . UHF, drug electrophoresis, magnetotherapy and other techniques are shown. Exercise therapy, massage, manual therapy are prescribed.

For malignant neoplasias, radiation therapy or chemotherapy may be performed.

Surgery

For the treatment of diseases accompanied by pain in the pelvic bones, the following surgical interventions are used:

  • Traumatic injuries : osteosynthesis of the anterior and posterior pelvic half rings, reconstruction of the acetabulum.
  • Infectious processes : sequestrectomy, resection of the sacroiliac joint.
  • Tumors : resection of the pelvic bones, resection of the pubic or iliac bone, interilio-abdominal resection.
  • ARS - syndrome : operations for ARS-syndrome.

In the postoperative period, patients are prescribed analgesics and antibiotic therapy. Subsequently, complex restoration measures are carried out.

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